Acupuncture alleviates depression and cravings associated with alcohol dependence. Affiliated Hospital of Henan Institute of Traditional Chinese Medicine researchers conducted a controlled clinical trial quantifying changes in alcohol cravings and depression levels using the Hamilton Depression Rating Scale (HAMD) and the Visual Analog Scale (VAS). Two groups were compared. One group received Traditional Chinese Medicine (TCM) emotional reconciliation therapy. Another group received TCM emotional reconciliation therapy plus acupuncture. The results demonstrate that the combination of acupuncture with TCM emotional reconciliation therapy is effective for the alleviation of depression and cravings in patients with alcohol dependency. 

Alcohol dependence is a serious physical and psychological problem and it is estimated that approximately 70% of those with alcohol dependence also suffer from varying degrees of depression. Many people that become dependent on alcohol do so as a result of pre-existing mood disorders, and alcohol dependence often leads to loss of confidence and low self-esteem. Effectively treating patients with alcohol dependency is challenging for healthcare professionals due to poor compliance with medical interventions, resulting in recurrent relapses.

According to traditional Chinese medicine (TCM) theory, emotional imbalances are a major cause of disease, leading to qi stagnation and disharmony between yin and yang. Alcohol dependence involves pent-up, negative emotions that accumulate over time, initiating a cycle of depression. The major treatment principles are to reconcile the emotions, warm and free the channels, and restore harmony between yin and yang.

For this study, a total of 85 participants were recruited and randomly assigned to either the control group (n=42) or the observation group (n=43). The control group was comprised of 31 males and 11 females, ages 33–64 years. Their drinking history spanned between 10–39 years, with a mean duration of 24.7 years. Participants in the control group were assigned to receive emotional reconciliation therapy, based on the principles of TCM.

The observation group was comprised of 32 males and 11 females, ages 34–65 years. Their drinking history spanned between 10–40 years, with a mean duration of 25.1 years. Participants in the observation group were assigned to receive both TCM based emotional reconciliation therapy and acupuncture.

Inclusion criteria for the study included a diagnosis of alcohol dependence, according to the World Health Organization (WHO) criteria (e.g., daily drinking, strong desire or compulsion to drink alcohol, difficulty controlling alcohol use, high alcohol tolerance, physiological withdrawal symptoms). Exclusion criteria included communication problems accompanied by neurological disorders, serious heart, brain, liver, or kidney disease, and the inability to complete the study.

 TCM Emotional Reconciliation
Emotional reconciliation therapy was based on the principles of TCM and aimed to open the heart, dispel accumulated depression, and guide the patient to physical and mental health. Both groups attended sessions once a month for three months, adopting the following four-part approach to treatment. 

• Part 1 – Incentive
  Patients are encouraged to admit to their alcohol dependency by having their attention drawn to the various issues it may be causing in their life, and given the incentive to make changes.
• Part 2 – Communication
  Healthcare staff are encouraged to use warm and supportive language to alleviate emotional tension and depression, and to reinforce the positive outcomes of the treatment.
• Part 3 – Guidance 
  Patients are guided to transform their unhealthy lifestyles and activities using cognitive behavioral interventions.
• Part 4 – Opening
  Further help and guidance is provided to patients based on their individual, ongoing needs (including treatment for psychological and physiological symptoms).

 Acupuncture Protocol
In addition to the above, participants in the observation group received acupuncture treatment, twice weekly. Eight treatments made up one course of care, and a total of three courses were administered. The following acupoints were selected for the study:

• Baihui (GV20)
• Neiguan (PC6)
• Zusanli (ST36)

Needles were inserted into Baihui and Neiguan and manipulated using a balanced reinforcing-reducing technique to obtain deqi. Needles were retained for 30 minutes and rotated once, after 15 minutes. Moxibustion was applied at Zusanli.

The acupoints were chosen for their specific functions according to TCM. Baihui is the meeting point of all of the yang channels, and has the ability to clear and calm the mind. Neiguan, being the opening point of the Yinwei Mai, connects all of the yin channels, and is an important point in the treatment of any emotional disorder. Together, these points have a harmonizing effect on the yin and yang of the entire body. Zusanli with moxa has the ability to warm the channels, enhance immune function, strengthen uprightness, eliminate pernicious influences, supplement the center, and tonify qi.

 Results and Discussion
Outcomes were measured using the Hamilton Depression Rating Scale (HAMD). The HAMD is a 17 item scale, with each item rated from 0–4 depending on the severity of depressive symptoms. An overall score of 0–7 is considered normal, and a score of 20 or above indicates at least moderate depression. Mean pre-intervention HAMD scores were 35.7 in the control group and 36.0 in the observation group. After three weeks, the scores improved in both groups, reducing to 28.5 and 24.0 respectively. After nine weeks, the scores fell again, to 16.9 and 11.5 respectively, showing significantly greater decreases in depressive symptoms in the acupuncture observation group (p<0.05). [1]

A Visual Analog Scale (VAS) was used to quantify the severity of alcohol cravings before and after the study. The participants self-rated their desire for alcohol on a scale from 0 to 10. They were exposed to an environment designed to induce alcohol cravings for three minutes and asked to repeat the process. At the beginning of the study, mean VAS scores in the control group were 6.7 before and 6.0 after induction. Mean VAS scores in the control group were 6.6 before and 6.2 after induction, with no significant difference between the two groups(p>0.05). At the end of the study, mean VAS scores in the control group were 4.9 before and 6.5 after induction. Mean VAS scores in the acupuncture observation group were significantly lower at 2.7 and 3.1 respectively (p<0.05), indicating a decrease in alcohol cravings following acupuncture treatment.

The results of this study indicate that acupuncture combined with emotional reconciliation therapy effectively alleviates symptoms of depression and reduces cravings in patients with alcohol dependency. This is a minimal intervention and is applicable to a wide range of clinical settings. The simplicity of the clinical design may also help to improve patient compliance, thereby warranting further research.

 Reference:
1. Tian Ji, Han Ruihong, Sun Lijia, Wang Huili (2018) “The Effect of Acupuncture and Moxibustion Combined with Traditional Chinese Medicine Sentiment on the Depression of Alcohol Dependent Patients” Guangming Journal of Chinese Medicine Vol. 33 (15), pp. 2225-2227.