Support for HB 1106, SB 919
John Harvey EdD, LPC, ADS
Martha B. Marshall MA, LPC, ADS
January, 2023
John Harvey EdD, LPC, is Founder and Executive Director of Northwest Counseling and Wellness Center (NCWC) in Austin, Texas. Dr. Harvey has used acudetox for mental health since 1997 and has been a registered trainer of the protocol since 2001. NCWC has used the protocol as an adjunct to its holistic treatment regimen for over 25 years to assist clients in recovery from substance use disorders and co-occurring diagnoses.
Martha B. Marshall, M.A., LPC, owner of Wild Basin Wellness in Austin, Texas. Martha is a holistic mental health counselor in private practice, integrating traditional talk therapy with physical movement and spiritual awareness. She leads workshops for veterans, National Guard, and first responders in Central Texas, teaching about mental health and the mind-body connection using water sports and nature experiences. She has used acudetox since 2014.
Auricular Acupuncture in Behavioral Healthcare
Texas is experiencing a behavioral healthcare crisis, exacerbated by Covid, and lacks
resources and solutions to address the problem sufficiently (Czeisler, M. É., et.al, 2020; Texas
Health and Human Services 2022). An auricular acupuncture procedure known as “acudetox” is
a powerful, economical and underused tool, currently restricted to help only those with an
addiction diagnosis. Texas law has allowed the use of acudetox by non-medical professionals
since 19991; the regulation needs revision to make it more available to address behavioral health
concerns beyond addiction. This argument supports revision as put forth in HB 1106 and SB
919.
Research has shown this auricular acupuncture protocol reduces craving, agitation, and
restlessness during detoxification and early sobriety efforts, hence the name acudetox (Stuyt,
Voyles, & Bursac, 2018). In the 40 years since its inception, acudetox has shown that it is
effective well beyond its original intention of drug detoxification. The protocol alleviates the
conditions that drive addiction: trauma, stress, depression, anxiety and other diagnoses that coexist with addiction. These same concerns contribute to suffering associated with a variety of
other behavioral health diagnoses. Acudetox provides relief comprehensively.
Acudetox is a protocol for behavioral health and wellbeing involving bi-lateral insertion
of five sterile acupuncture needles into specific ear points. The recipient typically sits with the
needles for 20-40 minutes. The therapeutic mechanism of acudetox is a reduction of stress in the
autonomic nervous system, creating a sense of calm, capability and hope for change (Carter &
Olshan-Permutter, 2015). It is easily administered in a group setting and could be instrumental
in reducing the economic burden of unmet behavioral healthcare needs (Whitehouse.gov, 2022). A skilled practitioner can treat up to 20 individuals over the course of a 60-minute session. It is a
standardized, well-tolerated treatment protocol which is recommended as an adjunct to other
treatment modalities to improve clinical outcomes. The communal component of group
treatment fosters connection and collaboration providing a unique resource for practitioner and
recipient.
The acudetox protocol was influential in treatment of trauma survivors and first
responders in the aftermath of 9/11, as an adjunct to other medical services. (Cooley, 2008).
Acudetox’s non-verbal approach worked for participants who simply did not have the ability nor
the desire to verbalize their traumatic experience. Acudetox is a trauma informed protocol,
aligned with the Center for Disease Control and Prevention (CDC) principles to trauma-informed
care (Wolkin, 2018).
Today, acudetox is used around the world, not only treating the various manifestations of
addiction, but also as psychological first aid to assist victims of earthquakes, civil unrest,
hurricanes, and other natural and man-made disasters, treating those who have limited access to
conventional mental health resources. In the United States, acudetox has been used successfully
as part of treatment planning in drug courts, prisons, domestic violence and anger management
programs, cancer treatment, HIV AIDS services and more. In Texas, acudetox helped trauma
victims after hurricanes Katrina and Harvey, and the El Paso Walmart shooting. The Texas
Veterans Administration Hospitals are rolling out acudetox in a variety of programs to help vets
suffering from addiction, PTSD, stress, trauma, depression, anxiety, insomnia, and to promote
general well-being.
1 Acudetox Specialist (ADS) Law, Sec. 205.303.
Expanding Acudetox in Texas
Acudetox is under-utilized and over-regulated in Texas. We propose three changes to current statute:
- Make acudetox available for trauma and stress induced behavioral health concerns including, but not limited to addiction.
