The first time Les Moncrieff saw acupuncture being used to treat addiction was in 1989, at a Portland facility called the David P. Hooper Detoxification Center. "I went down there and walked into a room and there were about 35 hard-core skid-row addict guys. But it was like walking into a Buddhist monastery. They were just sitting there, so tranquil and calm; I couldn't believe it. This was nothing like any detox I'd ever seen before."
Moncrieff had an acupuncture treatment that afternoon, and the sense of peace it brought him lasted all day and well into the next. "I thought to myself, 'Any addict and alcoholic who's in pain and suffering has to experience this,'" he recalls at the downtown detox centre where he works in Vancouver.
The addictions specialist spent the next decade collaborating with others to establish acupuncture as a viable treatment in the health centres of East Vancouver. After much campaigning at the federal, provincial, and local levels, their efforts met with success. In 1998, acupuncture became one of the first so-called complementary therapies to be offered in B.C. government--funded health facilities, where staff use it alongside drug therapy (methadone) and counselling to treat people overcoming addictions.
Complementary therapists are the first to point out that, on their own, the services they provide don't solve the puzzle of addiction. At the same time, some in the scientific community believe the benefits of these treatments are exaggerated. Proponents counter that together with mainstream medicine, complementary therapy can help alleviate the emotional and physical pain that addicts frequently experience on the road to wellness.
Meanwhile, the Canadian public is becoming increasingly accepting of complementary medicine, according to excerpts from an Ipsos-Reid (formerly Angus Reid) "trend report". A 1997 Angus Reid poll of 1,200 adult Canadians showed that 42 percent of respondents had used such treatments, an 81 percent increase from 1992. In a 2000 Angus Reid survey of 1,500 Canadians, that number rose to 52 percent. In 2000, British Columbia had the highest rate of all provinces, at 65 percent.
And when it comes to integrating complementary therapies into the health-care system, Vancouver is progressive, according to one local expert. David Marsh is head of addiction medicine for Providence Health Care--which owns and operates six Catholic health-care facilities in Vancouver--and medical director of addiction, HIV services, and aboriginal health at Vancouver Coastal Health Authority. "Compared to the other places where I've worked in Canada, it does seem to me that VCH is well-advanced in integrating complementary therapies into the treatment for addictions," he says in an interview at his office.
In the Downtown Eastside and beyond, complementary therapists have gradually been taking their places beside local doctors, nurses, social workers, and counsellors. As well as getting mainstream treatment, people recovering from addiction can seek the services of these acupuncturists and massage, music, and energy therapists. The Georgia Straight spoke with four complementary-therapy practitioners in the Downtown Eastside, to get their perspectives on the nature of addiction and how they address this complex problem.
LES MONCRIEFF CONSIDERS himself a specialist in a "house of pain". He calls acupuncture "the ultimate pain medicine".
"Pain and suffering are my life," he says with a laugh. "Working in a place like this, one is exposed to an incredible array of suffering." Moncrieff is referring to Vancouver Detox, a VCH--funded residential facility where he is a registered acupuncturist with a focus on addictions management.
The style of acupuncture he practises at the East 2nd Avenue premises is called Acu Detox, whereby five tiny needles are inserted into both outer ears at specific points. When stimulated by the needles, Moncrieff says, the points help relieve physical pain and improve liver and kidney function. According to him, they work with the emotions, too, helping to relieve grief and anger and strengthening willpower.
This form of acupuncture also helps people to relax, a benefit most evident in the comfortable room where Moncrieff and his apprentice, Benjamin Chang, are working this April afternoon. The two move with an air of compassion and efficiency, needling peoples' ears and addressing concerns as they arise. Needles in place, the half-dozen patients move on to couches, where they sit back and listen to soft music.
Moncrieff says he treats a lot of migraines, back and shoulder pain, and arthritis. "You can just imagine some of the trauma that these clients have experienced," he explains. "They come in very stressed out with withdrawal pain, and in a very short time they become tranquil. You see a reduction in anxiety and physical pain, they sleep better, and their depression, their anxiety, seems to be disappearing." He describes the more traditional style of detox as "rough", and not a pleasant place for patients or staff.
