In the late 1990s, Barbara H.’s substance abuse came to a head.
“My life fell apart because of my addiction,” says the 61-year-old New Haven woman, who asked that her full name not be used. After attending rehab, she began treatment at the Substance Abuse Treatment Unit in New Haven that is run by the state Department of Mental Health and Addiction Services and the Department of Psychiatry of Yale University School of Medicine. There she learned about a program that treats addiction with acupuncture, a traditional Chinese medicine that involves pricking the skin with needles.
Barbara began receiving the National Acupuncture Detoxification Association protocol, which is a five-point, ear-based treatment. All these years later she is still receiving the treatment and credits it with helping her stay drug and alcohol free.
“I just came to really, really like it a lot,” she says. “Almost like some people enjoy going to massage therapy.” After an acupuncture session, “You feel this flush of fresh energy, and it’s very uplifting. ... It’s so remarkable, its effectiveness in such a clean, pure, non-invasive treatment. There are no side effects.”
Since 1995, the state Department of Public Health has allowed trained acupuncture-detoxification specialists to provide the protocol to patients in substance-abuse clinics licensed by the department, or in Department of Mental Health and Addiction Services facilities. In October, a new state law went into effect eliminating the requirement that the protocol only be administered at those state-licensed addiction sites, allowing it to be used as an adjunct therapy by trained practitioners for a variety of mental health issues.
It’s the latest in a long line of advances for natural and alternative medicines in Connecticut which, like much of the country, has seen an increase in these therapies. According to the latest survey conducted in 2012 by the National Center for Complementary and Integrative Health, about 59 million Americans spend money out of pocket on such health approaches, paying a total of $30.2 billion a year, a number that does not include alternative medical treatments that are covered by insurance.
Connecticut is home to about 230 practicing naturopaths (NDs), physicians who specialize in natural treatment of disease and injury, and the state has the oldest law in the country that licenses them. It is also home to the College of Natural Medicine at the University of Bridgeport, one of only six naturopathic medical schools in the U.S., and the only one east of Chicago.
This legislative session, naturopaths and natural health enthusiasts are pushing for an update to Connecticut’s existing ND law that would allow NDs some drug-prescribing rights. Under current law, though NDs are licensed and can legally see patients and receive insurance reimbursement, they cannot prescribe controlled medication.
Natural medicine encompasses disciplines like acupuncture, herbal medicine, hydrotherapy (the use of water treatments for pain relief) and homeopathy (an alternative system of medicine that features highly diluted remedies). Nutrition and preventive medicine are key tenets of natural health, as is avoiding the unwanted natural side effects of conventional medical treatments. Natural health is also linked to less-clinical lifestyle and wellness practices such as mindfulness, meditation and yoga.
While the mainstream medical community remains skeptical of some natural-health traditions, there is growing acceptance of some of its practices, particularly the emphasis on nutrition and preventive medicine, as well as the wish to find ways of dealing with health issues such as chronic pain without relying on treatments like opioids, where there is high potential for abuse.
Denise M. Romano, a nurse practitioner who oversees the acupuncture program at the Substance Abuse Treatment Unit, says since the program started in the late 1990s people have grown more interested in it.
“It’s an adjunct to treatment, it is not a standalone treatment, but we know that it can work,” she says. “I’ve been a nurse practitioner for 38 years, and this is one thing I do that has so much impact on the client without me having to say a word.”
Yale and Bridgeport are not the only health institutions in Connecticut with programs utilizing natural therapies. In 2004, the UConn Health introduced a complementary and integrative medicine program. Dr. Mary P. Guerrera, the program’s director, familiarizes students at the UConn School of Medicine with the types of alternative treatments many of their patients will inevitably seek out. She also utilizes acupuncture in her own family practices, and praises many of these treatments, including the focus on nutrition, mind-body techniques that lower stress, and homeopathy, which she believes “is underappreciated as a complementary therapy.”
The integrative medicine program is not the only way UConn Health has embraced alternative ways of thinking. In 2010, Brad Biskup, a physician’s assistant with a background in exercise physiology and nutrition, started the lifestyle medicine program at the Pat & Jim Calhoun Cardiology Clinic. “We’ve always had the guidelines that you need to focus on your diet and your exercise, but nobody really gives people the specifics of health,” Biskup says. “If you look at physician training, over 80 percent of physicians don’t even get one class in exercise or activity in the United States, and nutrition isn’t much better. Even though we tell people they need to eat better and they should exercise, we don’t train our providers.”
Dr. Rick Liva has been a practicing naturopath in Connecticut since the 1980s, and is the president and legislative chairman of the Connecticut Naturopathic Physicians Association. He has witnessed this trend as well. “A whole slew of people, professionals and nonprofessionals, have really taken up the mantle or the moniker of natural medicine; medical doctors have started to do this much more,” he says. “They, and we, coined the term integrative [or functional] medicine, which is designed to combine conventional medicine at its best along with natural medicine, naturopathy and so on.”
But, Liva, who runs the Connecticut Center for Health in Middletown and West Hartford, says the numbers of conventional health practitioners interested in alternative treatments is still small. “When you look at the fact that there are 800,000 medical doctors in this country, there’s probably less than 50,000 of them that have any bent toward integrative medicine,” Liva says.
