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Jurnal Pertahanan: Media Informasi tentang Kajian dan Strategi
Pertahanan yang Mengedepankan Identity, Nasionalism dan Integrity
Vol. 9 No. 1 (2023) pp.42-52
http://jurnal.idu.ac.id/index.php/DefenseJournal
The Effectiveness of Acupuncture Therapy in the Drug Addiction to
Ward Off the Social Culture Threats
Dion Rukmindar1, Elies Fitriani2, Inria Chandra3, Herlina Tarigan4, Wahyuningsih
Djaali5*
1,2,3,5Medical Acupuncture Specialist Program, Faculty of Medicine, Universitas Indonesia,
Indonesia
2,4Faculty of Medicine and Health Science, Indonesia Defense University, Indonesia
dion.rukmindar@ui.ac.id1, elies.fitriani@ui.ac.id2, inria.chandra@ui.ac.id3, helin8@yahoo.com4,
inchy86@yahoo.com5*
*Corresponding Author
Article Info
Article history:
Received: November 30, 2022
Revised: March 4, 2023
Accepted: April 28, 2023
Keywords:
Acupuncture,
Auricular Acupuncture,
Drug Addiction,
Drug Rehabilitation,
Ear Acupuncture,
NADA Protocol
DOI:
http://dx.doi.org/10.33172/jp.v
9i1.1951
Abstract
Drug addiction is a social-cultural threat and has a serious
impact on national defense. It is required a comprehensive
approach as it would influence the quality of the next
generation. Treatment for drug addicts is called the
rehabilitation process and one of the stages is the
detoxification process, where drug-class substances are
removed from the addict's body. The current detoxification
process uses pharmacological and non-pharmacological
methods. Acupuncture through the NADA (National
Acupuncture Detoxification Association) protocol can be a
non-pharmacological approach to the drug detoxification
process by overcoming the weakness of previous
pharmacological and non-pharmacological therapies. This
article is a narrative review from the last ten years published
in PubMed, Embase, Google Scholar, and Elsevier. This
literature review aims to study whether or not acupuncture
is a beneficial therapy in the detoxification process in the
rehabilitation of drug addicts proven with scientifically
based evidence. This result then could become a
consideration for stakeholders to make a standard protocol
in the rehabilitation process for drug users in Indonesia.
Based on the studies reviewed in this literature review, the
NADA protocol is feasible to become a non-pharmacological
approach in the rehabilitation of drug addicts. Additional
research on the use of the NADA protocol is needed.
2549-9459/Published by Indonesia Defense University. This is an open-access article under the
CC BY-NC license (https://creativecommons.org/licenses/by-nc/4.0/).
INTRODUCTION
In the past, national security only revolved around military security. However,
security concerns have now departed and welcomed security aspects including political
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
43
security, economic security, and health security. Nowadays, the global security condition
is marked by the increasing intensity of asymmetric security threats in the form of cross-
border security threats. Acts of piracy, smuggling of weapons and explosives, smuggling
of women and children, illegal immigrants, illegal logging, disposal of hazardous toxic
waste (B3), human trafficking, and narcotics and illegal drugs (narcotics) are forms of
threats that most prominent in cross-border security in the last decade (Ministry of
Defense of the Republic of Indonesia, 2008).
Drug addiction is a serious social-cultural threat that needs serious attention and
has a negative impact not only on the users, but also on national, regional, and
international security. Security is defined not only as dealing with external military
threats but as addressing challenges to the effective functioning of society. It poses a risk
to security at the individual level as the younger generation is a national asset of
defense. Drug addiction could affect the productivity of the next generation if does not
resolve properly (Ministry of Defense of the Republic of Indonesia, 2015). According to
2021 global data released by the United Nations Office on Drugs and Crime (UNODC),
275 million people in the world use drugs, with approximately 36.3 million or about
13% of them experiencing drug dependence. Drug users tend to increase annually,
there was an increase of 22% in drug users between 2010-2019. From previous data, it
is estimated that drug users globally will increase by 11% in 2030 (United Nations Office
on Drugs and Crime, 2021). According to the Research Center for Data and Information
of the National Narcotics Agency (2022), in 2021 there were 1.95% or 3.66 million drug
users di Indonesia. This data increased by 0.15% compared to 2019, which was 1.80%
or 3.41 million people (Research Center for Data and Information of the National
Narcotics Agency, 2022).
