This certainly proved to be an exciting, moving, interesting two day event beautifully summed up by the following report. For copies of presentations and pictures/videos go to www.nadaeireann.com    Enjoy the read….

“Meeting Needs With Needles”: A Summary of the 2011 NADA International Conference, Dublin.

I have to admit that, when I was asked to write a summary of the 2011 NADA conference in Dublin, I immediately became nervous. I had been enjoying the conference immensely, and found each of the presentations entirely fascinating. However, I had my own misgivings. I am not a member of NADA. I am not trained in the protocol, or, for that matter, in any protocol. I am not a healthcare or social services worker. I am an historian and a social scientist.

But it seemed, in a sense, only appropriate, as one of the things which fascinated me the most about the weekend was the repeated de-emphasis of so-called “qualifications,” in favor of an ethos of “attack the problem the best we can.” This, I know, is a gross oversimplification, but I offer it as a way of introducing some of the more salient themes I perceived in the weekend: in each of these, it seemed there was some element of the “get it done as best we can” ethos. I may not be well enough qualified to remark on the proceedings of such an extraordinary conference, but I’ll leave that to you to determine.

In speaking with many of you informally, and after a week reflection, I settled on four related themes:

1. Affordability and easy access not only to treatment, but also to training.
2. The importance of community and community empowerment in all aspects of health and recovery.
3. A necessary skepticism of many of the authoritative claims of what we in the U.S. have come to call the Medical-Industrial Complex, especially the overuse of commercial (industrial) pharmaceuticals.
4. The necessity of political mobilization.

Access and affordability of treatment and training. This, perhaps more than any of the other three themes, pervaded the two days in Dublin. Rightfully so, since the rapid international spread of the NADA protocol owes itself to the principle, formed at the Lincoln Recovery Center in the South Bronx of New York City, that treatment should be effective, affordable, and accessible. Similarly, NADA-UK’s website, just as one example, announces its dedication “to ensuring the service is free at the point of access.” Jorma Paalasmaa reports the existence of some 700 NADA trainees in Finland. The relatively young NADA France, to take another example, literally has gone mobile by starting a NADA bus program (adopted from a methadone bus program operated there). Further, most delegates reported increased activity in training as well as treatment. This, of course, has facilitated a robust spread of the protocol within countries and across borders. The existence and success of NADA in Germany is due in part to Dr. Ralph Raben’s implementation of training programs, including in the prisons. It seems that programs in the French Antilles, with a strong record of service to clients, has provided strong impetus and encouragement for NADA France. Dr. Mike Smith later told me that NADA branches all over the United States (Louisville, Dallas, Cincinnati and San Francisco), and in Siberia, Greenland, Gaza Strip, Ethiopia, and Namibia may be credited with strong work using needles to help clients.

This is not to say that there are not challenges in providing affordable treatment and training. When Dessie Kyle from Derry spoke of lack of government support – “something which I’m sure rings a bell with a lot of you” – it seemed that virtually everyone in the room nodded their heads in agreement. In 2009, Rita Nilsen’s Retretten group (founded in 2002 in Norway) managed to attain government funding for its work. However, she and everyone else expressed concern at government cutbacks in their countries. On the other hand, Dr. Kenny Carter’s closing remarks on Saturday specifically pointed to the problem of those acupuncturists, as represented often by official acupuncture boards, who preferred to see barriers to the spread of the NADA protocol. Such opposition comes out of fear and competition.

The importance of community and community empowerment in all aspects of health and recovery. Sometimes that which is taken for granted needs nonetheless to be reiterated. In most of the talks which I was able to attend, the aspect of the empowerment of communities was a resounding theme. Some time ago, I met the staff of Lincoln Recovery in the course of my research on the history of community-based addiction treatment programs in the United States. As Mike Smith, Nancy Smalls, Jeanette Robinson, and Jo Ann Lenney noted, Lincoln Recovery began in the early 1970s (as Lincoln Detox) and persisted for over four decades as the strongest and most enduring example of the community-based movement. This year, virtually all of the delegations at the Dublin conference seemed to have in common not just the modality of auricular acupuncture, but also the emphasis of community empowerment through mobilization, access to treatment and training, and active participation in (and not just passive reliance upon) the treatment program.

By communities, I refer not only to the local, national, and international communities of service providers, and not only to the communities of patients who receive these services. For, as a number of delegates noted, in many ways rates of substance dependency often reflect the turmoil that an entire community – even those who do not use intoxicants at all – may experience. This was most explicit in, for example, presentations by Tomas Fisher (Belfast), Nic Constable (Cornwall), and delegates from Derry’s HURT organization (Dessie Kyle, Bernard, and Hugh Quigley). For Fisher and the Derry delegation, respectively, the problem of political violence and repression looms large in the issue of drug abuse. Dessie, Tomas, and Hugh brought home the point that their mission was not simply the treatment of drug use, but the treatment of trauma which had led thousands to self-medicate for symptoms of stress and pain. Drug use therefore actually compounds trauma: Dessie and Tomas each had lost a son to drug misadventure, and each had begun their work to help others who had survived similar losses or were perhaps in danger of doing so. The bittersweet irony of Bernard’s testimony was that, as he and his brother had grown up amidst police violence and community stress, the death of one prompted the other to rethink the negative path he had taken. On the other hand, while neither Nic Constable nor any of the delegates used the exact phrase “political economy of drug use,” I think that few would deny that the character of economic stagnation (as evidenced in unemployment, underemployment, and lack of educational opportunity) found in Cornwall and innumerable locales around the world readily produces conditions in which individuals will look to intoxicants for escape and relief. Indeed, in many places, the sale of drugs presented to many at least a hope for steady if not lucrative wages. Unfortunately, and as Nic put it, official policy too often recognizes only those who have entered “the system” of criminal justice or weakening public health, while giving comparatively little attention to the fraying community fabric of people who may not be “drug users” but who daily are made vulnerable to stress. For providers such as Mette Wiinblad (Denmark), building community into practice will be realized through efforts which Mette described as “Acupuncture for the People”: outreach efforts through a newsletter, a Facebook campaign, etc.

