COST EFFECTIVENESS OF NADA
PROTOCOL IN A SUBSTANCE USE
TREATMENT SETTING
NADA Conference 2017
Background Information
 SC LAW
 prior to 2005 there was no law in regards to ADS and NADA
protocol.
 SC Acupuncture Act was passed requiring direct (on-site)
supervision by a licensed acupuncturist or person licensed to
practice medicine
Hypothesis for Study:
 determine whether NADA plus standard treatment is better than
standard treatment alone in improving and sustaining treatment
outcomes including:
 quality of life and psychiatric symptoms,
 maintaining abstinence from drug, alcohol and tobacco, and
 decreasing healthcare utilization.
Collaborations
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Keystone Substance Abuse Services, Rock Hill, SC
Winthrop University, Rock Hill, SC – Dr. Jonathan Marx
Kenneth Carter, MD, MPH
Simon Cairns, L.Ac.
Michelle Olshan-Perlmutter, PMHCNS, FNP
General Information
 First participants were
enrolled July 2015
 Had 100 people enrolled
 59 women and 41 men
 Last person was
discharged from study
March 2016
 Participants could not
participate if they had been
in services prior to 2 weeks
of enrollment
 All participants were from a
gender specific Intensive
Outpatient Program (IOP)
Standard Treatment
 Provided to both NADA protocol and control groups
 Standard treatment included individual, 12 step orientation
and a variety of group therapies.
 Patients in the control group participated in various didactic
and process groups while patients in NADA group received
NADA protocol.
 Both NADA and control groups were treated by the same
group of therapists including certified substance abuse
counselors and licensed clinicians.
Exclusion Criteria
1. Bruising, cut, or other lesion at the site of insertion
2. Patients unable or unwilling to follow direction for any
reason
3. Younger than 18 or older than 65 years of age
4. Patients who do not meet substance use diagnostic criteria
5. Non English speaking or unable to follow oral/written
directions
6. Probate Court ordered clients
What To Expect
 Receiving the procedure by a certified/licensed Acupuncture
Detoxification Specialist @ Keystone Substance Abuse
Services.
 Receive 1-5 point auricular (ear) acupuncture while seated
together in a group (same gender)
 Needles are inserted and generally remain in place for 30-40
minutes.
 Needles are provided in sterile packages, are single use,
inserted once and discarded in designated sharps disposal
containers.
 Needles are inserted with brief but steady movement, twirled
180 degrees for smoother insertion.
 Client may request needle removal at any time during the
treatment.
 Acupuncture treatments will be available 2x/week and patients
will be encouraged to attend all sessions.
 Patients will resume their normal treatment sessions following
the acupuncture session.
If you agree to participate, you will
be randomly assigned to one of
two treatments.
EXPERIMENTAL GROUP
 Will receive a 1-5 point
auricular (ear) acupuncture
protocol free of charge.
CONTROL GROUP
 Standard group activities
WITHOUT the auricular
acupuncture protocol.
 You will have the
opportunity to receive
acupuncture Treatment
after your 6 month followup.
Both groups will complete:
At admission
& discharge
1. Quality of Life and
Satisfaction
Questionnaire
2. Depression Screening
3. General Anxiety Disorder
Screen
4. Drug Screens
Additional follow up at 3
and 6 months postdischarge
1. Physical health
2. Behavioral health
3. Substance use and
treatment
Biweekly completion of:
1. Depression Screening
2. General Anxiety Disorder
Screen
Risks
1.
2.
3.
You may be in the control
group and have no
acupuncture for your
condition for 6 months.
It is possible that you get
the acupuncture
treatments but do less well
than you have been doing.
Because the treatment is
relatively new, we may not
yet know all the side
effects: something
unexpected could happen.
The KNOWN side effects are:
Likely
 Brief ear discomfort
 Minimal local bleeding upon
needle removal
Less Likely
 Local bruising
 Metallic irritation from needle
 Temporary headache
Rare but Serious
 Vaso-vagal response (fainting)
Confidentiality
 The researcher shall make every possible attempt to maintain
confidentiality of the research and your shared information.
 Alcohol and/or drug treatment records are protected by HIPAA
as well as 42 C.F.R., Part 2, 45 C.F.R., Part 160 and 164, and
cannot be disclosed without your written consent unless
otherwise provided for in the regulations.
 The investigators in this study are protected from being forced to
tell people that are not connected with this study about your
participation in this study, even under subpoena.
 Exceptions to confidentiality:
 Suspected or known sexual, physical, or other abuse of a child or
older person, threats of violence to self or others.
 To reduce the risk of confidentiality loss:
 Subjects will be coded by numbers and will not contain names of
participants or other identifying information.
 Linking information will be kept in locked files.
 Identifiers will be destroyed when the study is complete.
 A password protected computer will be allocated for storage and
data management.
 Only Principal Investigators will have access to this computer.
Authorization
 If you wish to participate in the study, you will be asked to sign a consent form. It allows
the study investigator to collect, process and pass relevant personal health information
collected from you during the study. These are activities routinely carried out during all
clinical studies.
 You have been told that personal info about you (sensitive personal health info, such as
medical history and your racial/ethnic origin if relevant to the study) will be reviewed,
collected on a computer database, stored in electronic or manual files, audited, and/or
otherwise processed by:
 The clinical study investigator, and research staff: Dr. Jonathan Marx, Dr. Kenneth Carter, Janet Martini
 Keystone employees
 Other persons or agencies as required by law or allowed by federal regulations
 You have been told that your personal data is being collected and processed to:
 Check your suitability to take part in the study
 Monitor your Treatment with the study procedure
 Compare results with those of other subjects in clinical studies
 By signing this document, you explicitly consent to the transfer of your personal info,
including sensitive personal info, collected during this clinical study, for review,
processing and/or storage. However, all groups are committed to keeping your personal
info confidential.
 You may refuse this authorization to transfer your personal info. If you choose not to
agree to this authorization, you might be ineligible to participate in the study. If you
decide not to sign this authorization, that will not harm your relationship with Keystone
Substance Abuse Services.
NADA Consent to Treatment
Winthrop Release of Information
Initial Demographics
Locator Form
GAD-7
PHQ-9
Quality of Life
General Outcomes
 13 dropped out of study and treatment prior to their 2nd
acupuncture session for various reasons
 A few dropped out of study but remained in treatment after
their 2nd session
 Some clients that experienced the NADA protocol during this
study have returned needing services and requested NADA
protocol.
Outcomes
 The average length of stay was between 10-12 weeks for
patients in both groups.
 The average number of NADA treatments was 10.14 over an
average of 8.3 weeks
 Treatment completion rates for the NADA group (59%) and
control groups (64%)
Outcomes
 Patients in both groups at program completion had significant
psychological improvement in anxiety (GAD-7) and
depression levels (PHQ 9).
 However, only the NADA completers show statistical
significant improvement (p<.05) in quality of life (Q-LES) on 2
items (“feeling tired or having little energy” and “feeling bad
about yourself or that you let your family down”)
Outcomes
 NADA group trended better for drug use and decreased
healthcare utilization at 3 and 6 months follow up.
 NADA group showed statistical significance when compared
to control for maintaining abstinence from alcohol at 3 and 6
months and tobacco use at 6 months following program
completion.
What’s next
 Due to resources and law restrictions Keystone has been
unable to perform NADA protocol since this study, but we are
in hopes in very near future of being able to do so.
 A longer term and more permanent outcome we would like to
see with the influence of this study is to modify the SC law in
regards to ADS.