The rehabilitation process was more challenging for people who have a
dependence on illegal drugs because the body was used to being in a state of pleasure
and comfort as a result due to taking drugs as a result of increased dopamine levels in
the brain. Increased dopamine levels in the brain through the intake of exogenous
opiates were believed to be an addiction mechanism in drug users (Lin, Chan, & Chen,
2012). There are four steps in the process of rehabilitation of drug users: examination,
detoxification, stabilization, and activity management. The detoxification process plays a
vital role in the rehabilitation process of drug users, the length of the process also varies
depending on the individual variance. There are two detoxification mechanisms in the
rehabilitation process of drug users, pharmacological and non-pharmacological
approaches. Pharmacological detoxification therapy or known as Rapid Opiate
Detoxification (ROD) uses opioid antagonists, such as naloxone and naltrexone (Tanum
et al., 2017). This pharmacological detoxification has quite good results in the
rehabilitation process, but it has weaknesses such as the cost of rehabilitation tends to
be high. The second detoxification mechanism is non-pharmacological, it allows a
natural detoxification process in the user's body, however, this process tends to be
painful because the body will enter a withdrawal phase causing dysphoria and
significant suffering an also other side effects e.g miosis, respiratory depression (Lin et
al., 2012). The non-pharmacological approach could become an option for the deterrent
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
44
effect to drug users but still leave a painful suffering process (Stuyt, Voyles, & Bursac,
2018).
Acupuncture has the potential as a therapeutic option in the detoxification process
of drug addiction considering the weakness of existing pharmacological and non-
pharmacological therapies. Acupuncture therapy for opiate addiction is (1) inexpensive,
simple, and has no side effects; (2) acupuncture can be used for the prevention of opiate
relapse; and (3) acupuncture therapy is safe for pregnant and parturient women.
Acupuncture is less painful and simple. The NADA protocol only uses five points (Lin et
al., 2012). The NADA protocol is an ear acupuncture method used to treat addiction. The
NADA protocol uses five acupuncture points in the ear: The Shen Men (acupuncture
point located on the superior antithetical crus, just above the Hip Point), Sympathetic
(presented in the groove of the descending helix), Kidney (On the inside of the ascending
helix, right in the concavity, at the level of the triangular fossa, Liver (On the right ear in
the mediolateral portion of the concha), and Lung points (On the right ear in the
mediolateral portion of the concha). The results of several studies regarding the NADA
protocol and drug addiction show that the NADA protocol can reduce withdrawal
symptoms and improve the quality of drug addict rehabilitation (Carter, Olshan-
Perlmutter, Marx, Martini, & Cairns, 2017). A systematic review from Baker & Chang
(2016) showed there were significant differences between NADA protocol
administration compared to controls. One study reported that the dose of MMT
(methadone maintenance treatment) became less after the administration of the NADA
protocol.
This study will discuss the effectiveness of acupuncture as a non-pharmacological
method in the rehabilitation process of drug addicts. The result of this article could
become a literature guideline to use the NADA protocol for drug addiction rehabilitation
in Indonesia as addiction is a social and cultural threat to national and global security.
