Blending West and East

On any given day, one can go through the daily newspaper or click on the television and find a story about a celebrity entering or leaving a rehabilitation center for drug or alcohol treatment. The public perceives these episodes in a relatively simplistic context: The rock star or the diva needs to take the cure by putting himself/herself in other people’s hands, and do his/her own part by staying sober or drug-free.

The public’s fascination with the dramas of the rich and famous is a phenomenon better left for a sociologist to explain. But examined in a far larger context, this “treatment-centric” approach sheds light on a gap that exists between Western and Eastern cultures in their respective approaches to medical treatment of all kinds.
Staying with another mainstream American reference, consider the human body as a computer system. We are blessed with an abundance of medical technology to treat the “hardware—the patient’s body. We have state-of-the-art hospitals, cutting-edge diagnostic tools, and an array of constantly evolving medications for most every malady. All these tools have something in common: They are reactive tools put into play after the medical problem has introduced itself.
What is lacking is the “software,” a way of thinking and living that Eastern cultures have followed for centuries and one that could have positive implications for Western medical systems if integrated more fully into their philosophies and practices.
Any practical discussion of this “East-West” dynamic should begin by first examining the very foundations of Eastern philosophy. Eastern medicine takes the position that humans are not perfect, and that we are powerless over many forces in nature. The idea is that life is a work in progress, inevitably subject to universal, natural forces. These tenets can apply to all individuals, of course, but they also can take the form of a blueprint for recovery in the context of addiction treatment. Consider the following “guide” for addiction treatment patients:

• Recognize the natural rhythms of the body. Sleep, don’t work, when the body tires at night. Be active during the day, when your hormones are most active. Follow this logical routine daily, not in fits and starts.
• Respect the notion of “we are what we eat.” Eat and drink in moderation, and ritualize your intake. For instance, drink tea at a specific time every day.
• Keep the body limber and the mind at peace. Practice exercise, stretching, and yoga to get the body back to normal.

The implicit assumption in American and other Western medical systems is that we are inherently perfect and that when imperfections (i.e., illness and addiction) surface, various treatments and medications can get us back to our perfect state. We eat too much, so we take diet pills. We overstress ourselves, so we pop an anti-inflammatory medication or two, or a tranquilizer. We don’t get enough sleep, so we take a sleeping pill. We have no breakfast, and then have a heavy meal in the evening. We are out of sync. We give fish to our patients, rather than teach them how to fish.

All in the family
One of the greatest divides between East and West in the addiction recovery process lies in the role of the family. I once treated a 16-year-old patient who had been stopped in a car with marijuana three times. In such a case, the approach in this country is too often punitive, involving a trip to a treatment center or juvenile detention facility, often coming into contact with older individuals with substance use problems and being separated from the family. This attitude mirrors the historical American emphasis on independence and the individual—picture the lone cowboy in the Old West.

By contrast, the Eastern approach places special emphasis on the family. As an example, when my Haitian patients come in at my medical practice, their entire family accompanies them. The family ideal is a core component of the treatment process.
Of course, at the very heart of this dichotomy is the fact that medicine is big business, especially in this country. The United States spends roughly twice as much on healthcare as Canada does, for instance. A total of 16% of our gross domestic product is spent on healthcare, according to a 2007 report by the National Coalition on Health Care. ¹ But healthcare also is compromised by other big business influences. Consider that while public health messages on television, in newspapers, and on cigarette packages warn of the dangers of smoking, tobacco companies are allowed to use habit-forming nicotine in cigarettes to ensure sales of their products—and lobbyists advance their interests. Giant drug companies profit via the pipeline of prescriptions that doctors write for patients.
These pressures make it extremely difficult to step back and examine our health system in the most fundamental way. We need to ask ourselves whether healthcare is being carried out in a fashion that recognizes the essence of how our bodies work, and what should be done to realize our well-being. Best of both worlds
Although some Eastern medical practices have been used in North America since the first settlers arrived, the concept was not introduced into mainstream America in a big way until 1971. That was when James Reston of The New York Times, one of the esteemed journalists of his era, wrote of having his appendix removed in emergency surgery while in China, and how a treatment called “acupuncture” was utilized in his post-op treatment. This was not some exotic fable for the readers, but the experience of a well-known American columnist lending credence to a practice that had long been considered routine in Eastern cultures. Reston’s article played a major role in enlightening Westerners on the feasibility of Eastern medical concepts.

More than three decades later, Eastern medicine has clearly made inroads in Western countries. Yoga has become a common practice. Health food stores abound, stocked with herbal products designed not to treat illness, but to stave it off by maintaining wellness. There are many more medical practitioners with Eastern roots working in the United States and other Western nations. In addition, the National Center for Complementary and Alternative Medicine, established in 1991, is dedicated to exploring complementary and alternative healing practices.
The most productive action the healthcare community can take is to infuse both Eastern and Western strategies into treatment programs as they are needed. For example, I prescribe the medications Campral and Vivitrol to treat alcohol cravings, Chantix for smoking cessation, and naltrexone to treat opiate addiction. But I often combine these medications with Eastern treatments.
For example, my 46-year-old patient “Denise” has been drinking since she was 16. She came in for detox, and because of some of the medications she was taking, she began to gain weight. We identified acupuncture as a solution that would help her lose weight while reducing her stress and cravings for alcohol. We later supplemented her acupuncture therapy with monthly treatments of Vivitrol, resulting in a very effective blend of East and West.
Another patient, 54-year-old “Bernard,” first came to my office a year ago. He had been drinking heavily since his 30s. He also has diabetes and a diabetic neuropathy in his leg. I started him on oral naltrexone, then moved him to the once-monthly injection of Vivitrol after several months. At the same time, I had him start acupuncture once a week. He receives a one-hour treatment for the neuropathy in his extremities. He says it relieves the stress and anxiety he feels in trying to maintain sobriety. In addition, he has been taking multivitamins and protein supplements to replenish his natural body elements. Finally, he goes to the gym to work out and keep his mind clear. For Bernard we utilize an effective, fully integrated treatment system incorporating Eastern and Western approaches.
Moving forward, it stands to reason that merging the best from both cultures is a goal worth pursuing as the American medical community searches for new and better ways to prevent and treat addiction. What is needed is a blending of Western “hardware” with Eastern “software.” To realize this goal, physicians, other health professionals, public officials, social scientists, and the media need only to keep an open mind, to promote the proven benefits of this dual approach, and, above all, to be guided by that foundational belief of Eastern philosophy—that we are all imperfect. Reference
1. Poisal JA, Truffer C, Smith S, et al. Health spending projections through 2016: modest changes obscure Part D’s impact. Health Affairs 2007;26:w242-53.


Punyamurtula S. Kishore, MD, MPH, is the Founder of the National Library of Addictions and President and Founder of Preventive Medicine Associates, a group of family practices in Massachusetts. He has been a practicing public health scientist for more than 30 years and treats addictions with a “sobriety maintenance” model that blends the prescription of non-toxic substances with work on patient coping skills. His e-mail address is pskishore@msn.com.