If there's anyone who can do a comparison of the old style with the new, it's Moncrieff. He's worked in addictions for two decades. "For most of those years, it was a pretty harsh environment; it wasn't very satisfying, and the relapse... It was a burnout job." He says he didn't see much progress or real recovery and was always looking for treatments that got better results.
Below the detox residence is Vancouver Daytox, where the complementary therapies offered in addition to acupuncture include healing touch, Bach flower remedies, and thought field therapy. Patients are still medicated, but all these treatments are effective in reducing their drug intake, Moncrieff claims. They are adjunct therapies, he notes: not intended to stand alone, but used alongside orthodox medicine to form a complete package.
VIKKI KING'S LIFE has been a tapestry of the holistic and the traditional. When she was a child, her grandfather exposed her to yoga, organic food, and homeopathy. King graduated from medical school in 1985 and completed her specialty training in emergency medicine four years later. In 1993, she took a year off to explore other areas that held meaning for her. She lived in an ashram in New York state, studied yoga intensively, and worked for Doctors Without Borders in southern Sudan. When she returned to Canada, she chose to apply her skills in the Downtown Eastside.
It seems natural that her role at the Downtown Community Health Clinic on Powell Street--where she worked for four years--was that of integrator between complementary and allopathic therapies. As a clinical faculty member of UBC's family-practice department, she's in a good position to build such bridges. She's also enrolled in the two-year integrative-medicine program offered at the University of Arizona by U.S. alternative-medicine guru and author Andrew Weil.
At the Downtown Community Health Clinic, King was responsible for overseeing the complementary therapists and integrating them into the clinic. "You can have somebody who comes in two days a week and who works in isolation," she explains over a sushi lunch, "[or] the doctor refers to the therapist, the therapist refers back to the doctor, and they're working as a team." To achieve this outcome, King made sure that doctors, medical residents, and other staff became familiar with the nature of the therapies being introduced.
The character of addiction, with its host of underlying problems, makes it no different than any other chronic disease, King says. And although she describes emergency work as the area where Western medicine really shines, she sees limits to its capacity to treat chronic conditions.
"There can be a biological focus to addiction," she argues. "But you can also look at it in a spiritual way, as a lack of meaning and focus in life. You can look at it from [the perspective of] the abuse that may have happened in the past....So you can't...treat heroin addiction [solely] with methadone....By looking at it from multiple levels, you're more likely to have a successful treatment."
SITTING IN A sunny café on Commercial Drive, music therapist Jeffrey Hatcher shares his perception of the path that leads to drug addiction.
"People very rarely grow up healthy and happy and well-adjusted and content and safe," he says, "then suddenly become drug addicts. And really desperate drug addicts. It's not as abrupt as that...it's a long and tangled trail before then which has a certain logic to it."
As a staff music therapist at the Dr. Peter Centre and the Vancouver Native Health Society, Hatcher estimates that more than 75 percent of his clients are dealing with substance abuse. He says addiction almost always indicates a history of neglect, physical and/or mental abuse, or developmental delays.
"It [addiction] should teach us about abuse and trauma, really," he adds. "Because when you scratch the surface of so many people with addictions issues, there's somebody who's made it out of an abusive situation in their life.
In treating people with addictions, Hatcher notes that typically, it's people's emotional lives that are most present during a session. "Sometimes it's not as obvious," he says. "But the emotional life of the client is really what's being accessed at some level, I think. Even if they're not comfortable at all with their emotions...or confused by them. Music therapy is working on as deep an emotional level as the client is comfortable with."
He says music therapy can take many forms: improvisation, therapeutic songwriting, music and imagery for relaxation and pain management, music education, jam sessions, and singing. Clients don't need to have a musical background to participate.
According to Hatcher, the results can be dramatic. "I've seen people increase their level of socialization with other people--people who have been very reserved," he says. "I've seen First Nations clients show more interest in family roots...exhibiting pride in their cultural knowledge and being happy to share that knowledge with me."
