Ear acupuncture strategies for addiction, pain, anxiety, and trauma

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When I have agitated patients in my clinic describing traumatic events, I ask them if they would be open to ear acupuncture. I find that, for patients who are open to it, change is often rapid. Within minutes, their emotions completely shift, and they walk out of the sessions feeling calm. The therapeutic effects are immediate, especially for pain and anxiety.

Ear or auricular acupuncture is a well-researched and recognized microsystem of acupuncture that has been around for over five thousand years. Research indicates over one hundred acupuncture points on the external ear. This research allows practitioners to stimulate ear points to effect change in the body part represented on the ear.

The most famous use of ear acupuncture is the National Acupuncture Detoxification Association (NADA) protocol, which is primarily used for addiction, though it is useful for stress, anxiety, allergies, mood dysfunction, digestive issues, and hormone imbalances.

There are many ways to stimulate the ear acupressure points, using different types of needles, such as traditional acupuncture needles or semi-permanent intra-dermal ear studs in different metals. These do not require any sort of manipulation or stimulation on the part of the patient. 

I will not use any needles on anyone who has a fear of needles, a history of needle use, or may have a transmissible infectious disease such as hepatitis or human immunodeficiency virus. I also do not use needles on anyone with severe cardiovascular disease to avoid excessive stimulation. In those cases, I would use vaccaria seeds, which can be massaged to stimulate the points. I send patients pictures of their ears or diagrams of the points we have used and the order in which to massage the ear if they need support and cannot get to clinic.

In my practice, I primarily use gold semi-permanent intradermal studs, as these can be left in for a week or so, or until they fall out on their own.  I advise patients to remove them if they get irritated by them or find them painful after a few days.

Safety precautions to consider include not using acupuncture with anyone who has been drinking alcohol, to avoid use with patients who have a vasovagal response to needles, or who may have an active infection or dermal irritation at a bleeding site. It’s also wise to screen patients for bleeding disorders, and not to use with pregnant patients, although some midwives in Europe are using the NADA protocol to prepare women for childbirth, reduce the duration of labor, and improve contractile coordination.

When treating conditions, the ear point should always be in the same ear when using one set of point combinations. Both ears can be used, but only if addressing two conditions. If the treatment is pain-related, it’s more effective to emphasize treatment on the side of the body where the pain is felt. If in both sides, it’s possible to repeat the point combination on both ears.

For practitioners, ear acupuncture is easy to learn, safe, effective, and can be done in a group setting, which is attractive for low-income patients. There is no need for the patient to remove clothing, so it is somewhat non-invasive. Ear acupuncture is unique, as it can be both a diagnosis and treatment at the same time. We can select points based on tenderness of the location when pressed and we look at the functional connection between the stimulation of ear acupuncture points and its effects on the body. 

I always do a full health assessment before I will see someone for a series of ear acupuncture sessions so we can incorporate this into an integrative approach.

There are different ways to approach point selection, including:

  • Looking at corresponding organs or areas. For example, ear point selection for irregular menstruation would include the internal reproductive, endocrine, and liver points.
  • Selecting according to traditional Chinese medicine (TCM) theory. For example, psoriasis would include the lung point as the lungs govern the skin, and tinnitus would include the kidney point as the kidneys are associated with the ears.
  • Choosing based on modern medical theory. For example, the Sympathetic point is used to regulate the sympathetic nervous system, vagal tone, and relieve smooth muscle spasms and pain, which is why it is often included in a protocol for digestive disturbances driven by stress.
  • Choosing according to point functions. For example, the ear Shen men is a master point and considered a healing point to calm the spirit, clear heat, dispel wind, relieve pain, and resolve toxins.

The Shen men is the singular point I use with agitated patients in my clinic. The sub-cortex point is very useful for panic, swelling, shock, and inflammation, while the occiput is related to unconscious behavior and is good for headaches, stress, insomnia, and pain, particularly in the head and shoulder. The forehead point is used for frontal headaches, sinusitis, disturbing dreams, and excessive worrying.

Side-effects with ear acupuncture are uncommon, but some people may experience localized pain and bleeding, bruising, brief euphoria, dizziness, lightheadedness, or emotional release. Other rarer side effects may include fainting or infection. For my patients, I only occasionally see localized bleeding, minor pain, and some euphoria or sleepiness. Patients may become desensitized if the point combination is repeated on a regular basis too frequently. Very rarely have I seen anyone respond negatively to or not feel positive benefit from an ear acupuncture treatment.

The NADA protocol is the point combination I use most in clinic as I find it invaluable with patients who not only wish to give up smoking, alcohol, or recreational drug use, and on the other end of the spectrum, with those who feel social pressures to take recreational toxins or to increase their confidence to perform or engage in public speaking roles in their jobs. It’s also a useful adjunct for patients experiencing low mood, or for those who are emotional eaters and would like to lose weight.

The five-point NADA protocol involves the Shen Men, Sympathetic, Kidney, Liver, and Lung points. This point combination helps to alleviate cravings, physical withdrawal symptoms and emotions associated with cessation of addictive substances and behaviors.

I have recently been treating a patient on a weekly basis who was drinking more alcohol at meals than she felt was appropriate, purely due to social anxiety and shyness. Her diet was extremely clean, but after just a few weeks of treatment, alongside an integrative approach involving minimal core supplements such as fish oil, short chain fatty acids, digestive enzymes, and an adaptogenic herb blend including lion’s mane mushroom, Korean ginseng,  and ginkgo biloba, she reported she no longer had the desire to drink alcohol, she had relaxed her extremely restrictive diet, felt she had more energy, and felt she was enjoying life more.

This year I have also treated a stressed middle age businessman with digestive issues, poor blood sugar regulation, fatigue, obesity, and insomnia. We did weekly sessions using the stomach, small intestine, mouth, Shen men, and liver points for the first two months, dropping to bi-weekly sessions for the following four months. His commitment to regular sessions improved compliance and accountability, and the patient worked hard on improving his diet as much as possible within the constraints of dietary limitations at work and an unsupportive family and friend network. Regardless, he adjusted his diet, eliminated alcohol, took up meditation, and started regular exercise as energy levels, symptoms, and mood improved.


Federman D.G., Zeliadt S.B., Thomas E.R., Carbone G.F Jr., and Taylor S.L. (2018) Battlefield Acupuncture in the Veterans Health Administration: Effectiveness in Individual and Group Settings for Pain and Pain Comorbidities.  Medical Acupuncture. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/30377463

Avants S.K., Margolin A., Holford T.R., and Kosten T. R. (2000).  A Randomized Controlled Trial of Auricular Acupuncture for Cocaine Dependence. JAMA Internal Medicine. Retrieved from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/746723