METHODS
During the research process, the authors conducted a search of studies published
in the last 10 years publication from PubMed, Embase, Google Scholar, and Elsevier with
keywords are (((((((acupuncture[MeSH Terms]) OR (ear acupuncture[MeSH Terms]))
OR (NADA protocol[MeSH Terms])) AND (narcotic addiction[MeSH Terms])) ) OR
(narcotic abuse[MeSH Terms])) OR (narcotic-related disorder[MeSH Terms])) OR (drug
addiction[MeSH Terms]). The inclusion criteria were (1) publication in English; (2)
Meta-Analysis, Randomized Controlled Trial, Systematic Review, Literature Review; and
(3) studies that used NADA protocol for drug addiction or drug rehabilitation. Exclusion
criteria were (1) comments and replies and (2) animal study. This study was
conducted from literature searching and selected appropriate literature according to the
keywords. After duplication screening and excluding the literature that does not meet
the criteria, then finally the authors determined which literature to be included. All
authors write the manuscript together from the selected studies.
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
45
RESULTS AND DISCUSSION
The literature search described in the Methods section resulted in 92 studies in the
initial search. After the screening, four studies met the criteria to be included in this
literature review.
Figure 1. Search Strategy Scheme adapted with change from http://prisma-statement.org
The trend of global developments influences the characteristics of threats with the
emergence of new security issues that require handling with a more comprehensive and
integrative approach including the area of medical science. These security issues are
terrorism, cross-border security threats, the proliferation of weapons of mass
destruction, biological weapons, the use of drugs and narcotics, etc. The emergence of
new security issues is inseparable from globalization, advances in information
technology, primordial identity, and the strengthening of the role of non-state actors
(Ministry of Defense of the Republic of Indonesia, 2008).
According to Indonesian National Narcotics Agency (BNN) in cooperation with the
Center of Health Studies of the University of Indonesia (UI) survey in 2015, the
prevalence number of drug abuse in Indonesia was 2.20% which indicates that about 4
million people were narcotic drug users. The number of narcotic drug users is still
Identification
Records removed before the
screening:
Duplicate records removed
(n = 3)
Records screened
(n = 92)
Records removed before the
screening:
Duplicate records removed
(n = 3)
Screening
Reports excluded
(n = 88)
Records
screened
(n = 92)
Records identified
from:
PubMed (n = 5)
Google Scholar (n = 29)
Embase (n = 43)
Elsevier (n = 18)
Identification of studies via databases and registers
Screening
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
46
increasing to 5.9 million people and ironically, 1.7 million increases were new users
(Rifqi & Bangun, 2020).
Figure 2. The Nature of Threats (Ministry of Defense of the Republic of Indonesia, 2015)
The current and future threats can be classified into three types hybrid threats,
military threats, and nonmilitary threats. These can be classified into factual and
nonfactual threats. The factual threat is a threat prioritized in handling terrorism and
radicalism, separatism and armed uprisings, natural disasters, border trespassing,
piracy, natural resources theft, epidemics, cyber-attack, and espionage, as well as
trafficking and drug abuse.
Figure 3. Factual and Nonfactual Threats
(Ministry of Defense of the Republic of Indonesia, 2015)
National securities are defined as creating safe conditions mostly by combating
“existing threats” or even perceived threats. The goal of national security is to ensure the
survival of the nation-state, which consists of two main elements, the continuation of the
next generations, and the maintenance of their nation-state in the future. Drug abuse is a
national threat that weakens a country's ability to maintain its national security and
defend itself from external threats. Narcotic drugs can damage the nation's generations,
both physically and mentally. The long-term impact is expensive and difficult to recover
(Ministry of Defense of the Republic of Indonesia, 2015).
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
47
A drug is a substance that is taken into the human body and alters some processes
within the body and can be used in the diagnosis, prevention, or treatment of a disease.
Most drugs that can affect the work of nerves are said to be misused if they are
overused. Drug abuse is the use of drugs for the reason not for the treatment but to
enjoy the effects. Meanwhile, another source said that drug abuse is the use of
pathological drugs which have lasted one month, disrupting work, and social function. It
can be concluded that the definition of drug abuse includes (1) the nonmedical use of a
substance, (2) altering mental state, (3) hurting the individual or community, and (4)
illegal. The use of the "abuse" term only when the user becomes dysfunctional
consequences include being unable to maintain employment and daily activity, impaired
social relationships, aggressive behavior, and or significantly endanger health (Rifqi &
Bangun, 2020).
