TAMPA — Lucas Pacheco says he's "deathly afraid of needles." • Similar phobias have kept others away from Hillsborough County's drug court, the only program in the Tampa Bay area and one of just a few in the state that includes acupuncture as part of its treatment. • But Pacheco, 23, submitted to the daunting treatment and, surprising himself, felt calmer. • "It's a nice stress relief," he said. • That's the sort of positive anecdotal evidence that supporters have long relied on to vouch for acupuncture, a part of traditional Chinese medicine that has been a fixture of Hillsborough's drug court treatment since the program began in the early 1990s.
Not everyone is convinced that the costly and time-consuming treatment — a mandatory requirement to successfully complete drug court — is worthwhile for addicts. Even the judge assigned to drug court has asked if there are more useful treatment options, given the mixed reactions she's heard from defendants about acupuncture.
"It's hard to really know whether it really works," Hillsborough Circuit Judge Vivian Corvo said.
Here's why: Major studies have questioned the treatment's effectiveness, particularly if used as a standalone treatment. Other research that found the method promising has been beset by high dropout rates, biases and questions about reliability.
Those who run the Hillsborough program say acupuncture helps stem cravings, alleviate withdrawal symptoms and reduce stress and anxiety.
Acupuncture can't hurt, said Dr. Martha Brown, director of the division of addiction medicine and professional health services at the University of South Florida. But she cautioned that it's an adjunct treatment at best, something that might be helpful on some level but won't reduce cravings or prevent a relapse on its own.
"It just doesn't have enough proven efficacy," Brown said.
State court officials don't have a good read on how many of the 46 operational drug courts in Florida incorporate acupuncture into their treatment regimens, but it doesn't appear to be more than a handful. It's optional for participants in Broward and Miami-Dade counties.
Inconclusive and conflicting data have kept some away. Bob Freeman, CEO of Alpha Counseling Services, which provides drug court treatments in Pasco County, said acupuncture has never been part of the center's philosophy because he didn't find it effective or ineffective.
Cost is another deterrent.
Alachua County's drug court used acupuncture for about a dozen years until budget shortfalls led its program manager to reluctantly cut the $20,000-a-year treatment two years ago.
"Nationally, it used to be that everybody did it," said Jim Downum, Hillsborough's interim drug court coordinator. "We're way in the minority now, no doubt about that."
Hillsborough's drug court treatment provider, the Drug Abuse Comprehensive Coordinating Office, spends about $50,000 a year for the services of three acupuncturists to cover its clinic's morning and afternoon sessions, said chief operating officer Liz Harden.
DACCO officials say it is money well spent, but don't tout acupuncture as a cure-all.
To graduate from the voluntary drug court treatment program, participants also must complete more traditional components of substance abuse treatment, including random urine screens, group and individual counseling sessions and Narcotics Anonymous and Alcoholics Anonymous meetings.
They pay $972 for the year-long program.
If successful, first-time, nonviolent third-degree felony offenders can avoid jail and get their charges dismissed.
"We think it's just an added service to the program," Harden said of acupuncture. "Who's to say what part of the process makes the difference?"
Statistically, it's difficult to know.
Hillsborough's retention rate in the drug court treatment program is no better than the rate in Pinellas, which does not use acupuncture.
The acupuncture component requires a significant time commitment. Participants must report for three, 50-minute sessions a week for a total of 21 treatments.
On a recent Wednesday afternoon, a lighter-than-usual crowd took turns getting acupuncture at DACCO's headquarters in Tampa.
Anisha Durve, a licensed acupuncturist, worked swiftly, swabbing ears with hydrogen peroxide before tapping needles in.
The ears are a microcosm of the entire body, she explained. National protocol calls for needles to be inserted in five stimulation points on each ear, allowing for the entire body to be regulated. Each person gets the needles in the same five points, no matter what the addiction.
The ear method is the most popular among detoxification centers because it's efficient and doesn't require privacy.
It isn't painful either. The actual insertion pinches a bit, followed by a slight pressure. Afterward, participants head to a darkened room where soothing music and vinyl recliners beckon. Some people get so relaxed they fall asleep.
Experts says the therapeutic effects of the communal atmosphere may contribute to the treatment's success.
Corvo, the judge, is willing to make exceptions for someone who truly doesn't like needles, but she said that doesn't happen very often. The alternative for those people is a little seed that is pressed into the same five ear pressure points.
Sometimes, the biggest cynics of acupuncture become the biggest fans, Harden said. Sometimes they don't.
Patty Young, a recovering methamphetamine addict, chatted happily as Durve tapped needles into her ears. She had quit smoking the week before, she said, seeming to credit acupuncture for helping.
But away from the treatment providers, Young, 57, let out a little secret.
"I don't think it does anything."
"I quit smoking on my own."
The week before, the price on a pack of cigarettes had gone up a dollar. So she quit.
The Thonotosassa woman admits she's hard-headed.
But why suggest to the acupuncturist that the treatment was helping her more than Young actually believed it was?
"I humor her."
Times researcher John Martin contributed to this story. Colleen Jenkins can be reached at firstname.lastname@example.org or (813) 226-3337.