Skepticism of many of medicine’s authoritative claims, especially in the face of evidence to the contrary. As I boarded the plane at John F. Kennedy international airport (named, of course, after the U.S.’s first and only Irish-American Catholic president), I carried with me an essay by Adele Clarke, on “Biomedicalization,” a term which she uses to define the recent tendency (over the past 2-3 decades) of the Medical Industrial Complex to privilege high expert, large-scale, technical, and technocratic approaches to problems which often may be social in origin and nature. All delegates at the Dublin conference appeared to have an investment in countering this tendency in the first instance because biomedical approaches tend to ignore the social dynamics of, for example, community. In the second instance, while acupuncture detoxification requires technique, it is not highly technical in that individual acquisition of the protocol’s skill set has a low barrier to entry (simple training enforced by repeated application). Its spread is diffuse and not warehoused in large politicized research institutions or industrial profit-taking pharmaceutical concerns.

This is important, because many of the delegates had treated successfully conditions to which biomedicine attempts to lay exclusive claim. Even more problematically, biomedicine has staked its claim to these conditions through the liberal and zealous distribution of pharmaceuticals. Interestingly, Ray Gandhi (London), who has worked for over 35 years in addiction services and mental health, presented a case study in which he had treated with acupuncture a patient who suffered a series of emotional disturbances, including dual diagnosis and (ironically) an acute dependency upon pharmaceuticals (benzodiazepine) previously prescribed as part of treatment. The key, according to Ray, was the establishment of a relationship between patient and provider of “therapeutic alliance,” which is to say that the patient must trust the treatment provider and feel herself an active participant in treatment. Ralph Raben, along with at least 300 of his colleagues in Germany (of 600 surveyed), similarly reported the use of NADA protocol in a wide spectrum of treatment regimens (this despite the fact that German regulations mandate that medically trained personnel only should use the protocol). Others talked about how they found the NADA protocol useful in treatment of depression, schizophrenia, bipolar affective disorder, borderline-personality, and anxiety. Lars Wiinblad (Denmark) threw down the gauntlet, reminding us that in most cases the commonly prescribed pharmacopeia is of dubious efficacy and unknown action on the brain.

The necessity of political mobilization. Given the emphases on easy and affordable access, community empowerment, and the necessity of skepticism toward the often unjustified claims of biomedicine, it is only appropriate that some space be given to political mobilization. As I had learned as a historian and as a guest at the Dublin conference, NADA at its genesis and in its subsequent decades of proliferation has at its core the recognition that NADA members must think and move politically in order to ensure the survival of the protocol and the communities it serves. Under sway of the biomedical impulse, the Hungarian government seems poised to bar non-medical personnel from practicing the NADA protocol, an issue which the Dublin delegates addressed in an open letter crafted by retired judge, Sheila Murphy and others. In his closing remarks, Kenny Carter emphasized the utility of thinking of the NADA protocol as a “folk medicine” which stands in opposition to the monopoly which in many cases the state is willing to grant to the Medical Industrial Complex. In Kenny’s words, “a fancier way to say ‘folk medicine’ may be to say ‘wait list control’,” because the demand for detox services in the U.S. is so high, that potential patients have to wait for weeks or months to enter a program.  Kenny also pointed to the necessity of a return to the ethos of the South Bronx’s Lincoln Recovery, the home of “people who love their community enough to take a risk… and make that treatment available” when government stood willing to ignore the urgency of the problem. Retired Judge Sheila Murphy and Dr. Margaret MacCurtain sounded the clarion call for outright and forceful mobilization in the courts, the jails and prisons, and the streets.

There certainly are themes which I have not explored and wonderful presentations which I have not described. For this oversight, I ask forgiveness and offer the excuse of space limitations. Thank you to those of you who so generously shared your insights with me, and for a fascinating and inspiring two days with NADA in Dublin!

Samuel Roberts

Columbia University

New York City

skroberts@columbia.eu.

Samuel Roberts, PhD

Associate Professor of History, Columbia University

Associate Professor of Sociomedical Sciences, Mailman School of Public Health

322 Fayerweather Hall; MC 2519, Box 4

1180 Amsterdam Avenue

New York, NY 10027

212.854.2430 (o)

skroberts@columbia.edu

Infectious Fear: Politics, Disease, and the Health Effects of Segregation (University of North Carolina Press, 2009)

http://www.uncpress.unc.edu/browse/book_detail?title_id=1587