There are three parts of a holistic strategy oriented toward long-term prevention.
In dealing with the narcotic drug problem, prevention consists of primary prevention
and secondary prevention. Primary prevention is carried out to prevent unexposed
populations from exposure to drugs. Secondary prevention is carried out to prevent the
worsening of drug abuse in the population that has been exposed to drugs (abusers).
The aim of secondary prevention is also to recover abusers and prevent the spread of
drug abuse from users to the population. Secondary prevention is carried out through a
rehabilitation program. Rehabilitation must be carried out sustainably, i.e. through the
post-rehabilitation program to prevent former users from relapsing and empowering
them to return to society as productive people (Rifqi & Bangun, 2020). In secondary
prevention and rehabilitation, acupuncture could play a role in recovering the abusers.
The NADA protocol is an acupuncture method used to treat drug withdrawal
symptoms in cases of narcotics addiction. The NADA protocol uses five acupuncture
points in the ear which are Shen Men, Sympathetic, Kidney, Liver, and Lung points
(Baker & Chang, 2016; Lua, Talib, & Ismail, 2013; Oleson, 2002). The history of
acupuncture for narcotic addiction started in 1972 when Dr. Wen, a neurosurgeon
doctor from Hong Kong, accidentally discovered that acupuncture was not only used for
anesthetic but also could be used in patients with opioid dependence. NADA protocol
was also developed to help addicts with their recovery dealing with trauma, anxiety,
depression, irritability, and craving. Since then, many studies have been carried out to
prove the effectiveness of acupuncture for narcotic addiction. In 1985, dr. Michael Smith,
the Director of the Center for Detoxification, The National Acupuncture Detoxification
Association formed five points of the ear acupuncture protocol which is currently widely
known as the NADA protocol (Cui, Wu, & Li, 2013).
The five acupoints were named the Lincoln Model, which NADA later introduced
widely to the rest of the world. The NADA protocol has been shown to increase
dependency retention, decrease drug dropout symptoms, and reduce long-term
morbidity in drug-dependence patients. Currently, the NADA protocol has become a
very effective approach for many populations receiving behavioral rehabilitation and
primary health rehabilitation (Baker & Chang, 2016). The NADA protocol as it exists
today consists of the insertion of a small, stainless-steel, disposable acupuncture needle
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
48
administered to the left and right ears as much as one to five ear acupuncture points on
the outer surface of a person’s ear. The NADA protocol can be used effectively in both
acute and chronic dropout conditions, addiction treatment, and recurrence prevention.
The focus of treatment is to establish emotional balance and homeostasis. The NADA
protocol makes the detoxification process more convenient, and faster, and a much
smaller dose of narcotics compared to the standard method of methadone detoxification
(MMT).
The ear acupuncture points are Shen Men, Sympathetic, Kidney, Liver, and Lung
points (see Figure 2). The Sympathetic point lies in the confluence between the inferior
crus and the ear scapha and serves for the regulation of the central nervous system. Shen
Men's point lies at the apex of the fossa triangularis, and acts on the medulla oblongata,
overcoming insomnia, anxiety, depression, and drug dependence. Shen Men is well
known as an ear point that produces a sensation of relaxation. The Kidney, Liver, and
Lung points located on the concha, together serve to reduce cravings in addiction (Stuyt
et al., 2018).
Bearn et al. (2009) performed the NADA protocol daily for 30-40 minutes using a
32G needle for 14 days. Lua et al. (2013) intervened in the NADA protocol for 2 months,
3 times a week for 30 minutes at 1-3 mm depth. Washburn et al. 1993) carried out the
NADA protocol for 21 days, for 20-45 minutes. Wells et al. (1995) conducted 5 days per
week for the next 2 weeks every day for 6 months with a duration per session of 20-45
minutes (Baker & Chang, 2016). Therapy is given as often as possible; it is usual to do it
daily for 30-45 minutes. Therapy can also be given by the application of seeds or beads
at Shen Men points (Stuyt et al., 2018).