- Eliminate the requirement for medical or acupuncturist (M.D. or LAc) supervision of the Acudetox Specialist (ADS). Require proof of CEUs to support ADS competency.
- Expand the list of credentialed professionals permitted to be trained and certified to use acudetox. Allow the Texas Medical Board to revise this list in the future as advances in behavioral healthcare and research inform changes.
First, the benefits of acudetox should be more widely available to Texas communities for
trauma, and physical, emotional and psychological stress, in addition to substance use disorders.
When Acudetox law 205.303 was written over two decades ago, the psychological sciences saw
‘alcoholism’ and ‘chemical dependency’, as narrowly defined conditions. We now know that
negative coping behaviors exhibited in addiction are often a response to past trauma, however
self-defeating they are. Co-morbid issues such as depression, anxiety, mood disorders,
attentional difficulties, insomnia, the brain’s impaired executive function, etc., are present in
trauma responses experienced by many individuals, not just addicts. In its current form, Texas
law is a barrier to wider use of this therapeutic tool.
Second, the safety of acudetox has stood the test of time; there have been no reported
injuries or medical incidents resulting from acudetox since the adoption of this law. Zero. This
safe, inexpensive, drug-free treatment should be available in every county in Texas to serve
changing healthcare needs. Current language in the law requires ADS’s to apply for certification
with the Texas Medical Board, and to have an on-going supervisory relationship with a medical
doctor or an acupuncturist in order to practice. Finding an M.D. or an LAc supervisor is a
burdensome regulation for some ADSs to meet, particularly in underserved areas, defined in All
Texas Access Report (Texas Health and Human Services, 2022). It therefore creates a barrier to
Texans who could benefit from the protocol. Retaining the current Texas Medical Board
certification process for new ADS candidates to ensure integrity of the requirements of training
is prudent. However, after certification and renewal, the ADS should be held accountable to
their primary licensing board for the ongoing use of acudetox within their scope of practice, as is
the custom for all healthcare licenses. CEUs overseen by the TMB will help maintain ADS
proficiency and oversight desired by the board.
Third, the list of credentialed professionals who can be ADS-licensed needs to be
expanded. This tool should be in the hands of duly certified professionals for acute and ongoing
trauma and mental health care. At the time the law was written, the Licensed Marriage and
Family Therapist (LMFT) credential did not exist. Physician’s Associate (formerly Physician’s
Assistant), or PA, is another license that is appropriate and not in current statute. These
healthcare providers should be added. Also, board-certified professionals achieving provisional
hours are good candidates to train and offer acudetox and they should be added. We propose a
clause that leaves adding or deleting specific board-licensed credentials up to the Texas Medical
Board so that statute change is not required to respond to advances in behavioral healthcare.
The Time is Now
The CDC reported that activities intended to protect public health during COVID,
including social distancing, shelter in place, and quarantining, have resulted in a significant
increase in trauma stressor related disorders (TSRDs), and other diagnoses of the Diagnostic
Statistical Manual (DSM 5) related to the pandemic (Czeisler et. al, 2020, American Psychiatric
Association, 2013). Approximately one in five will develop a mental health diagnosis following
a COVID diagnosis with the greatest risks being for anxiety disorders, depression, and insomnia
(Brooks 2020). Mental health support is urgent in the education setting. The recent CDC Youth
Risk Behavior Survey data shows nearly 60% of female high school students and 30% of male
students reported persistent sadness or hopelessness in 2021 across the U.S. Sadly, 30% of
female students had seriously considered suicide, an increase of nearly 50% in five years (CDC,
2023)
Meanwhile, Texas healthcare professionals fear substance misuse concerns are going
underground and worsening because of the pandemic as the population turns to self-medicate.
National alcohol sales are up 55% and this increase pushes some towards addiction and death
(Spencer, et.al., 2022). Further, drug overdoses are up over 15% from this time last year (CDC,
2022). These effects are significantly higher among certain groups, such as racial and ethnic
minorities, essential workers, first responders and frontline workers who are at a tremendous risk
for compassion fatigue and burnout as they have coped with war against the plague. Behavioral
healthcare professionals are struggling with the fallout, as a backlog of new clients frustrate the
system (Price, 2020).
The CDC has called for “community-level intervention and prevention efforts including
health communication strategies, designed to reach these groups which could help address
various mental health conditions associated with the COVID-19 pandemic” (Czeisler et. al,
2020, p. 1050). The pandemic experience has brought these concerns into clear focus, though
they have haunted us for much longer. Texans deserve a collaborative effort to meet this charge.