The health clinic run by the College of Natural Medicine at the University of Bridgeport is housed in a building overlooking Long Island Sound. At the clinic, about 20,000 patients are seen each year by students and their faculty supervisors. Late on a Tuesday afternoon in February, students and faculty members at the clinic draw blood, give examinations, prescribe treatments and discuss patient cases in a manner reminiscent of a large conventional clinic.
Dr. Marcia Prenguber, dean of the College of Naturopathic Medicine, explains that while there is growing awareness of natural medicine techniques, misconceptions remain among some conventional medical practitioners.
“They think what we do is hocus pocus, and we don’t do hocus pocus,” Prenguber says. She adds that many “are just unsure what it is that we do, so as is human nature, people don’t want to reach out to something they don’t know at all. My experience has been the more I can help someone understand what we do, the more accepting they are of it.”
Prenguber believes the future will see more collaboration between practitioners of natural and conventional medicine as more of the latter realize natural practitioners do not seek to replace them.
“They think we’re there to take over what they’re doing, and we’re not there to do that, we’re there to work collaboratively with them,” Prenguber says.
Dr. David M. Brady, vice president for health sciences at the University of Bridgeport, agrees.
“The health care market needs it, the patients want choices,” he says. “They don’t want just drugs and surgery, they want more comprehensive solutions to their chronic health challenges.”
Naturopaths have been pushing for an expanded scope of practice in Connecticut for the past few years and will do so again this legislative session. Though they do not have prescribing rights in the state, they are trained in prescribing drugs and have prescription rights in many West Coast states, as well as other New England states such as New Hampshire and Vermont.
NDs argue they would like limited prescription rights so they can wean patients off unnecessary medications, and prescribe drugs such as an antibiotic when a patient is suffering from an acute infection or other ailment where prescription drugs are deemed necessary.
Liva says the effort has “a lot of support in the House and the Senate,” but there is resistance. “Does everyone support us? Absolutely not.” He adds many “MDs are lobbying so hard to prevent this from happening.”
Last year the Connecticut State Medical Society opposed expanding naturopaths’ scope of practice. The organization, which has more than 7,000 physician members in Connecticut, disputed that NDs are adequately trained in prescribing medications and voiced concern that NDs do not have the same residency requirements post medical school that MDs do — some NDs do residencies post medical school, many do not, while all MDs attend a residency. “There is something to be said for practice and especially for the supervised practice that is the cornerstone of medical school, internship, residency and fellowship training that physicians receive,” the Connecticut State Medical Society said in a statement submitted last year to the Public Health Committee in opposition to the proposed law. “At the present time there is no equivalent educational infrastructure in naturopathic training.”
Liva counters that many states have already granted NDs prescriptive rights and they enjoy “an extremely good track record in regards to malpractice and disciplinary actions.” He points to New Hampshire and Vermont, both nearby states where NDs can prescribe and do so safely.
“We’re asking for a limited prescriptive authority,” Liva says. “Anybody who wants to have that authority has to take a refresher pharmacology course. They have to pass an exam. They have to increase their continuing education hours. They also would have to have a collaborative relationship with an MD or DO [osteopathic doctor] or an APRN [advanced practice registered nurse] for a period of time.”
Supporters of the proposed law change also say it would prevent the brain drain that occurs when students graduate from Bridgeport and then move to states that are more friendly than Connecticut to natural medicine and NDs. This is one of the reasons members of the legislature who represent Bridgeport have voiced support for the proposed law. In addition, Brady says granting NDs prescriptive authority would better position them to help fill the shortage of general practitioners in Connecticut. “The state needs providers who are more conservative, lower costs, promote wellness and provide more options for patients to be seen, and we do that.”
Government Funding and Collaboration
Alternative treatments receive funding at the state and federal levels. The Toivo by Advocacy Unlimited wellness center in Hartford, for example, receives much of its funding from the state Department of Mental Health and Addiction Services and also receives federal grants. The center offers acupuncture and massage, as well as a range of mind-body wellness techniques, from meditation to yoga, aimed at healing mental health problems. “We believe there should be more of a relationship model, versus the disease model that exists,” says Deron Drumm, executive director of Advocacy Unlimited and founder of Toivo. “There’s a lot that goes into healing; it would be nice if it was as simple as someone takes a pill, but it’s not that simple.”
Nationally, the Veterans Health Administration, which oversees VA hospitals, has started to embrace alternative techniques to help veterans deal with the mental and physical scars of war without using opioid painkillers. At the Integrative Health Center at the Newington campus of the VA Connecticut Healthcare System, veterans are offered mindfulness-based yoga, and full-body and ear acupuncture for those with chronic pain and mental health issues, including post-traumatic stress disorder, depression, anxiety and insomnia. In addition, some acupuncture treatments are also offered at the VA’s West Haven campus. “Veterans love these therapies,” says Dr. Aysha Saeed, director of the Integrative Health Center at the Newington VA. “These [therapies] support our whole-health approach of promoting optimal health and well-being.”
Guerrera, director of integrative medicine at UConn Health, expects more of these programs to become available in the future and follow in the footsteps of the VA hospitals. “I do believe [the VA] will be the folks to show the safety and efficacy outcomes of this, and it will help move our whole health care system in this direction.”
The UConn School of Medicine and Bridgeport have had collaborative sessions in which the natural medicine and conventional students work in unison. “We’ve been working to come together and learn about what the other does and advance this whole movement of interprofessional education and interprofessional collaboration,” Guerrera says. “I think we all have a lot to learn from each other and it’s always a step in the right direction to begin the dialogue and look at working together.”