Figure 2. Ear acupuncture points for the NADA protocol (Stuyt et al., 2018)
Addiction is defined as a behavioral, cognitive, and physiological phenomenon that
develops after the continuous use of a substance characterized by using compulsive
drugs, the inability to limit the consumption of drugs, and the appearance of drug
dropout syndrome during the discontinuation of drug use. Addiction includes a strong
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
49
desire to take the drug, and difficulties in controlling its use, despite the dangerous
consequences. Drug addiction is a complex chronic disease that occurs in the brain, and
which modulated by genetic, developmental, and environmental factors. Drug addiction
is modulated by genetic, developmental, and environmental factors. The most consistent
in drug addiction is that the abused substance activates the mesolimbic dopamine
system.
The mesolimbic system consists of dopaminergic neurons in the ventral tegmental
area and their axonal projections into the terminal planes in the nucleus accumbent and
the prefrontal cortex, proven to play an important role in the mechanisms of opioid
addiction. Opioids, alcohol, nicotine, cannabis, and psychostimulants work to increase
dopamine at synapses (Gupta & Kulhara, 2007). Opioid abuse-induced changes in
dopamine levels in the brain are associated with feelings of comfort and pleasure,
providing positive reinforcement of sustained opioid abuse. In contrast, discontinuation
of chronic opioid use reduces dopamine flow in the accumbent nucleus. The cessation of
opioid use causes significant dysphoria and suffering, a state that drug user addicts want
to avoid and one that can be the main motive for continuing the use of opioids (negative
reinforcement) (Lin et al., 2012).
The mechanism underlying the work of ear acupuncture in lowering addiction
involves the stimulation of the parasympathetic nervous system. The ear of the concha
part is largely innervated by sensory and parasympathetic nerve fibers with numerous
connections to the central nervous system. Stimulation of ear acupuncture induces an
increase in the size of parasympathetic flows such as high-frequency bands on the HRV
(Heart Rate Variability) analysis spectrum as well as a decrease in plasma cortisol levels.
Acupuncture works by mechanisms against sympathetic dominance and autonomic
imbalance in patients with narcotic addiction (Krause et al., 2020). Another hypothesis
is from excitatory to the vagus nerve. It is known that the stimulation of small nerve
fibers of the skin can induce axon reflexes that affect the functioning of surrounding skin
structures innervated by the autonomic nervous system such as sweat glands, promotor
muscles, or blood vessels (Krause et al., 2020). It is well known that this local excitatory
on the skin can be continued towards the segmental and central. In the central,
acupuncture can stimulate the production of various types of endogenous opioids, such
as endorphins, enkephalin, endorphin, and dynorphins (Lin et al., 2012).
In 2008, Yang et al reviewed the mechanisms that may underlie the effectiveness
of acupuncture in the treatment of drug addiction and this review provides clear
evidence for the biological effects underlying the use of acupuncture to treat drug abuse.
This review provides a hypothetical model of the effect of acupuncture on the release of
dopamine in the nucleus of the accumbent. Regarding positive reinforcement,
acupuncture treatment activates GABA (Gamma-aminobutyric acid) receptors on
dopamine cell bodies and activates presynaptic opioid receptors in the accumbent
nucleus through dynorphin neurons, resulting in a decrease in dopamine release.
Regarding negative reinforcement, acupuncture treatment stimulates enkephalin
neurons in the hypothalamus and interacts with opioid receptors to inhibit the
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
50
interneuron of the ventral tegmental area of GABAergic and thereby increase the release
of dopamine in the nucleus accumbent (Lin et al., 2012).