Community-level examples where acudetox can be offered include high school and college
counseling offices, teachers’ lounges, first-responder support facilities such as the Public Safety
Wellness Centers, Border Patrol, Operation Lone Star and TX Army National Guard stations,
immigrant holding facilities, the Uvalde Hill Country Mental Health Center, and front-line
healthcare workers’ support services. These places could successfully deliver the benefits of
acudetox but would not have the opportunity if an ‘addiction’ diagnosis was required.
Summary
In sum, the acudetox five-point auricular acupuncture protocol is an effective,
inexpensive, drug-free treatment option to address not only substance abuse and addiction, but
trauma, and physical, emotional and psychological stress, as defined in other statutes. Acudetox
is safe, trauma informed, has few known side effects, and no reported cases of malpractice. Its
outcomes are predictable and beneficial. Because the acudetox protocol is non-verbal, there are
no language barriers to treatment, no need to intellectually understand nor need for prerequisite
skill in order to benefit from the treatment. The acudetox protocol is non-judgmental; does not
discriminate based on age, ethnicity, sexual orientation, skin color, status, appearance, IQ,
behavior, or any other bias that might come between patient and provider. Acudetox can work
despite resistance and skepticism. The tool creates space for healing to occur and in a subtle
manner; it enables inherent curative factors to mobilize, it is self-empowering. As founder Dr.
Mike Smith has said, the acudetox experience is similar to a meditation practice, except that you
don’t need to have patience or skill to experience the calm.
Many healthcare professionals in Texas are already trained and poised to use acudetox to
treat suffering beyond the tool’s narrow legal purpose. Many other professionals are legally
licensed to work with conditions of the DSM 5 within their scope of practice, but do not have
licenses recognized by Texas law to become acudetox certified. It is in the best interest of Texas
public health to make widely available the healing potential of the acudetox protocol through
deregulation. Now is the time to expand its use.
References
American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental
Disorders: DSM 5. bookpointUS.
Brooks, M. (2020). Nearly 1 in 5 develop mental illness following COVID-19. Medscape Medical News, November 13. Retrieved from https://www.medscape.com/viewarticle/940922_print
Carter, K. & Olshan-Permutter, M. (2015). Impulsivity and Stillness: NADA, Pharmaceuticals, and Psychotherapy in Substance Use and Other DSM Disorders. Behavioral Sciences
5, 537-546. doi:10.3390/bs5040537
Centers for Disease Control and Prevention (2023). Youth risk behavior survey, data summary &
trends report. Retrieved from https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf
Centers for Disease Control and Prevention (2022). U.S. overdose deaths in 2021increased half as
much in 2020 – but are still up 15%. Retrieved from
https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm#print
Cooley, L. (2008). Unimagined bridges. Retrieved from https://www.youtube.com/watch?v=vXBBaZF8JBk (Video)
Czeisler, M. É., Lane, R. I., Petrosky, E., Wiley, J. F., Christensen, A., Njai, R., . . . Rajaratnam, S. (2020). Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic – United States, June 24-30, 2020. MMWR. Morbidity and Mortality Weekly Report, 69(32), 1049–1057. https://doi.org/10.15585/mmwr.mm6932a1
Price, S. (2020) Pandemic pressures. COVID-19 poses serious behavioral health challenges. Texas physicians are finding ways to respond. Texas Medicine, October, 2020
Spencer, M. R., Curtin, S. C., & Garnett, M. F. (2022). Alcohol-induced Death Rates in the United States, 2019–2020.
Stuyt, E. B., Voyles, C. A., & Bursac, S. (2018). NADA protocol for behavioral health. Putting tools in the hands of behavioral health providers: the case for auricular detoxification specialists. Medicines, 5(1), 20.
Texas Health and Human Services (2022). All Texas access report. Retrieved from https://www.hhs.texas.gov/sites/default/files/documents/all-texas-access-report-dec- 2022.pdf
Whitehouse, (2022). Reducing the economic burden of unmet mental health needs. Retrieved from https://www.whitehouse.gov/cea/written-materials/2022/05/31/reducing-the-economic-burden-of-unmet-mental-health-needs/
Wolkin, A. (2018) Using trauma-informed care to guide emergency preparedness and response. Retrieved from https://blogs.cdc.gov/publichealthmatters/2018/07/trauma-care/