Ear acupuncture for co-occurring substance abuse and borderline personality disorder: an aid to encourage treatment retention and tobacco cessation

This retrospective observational study analyzed the effectiveness of auricular acupuncture using the NADA (National Acupuncture Detoxification Association) protocol in a 90-day residential program for the treatment of substance use disorder and concurrent mental disorders. The study was conducted between January 2009 and December 2011 at the Circle Program of the Colorado Mental Health Institute, a modified therapeutic program funded by the State of Colorado for people with dual diagnosis who had failed previous treatments.

The study population included 231 patients, 55% men and 45% women, with a mean age of 35 years. Of the participants, 88% had nicotine dependence and 79% had a personality disorder diagnosis, with 78 patients (43%) specifically diagnosed with borderline personality disorder (BPD). Most patients had failed multiple previous treatments, with a mean of 2.4 prior outpatient treatment attempts.

The NADA protocol consists of placing five sterile needles at specific points on the ear: Sympathetic, Shenmen, Kidney, Liver, and Lung. The treatment was offered voluntarily 4–5 times a week, with sessions of 40–45 minutes during which patients sat in silence, often listening to soft music. The protocol was incorporated into the program in 2000 when it became completely tobacco-free, initially to help with nicotine withdrawal syndrome and smoking cessation.

The results showed that 185 patients (80%) successfully completed the 90-day program. There was no correlation between successful program completion and factors such as gender, race, age, primary substance use diagnosis, or primary psychiatric diagnosis. However, the use of auricular acupuncture was positively correlated with successful completion (p=0.006). Among the 194 patients who used the NADA protocol, 84% completed the program, compared with only 62% of the 37 patients who did not use auricular acupuncture.

Patients with BPD showed particularly notable results. Of the 78 patients with this diagnosis, 87% successfully completed the program — 100% of men (19/19) and 83% of women (49/59). The number of auricular acupuncture sessions attended by patients with BPD was significantly correlated with successful completion: those who completed the program participated in a mean of 13±9 sessions, compared with 7±6 sessions for those who did not complete (p=0.026).

The one-year follow-up revealed that 140 patients (91%) completed follow-up. Of the respondents, 54% reported being sober and well at the end of the period, with 30% continuously abstinent throughout the year. Patients with BPD (51 individuals) reported similar results to the group as a whole, with 55% sober and well, and a slightly lower criminal recidivism rate (18% incarcerated) compared with groups with antisocial personality disorder (29%) or no personality disorder (23%).

A significant finding was the strong correlation between tobacco use after treatment and relapse to drugs or alcohol. Patients who continued to use tobacco had a relapse rate of 69%, compared with only 45% of non-tobacco users (p=0.01). Time to first relapse was also significantly longer for non-tobacco users (9±5 months vs. 6±5 months).

Interestingly, those who stopped using tobacco during treatment but returned to use after discharge had longer stays in the program, suggesting that auricular acupuncture may have contributed to greater tolerance to withdrawal stress.

The study suggests that auricular acupuncture functions as a safe, effective, low-cost, nonverbal intervention that helps patients become more present and aware, allowing greater openness to other therapeutic interventions. For patients with BPD, who often have never experienced the ability to sit silently for 40–45 minutes, auricular acupuncture provides an immediate calming effect and the realization that they can remain still. This calming effect increases their motivation to engage in other aspects of the treatment program and strengthens the therapeutic alliance.

The clinical implications are significant, considering that patients with BPD historically have high treatment dropout rates due to difficulties with emotion regulation, stress tolerance, and the formation of therapeutic bonds. The NADA protocol appears to specifically address these difficulties, providing a practical tool for developing self-regulation skills that are fundamental to success in substance use treatment.