In a systematic review from Baker & Chang (2016) of 4 RCT (Randomized Clinical
Trial) studies on the effectiveness of the NADA protocol on drug addiction, two studies
showed no benefit from the addition of the NADA protocols compared to standard
therapy, and two studies showed there were significant differences between nada
protocol administration compared to controls. One study reported that the dose of MMT
(methadone maintenance treatment) became less after the administration of the NADA
protocol. Two studies reported a decrease in retention of withdrawal syndrome MMT
therapy with significant differences. There were no reports of side effects from the 4
reported RCTs. One study showed an improvement in quality of life and psychosocial
relationships as a positive result of the NADA protocol. This was slightly different from a
systematic review conducted in 2011 in which 10 RCTs showed that acupuncture
provided significant results against drug dropout symptoms and significantly decreased
drug dropout symptoms in 6 of 7 studies. Researchers also reported changes in
psychological symptoms to positive in acupuncture groups from 3 RCT studies (Lin et
al., 2012). A systematic review involving 41 studies with 5,227 study subjects concluded
that there were no significant differences between the acupuncture therapy group and
the control groups (acupuncture sham, standard treatment) on the incidence of relapse
after therapy. Twelve studies mentioned the little risk of serious side effects, although
participants may experience slight bleeding or pain at the needle-piercing site (Grant et
al., 2016).
A randomized controlled trial conducted by Krause et al. aimed to assess the effect
of the NADA protocol acupuncture on cardiovascular autonomic function, psychological
effects, and abstinence in alcohol addiction patients. The results obtained in the NADA
protocol acupuncture group were an increase in heart rate variability immediately after
therapy and persisted four weeks after therapy. There was no change in the other
groups (Krause et al., 2020). The detoxification stage is an important part of the
rehabilitation process for drug addicts. Based on recent studies, shows that the NADA
protocol has good results in overcoming symptoms caused during the detoxification
process. Since acupuncture is simple, effective, cost-efficient, and drug-free, this
acupuncture method with the NADA protocol can be an alternative option for optimal
results in the rehabilitation process carried out can run optimally. Further research with
a randomized controlled trial study design to assess the effectiveness of the NADA
protocol in the rehabilitation process of illegal drug addiction in Indonesia is highly
recommended. The stakeholder could make the NADA protocol a standard in the
rehabilitation process of drug users in Indonesia based on the evidence of its efficacy.
CONCLUSIONS, RECOMMENDATIONS, AND LIMITATION
NADA protocol is a reasonable approach to overcoming symptoms caused by the
detoxification process and could become an alternative option for optimal results in the
rehabilitation process. From the literature, the NADA protocol is effective for the
treatment of drug addiction supported with evidence-based although some studies
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
51
showed no benefit from the addition of the NADA protocols compared to standard
therapy. But the significant positive result is more than no effect. From the literature, we
also conclude that acupuncture has minimal side effects. The limitation of this review is
the absence of research on the NADA protocol in the rehabilitation process in Indonesia.
Further research with a randomized controlled trial study design to assess the
effectiveness of the NADA protocol in the rehabilitation process of illegal drug addiction
in Indonesia is highly recommended so that the stakeholder could consider the NADA
protocol as a standard in the rehabilitation process of drug users in Indonesia.
REFERENCES
Baker, T. E., & Chang, G. (2016). The Use of Auricular Acupuncture in Opioid Use
Disorder: A Systematic Literature Review. The American Journal on Addictions,
25(8), 592–602. https://doi.org/10.1111/ajad.12453
Bearn, J., Swami, A., Stewart, D., Atnas, C., Giotto, L., & Gossop, M. (2009). Auricular
Acupuncture as An Adjunct to Opiate Detoxification Treatment: Effects on
Withdrawal Symptoms. Journal of Substance Abuse Treatment, 36, 345–349.
https://doi.org/10.1016/j.jsat.2008.08.002
Carter, K., Olshan-Perlmutter, M., Marx, J., Martini, J. F., & Cairns, S. B. (2017). NADA Ear
Acupuncture: An Adjunctive Therapy to Improve and Maintain Positive Outcomes
in Substance Abuse Treatment. Behavioral Sciences, 7(2).
https://doi.org/10.3390/bs7020037
Cui, C.-L., Wu, L.-Z., & Li, Y.-J. (2013). Acupuncture for the Treatment of Drug Addiction.
