By Ryan Bemis, published in Guidepoints: News from NADA, January 2012 – not available online, reprinted with permission.
Paid licensed acupuncturist positions within addictions and psychiatric programs in Oregon and California have sharply declined in recent years largely due to budget issues, and as a result dozens of acupuncture-based services for the public have ended, according to an informal survey conducted by the National Acupuncture Detoxification Association (NADA). Meanwhile NADA advocates and acupuncturists who have lost such jobs continue to work for NADA policy reform in the face of opposition from the acupuncturist profession.
Aren’t there enough licensed acupuncturists in the US to provide NADA ear acupuncture clinics within addictions and mental health programs? This is a common, and fair, question posed by acupuncturists.
To answer this question, Guidepoints zeroed in on 2 states that are home to some of the largest populations of acupuncturists: California and Oregon. We interviewed both addictions providers who have laid off acupuncturists, and acupuncturists who lost their jobs in treatment programs. According to their reports, very few acupuncture-based addictions programs currently operate in these two ADS restrictive states. Only five known NADA programs exist in Oregon.
The report contrasts with numbers of NADA programs in states that permit allied health workers to perform the NADA protocol, such as New Mexico, where currently there are 19 NADA programs, and Maryland which has 20. The survey supports a hypothesis that it is not sustainable for addictions and mental health programs to exclusively depend on hiring an outside contracted acupuncturist at $30-$70/hour to perform the NADA five point ear protocol.
Oregon: NADA giants cut in half
In Portland, Oregon, which at one time was home to more NADA programs than anywhere in the world, jobs for acupuncturists within addictions programs have almost disappeared. Due to severe budget cuts, the high salary of an acupuncturist (which can range from $30-$70/hour), is often the first item to be cut.
In 2004, 20-25 acupuncturists were employed within the network of NADA programs. Today, there are less than half as many employment opportunities: only 11 mostly part time jobs for acupuncturists. In a state like Oregon, if a program can’t pay a licensed acupuncturist or find a willing volunteer acupuncturist, the program can no longer offer NADA services to their clients.
“Lack of ADS is the killer,” remarks Guidepoints founding editor Jay Renaud about the massive program closures. Renaud worked for years as an addictions program administrator in the Portland area.
ADS refers to an Acu Detox Specialist, an individual who has received the full 70 hour competency based US training offered by the National Acupuncture Detoxification Association (NADA). ADS denotes a health worker qualified to provide NADA ear acupuncture protocol services for broad-spectrum behavioral health symptoms. Integral to a cost effective NADA model, ADSes are not licensed as acupuncturists, but are rather counselors, nurses, social workers, psychologists or other community health workers. According to one comparative study, NADA services provided by licensed acupuncturists was 16 times more
expensive for a treatment program than utilizing existing treatment staff trained as ADSes (Mercier, 1992).
Mercier, D.G. (1992) The Kent-Sussex Program: A Case for Acupuncture Specialists. NADA Literature Item # 1028. Laramie, Wyoming: National Acupuncture Detoxification Association.
The total cuts in the past 8 years are estimated to be 55%-59% (calculated by estimating the number of 3-4 hour shifts of NADA groups and acupuncture sessions accessible to Oregonians within psychiatric and addictions programs).
The rollback began in 2004 at Central City Concern (CCC), a comprehensive recovery and housing program located in the heart of Portland, a year after the National Health Care for the Homeless Council recognized CCC’s use of acupuncture as a model for providing care to the homeless. Eight psychiatric and addictions acupuncture based programs staffed by CCC acupuncturists lost funding. Acupuncture services at CCC’s detox and outpatient program were also scaled back, alongside two inpatient programs through Ecumenical Ministries of Oregon and Volunteers of America.
In 2007, the NADA based drug court program in Multnomah County lost funding; acupuncture is no longer a service for their clients. The NADA protocol was an integral component of their comprehensive drug court services since inception in 1991, and independent evaluators estimated that the NADA program reduced crime and saved taxpayers $79 million in “avoided costs” over a 10 year period.
Most recently in June 2011 the 18-year old NADA style program at the Washington County Community Corrections Center, where licensed acupuncturists served 100-150 clients weekly, free for the public, lost funding for salaried acupuncturists.
California acupuncturists just say no to NADA reform
In California, the picture is not better.
Between 1998 and 2003, eight NADA programs closed due to funding problems, which together had offered acupuncture within mental health and addictions programs for an estimated 30+ clinic sessions a week. Since then, NADA programs within a homeless shelter in Santa Maria and another inpatient program called Cottage Care lost funding. Just since the budget crisis of 2008, at least 10 NADA programs have been cut, according to reports from acupuncturists who worked in these programs.
The California Acupuncture Board was approached by state legislative assembly workers in May 2010 presenting the possibility of a NADA policy that would permit existing treatment staff, with ADS training, to perform NADA services. This effort was backed by the California Association of Alcohol and Drug Program Executives (CAADPE), a policy advocacy and workforce development organization representing addictions and mental health providers across the state.