Hatcher says addicts can teach us a lot: about public policy and how it helps to create addiction, about society's tendency to make drug use a moral instead of a health issue, and about compassion and being non-judgmental.
"No one plans to become a drug addict. You just want to feel better. All of us want to feel better sometimes, and almost all of us have tried some kind of substance for stretching our consciousness."
AS AN ENERGY therapist, Jo-Ann Svensson spends a considerable amount of time bringing people back into their bodies. She does this by drawing energy away from their heads and down toward their feet. "Often in our day-to-day life, energy accumulates around our head area; we get very into our heads," she says. "Once people are in their bodies, they can allow their truth to be spoken. And that truth might just be 'I am really sad right now'....It's amazing the amount of relief people feel just from that."
Complementary medicine explores the link between the emotional and physical bodies in various ways. Svensson tells the story of a client at Vancouver Detox who was coming off heroin. He was in a lot of pain, which she was attempting to reduce with hands-on energetic techniques. When that didn't work, she began to use a form of dialoguing unique to ARC Bodywork. ARC (A Return to Consciousness) is a form of therapy in which the practitioner works to balance and charge the client's energy system while asking creative questions that help them access their emotions and respond more directly from the realm of feeling.
"He was able to express some stuff that was really bothering him, and the pain released immediately," Svensson recalls. "Not to say that it's [exclusively] emotional issues that lead to heroin withdrawal pain, but they can really aggravate it."
In September 2000, Svensson initiated the pilot project that brought energy work to several of Vancouver Coastal Health's downtown clinics, where it is still practised. During her tenure with VCH, she participated in two studies into the effect of energy therapy on drug and alcohol addiction. The second study, which she conducted independently, looked at the efficacy of ARC therapy for people in early recovery from substance abuse. Results suggested that the work helped people to develop an "internal witness". She says this kind of self-awareness is vital for patients when they're responding to the emotional triggers that lead to addictive behaviour.
As a demonstration of the development of such leadership, she gives the example of an addicted client who felt that a physical condition marred his appearance and thus controlled and inhibited his life. Over the course of several sessions, Svensson helped him to separate his sense of himself from his condition. The man began to see where he was abdicating self-responsibility. He sought additional therapy and eventually entered a 12--step program.
NOT ALL MEDICAL professionals are enthusiastic about the role of complementary therapies in the treatment of addictions. Lloyd Oppel is a Vancouver physician and the coordinator of Canadians for Rational Health Policy, a group whose mission statement includes advocating "the development of health policies and programs based on the best available scientific evidence". Oppel says there is a lack of proof to support the efficacy of complementary therapies. He adds that addiction treatment has a large psychotherapeutic component.
"In an area like this where you're doing a behaviour-modification program [to encourage people to quit a drug], a lot depends on the faith of the person in the person [practitioner] they're going to," he claims. "You're going to get people experiencing positive results no matter what you're doing for them."
Oppel says that when people choose complementary therapies, they are almost always making their selection based on a prior belief, which subjects them to the placebo effect. Another factor he cites is the "norm of social reciprocity": in our society, it's considered poor manners to suggest that services rendered weren't helpful. Oppel disagrees with the argument that there's no difference between a genuine and a placebo effect. The problem arises when people give credit where it's not due, he says. Then there's the potential for "disaster" when patients seek complementary remedies for diseases that require mainstream medical treatment.
DURING HIS FIRST few years working in detox, Les Moncrieff wasn't getting much satisfaction, understanding, or insight. "There was a lot of burnout...in the old system, because of the difficulties, anger, abuse, and lack of real healing happening," he remembers as he sits in a small office at Vancouver Detox.
When he began to incorporate complementary medicine into his practice, however, it was "an incredible transformation".
"It's a 24-hour-a-day job for me, but it's not work, it's not stressful," Moncrieff insists. "I come in here every day and witness miracle after miracle. I see people in extraordinary pain and all of a sudden they have no pain," he says. "They'll wonder--they'll be confused where the pain went."