International Review of Neurobiology, 111, 235–256.
https://doi.org/10.1016/b978-0-12-411545-3.00012-2
Grant, S., Kandrack, R., Motala, A., Shanman, R., Booth, M., Miles, J., … Hempel, S. (2016).
Acupuncture for Substance Use Disorders: A Systematic Review and Meta-Analysis.
Drug and Alcohol Dependence, 163, 1–15.
https://doi.org/10.1016/j.drugalcdep.2016.02.034
Gupta, S., & Kulhara, P. (2007). Cellular and Molecular Mechanisms of Drug Dependence:
An Overview and Update. Indian Journal of Psychiatry, 49(2), 90.
https://doi.org/10.4103/0019-5545.33253
Krause, F., Penzlin, A. I., Ritschel, G., Barlinn, K., Reichmann, H., Weidner, K., … Siepmann,
T. (2020). Randomized Controlled Three-Arm Study of NADA Acupuncture for
Alcohol Addiction. Addictive Behaviors, 110.
https://doi.org/10.1016/j.addbeh.2020.106488
Lin, J.-G., Chan, Y.-Y., & Chen, Y.-H. (2012). Acupuncture for the Treatment of Opiate
Addiction. Evidence-Based Complementary and Alternative Medicine.
https://doi.org/10.1155/2012/739045
Lua, P. L., Talib, N. S., & Ismail, Z. (2013). Methadone Maintenance Treatment versus
Methadone Maintenance Treatment Plus Auricular Acupuncture: Impacts on
Patient Satisfaction and Coping Mechanism. Journal of Pharmacy Practice, 26(6),
541–550. https://doi.org/10.1177/0897190013489574
Ministry of Defense of the Republic of Indonesia. (2008). Buku Putih Pertahanan
The Effectiveness of Acupuncture Therapy in the Drug Addiction to Ward Off the Social Culture Threats
52
Indonesia. Jakarta: Ministry of Defense of the Republic of Indonesia.
Ministry of Defense of the Republic of Indonesia. (2015). Buku Putih Pertahanan
Indonesia. Jakarta: Ministry of Defense of the Republic of Indonesia.
Oleson, T. D. (2002). Commentary on Auricular Acupuncture for Cocaine Abuse. Journal
of Alternative and Complementary Medicine, 8(2), 123–125.
https://doi.org/10.1089/107555302317371406
Research Center for Data and Information of the National Narcotics Agency. (2022).
Indonesia Drugs Report 2022. Jakarta.
Rifqi, M., & Bangun, E. (2020). Drug Crime as A Threat to Indonesia’s National Security.
Jurnal Pertahanan, 6(3), 386–402. https://doi.org/10.33172/jp.v6i3.871
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).
https://doi.org/10.3390/medicines5010020
Tanum, L., Solli, K. K., Latif, Z. E.-H., Benth, J. S., Opheim, A., Sharma-Haase, K., … Kunøe, N.
(2017). Effectiveness of Injectable Extended-Release Naltrexone vs Daily
Buprenorphine-Naloxone for Opioid Dependence: A Randomized Clinical
Noninferiority Trial. JAMA Psychiatry, 74(12), 1197–1205.
https://doi.org/10.1001/jamapsychiatry.2017.3206
United Nations Office on Drugs and Crime. (2021). Global Overview: Drug Demand Drug
Supply. Vienna.
Washburn, A. M., Fullilove, R. E., Fullilove, M. T., Keenan, P. A., McGee, B., Morris, K. A., …
Clark, W. W. (1993). Acupuncture Heroin Detoxification: A Single-Blind Clinical
Trial. Journal of Substance Abuse Treatment, 10(4), 345–351.
https://doi.org/10.1016/0740-5472(93)90019-x
Wells, E. A., Jackson, R., Diaz, O. R., Stanton, V., Saxon, A. J., & Krupski, A. (1995).
Acupuncture as an Adjunct to Methadone Treatment Services. The American
Journal on Addictions, 4(3), 198–214.
https://doi.org/10.3109/10550499509038105