In addition, acupuncturists who lost their jobs as NADA protocol providers came out in support of the NADA policy. They envisioned creating new opportunities for acupuncturists to work as trainers, similar to states like New York, Texas, and Virginia. Such a policy would have also helped establish new educational opportunities for addictions and psychology graduate students, similar to the Yale Medical School’s NADA training program, which exists today as a result of the Connecticut ADS exemption rule.
However, the Acupuncture Board unanimously voted against NADA reformers, stating in their minutes that they would “not support the practice of acupuncture outside of licensed acupuncturists.”
And with that statement, the crisis has continued to worsen.
More jobs for acupuncturists have since been cut, which has led to fewer NADA ear acupuncture clinics accessible to the public.
“It is so painful to be looking at this sad reality,” laments Project Recovery’s Executive Director, Ruth Ackerman, who witnessed in spring of 2011 the slashing of NADA services in their outpatient program as well as a homeless shelter in Santa Barbara, California. “The programs all loved the acupuncture treatment, they have just been cut to the bone.”
Last summer, a 19-year old hospital based NADA detox program in Oakland staffed by Gregory Ross lost funding. For years Ross wrote a column, Not the Emperor’s Acupuncturist, in which he told his personal and professional experience as an employed acupuncturist in a public health setting, was dropped by Acupuncture Today editorial staff. In his farewell column, “Saying Goodbye to Healing”, he wrote, “I am far from alone in this experience in the acupuncture detox field. Over the last 10 years or so, I have known at least eight acupuncturists that have left the detox field due to the bad economy.”
NADA advocates refuse to give up. The news is not new to most: Acupuncturists are out of work.
Wait lists remain long for addicts seeking recovery, relapsing and returning to the streets.
And while some see the current economic downturn as the beginning of the end of acupuncture based healing for addictions, west coast legislators and licensed acupuncturists, addictions providers and acupuncture students alike continue to support the NADA concept and explore ways to make NADA services accessible to people seeking help.
Carolyn Reuben, a licensed acupuncturist who lost several paid NADA gigs amidst the 2008 California budget crisis, continues to advocate for reform. As the director of the California Addiction Recovery Association (CARA), Reuben has spent years building support for a NADA policy so that addictions programs can save money by training existing treatment staff in the NADA protocol. She expresses optimism about prospective support from California acupuncturists in the future.
In late 2011, after a 2-year funding hiatus, California legislators passed a measure that renewed a contract with CARA to resume NADA services for correctional clients. Burke Adrian, supervising officer at the the Sacramento Drug Court told Guidepoints in 2009 that CARA’s NADA and nutritional program had a “great deal” to do with their program’s reputation in the state for cutting crime (17% 2-year recidivism rate, a figure well below the weighted (27.5%) and unweighted ($25.5%) national averages, according to an independent study).
In Oregon, Central City Concern has for decades and continues to employ the NADA protocol as a front line treatment for the homeless. The cost effectiveness of utilizing the NADA protocol within addictions programs has long been promoted by former Central City Concern director, Richard Harris, who is the current state director for the Addictions and Mental Health Division of the Oregon Health Authority. Harris also served on past federal addictions panels, offering recommendations for expanding access to the NADA protocol for the US Center for Substance Abuse Treatment.
With credit to David Eisen, a former Central City Concern administrator and executive director of the Portland-based integrative health center Project Quest, funding for remaining NADA services has been stabilized through Medicaid and Access to Recovery third party reimbursement. In addition, Eisen is exploring multi-year grant funding to renew the Washington County program.
Eisen, a faculty at the Oregon College of Oriental Medicine (OCOM) in Portland, also has played an important role in educating students and acupuncturists in the NADA concept of ADS provided treatment. For the past two years he has mentored student research projects on the use of the NADA protocol by non-acupuncturist NADA trained women health promoters (promotoras) who currently provide free clinics for people affected by drug war violence in Mexico. Another OCOM student research project in 2009, mentored by former OCOM research director Richard Hammerschlag, recommended training veteran peer workers in the NADA protocol as a best practice for acupuncture care among military veteran populations diagnosed with Post Traumatic Stress Disorder.
Still, acupuncturists in Oregon cannot provide such training in their own state under current regulations. With a NADA policy, schools like OCOM in Oregon could offer ADS training to counselors and psychologists similar to Texas acupuncture schools.
Data collected and compiled with assistance of acupuncturists and program directors who have worked in programs suffering cuts: David Eisen, Ruth Ackerman, Debra Mulrooney, Lisa Kipplinger, Carrie Klein, John Blank, Christine Knight, Carolyn Reuben, Cally Haber, Gregory Ross, Lianne Audette. Reflects data current as of September 2011.