Use of Massage Therapy to Reduce Anxiety and Improve Sleep in Patients Participating in an Inpatient Withdrawal Management (Detox) Program: A Randomized Controlled Pilot Study

BACKGROUND Alcohol and Other Drug (AOD) abuse has become a prominent health issue in Canada. According to a recent drug abuse survey, it can be estimated that approximately 2 million Canadians may meet the diagnostic criteria for being dependent upon or having abused AOD. At almost $40 billion/year, the costs of AOD abuse in Canada are substantial. Substance abuse represents a significant drain (both direct and indirect) on Canada's economy, with the largest single direct cost being associated with health care.

The impact on the citizens of Nova Scotia is equally dramatic, as illustrated by the 10,949 individuals who accessed Addiction Services in this province during the 2005 calendar year. 3,252 of these individuals (29.7%) accessed these services through the Addiction Prevention and Treatment Services (APTS), Capital Health. Capital Health exists within the largest integrated academic health district in the Maritimes and provides core health services to 395,000 residents, or 40% of the population of the Nova Scotia and tertiary and quaternary acute care services to residents of Atlantic Canada. Specialized adult health services are provided to a referral population of 550,000 from the rest of the province, as well as to residents of New Brunswick and Prince Edward Island. Of the 3,252 individuals who accessed APTS, Capital Health in 2005, 2020 were male (62.12%) and 1,232 were female (37.88%).

AOD abuse affects people from all walks of life and one prevention and treatment approach cannot be sufficient for all possible forms of abuse. The harms associated with AOD abuse have a significant and detrimental effect on the determinants of health which poses a considerable threat to the social, emotional, physical, and economic well being of Canadian families and communities. Determinants of health are factors impacting on living and working conditions conducive to health in its broadest sense, and include housing, education, genetics, income, employment, culture, physical environment, equity, gender and race. Canada's Drug Strategy (CDS), which was renewed in May 2003, is the federal government's response to addressing the problems associated with the harmful use of AOD, and comprises a series of evidence-based guidelines. Using a comprehensive four-pillar approach, CDS strives to assist individuals, families and communities impacted by substance abuse through education, prevention, harm reduction and enforcement initiatives.

APTS is committed to Canada's Drug Strategy and strives to help individuals, families, and communities of Nova Scotia deal with the harm associated with abuses of AOD. It accomplishes this through a comprehensive range of prevention, intervention and treatment services designed to promote, maintain, and improve health. Included among the services offered by APTS are programs designed to assist in: addiction recovery; withdrawal and management (Detox); tobacco cessation and prevention; substance abuse prevention and community education; women's services; methadone maintenance treatment; and community support groups for gamblers (http://www.cdha.nshealth.ca/programsandservices/addictionprevention/index.html).

The Withdrawal and Management (Detox) program was established at APTS in 1975 and provides care and treatment to approximately 800 individuals each year. This inpatient program consists of detoxification, assessment and education and employs a biopsychosocial approach to treat and empower individuals experiencing the physical/emotional stressors associated with AOD withdrawal. It operates through a supportive community atmosphere that nurtures the difficult process of change. The length of stay in the Detox program depends upon individual assessment, with an average stay of 5 days during which residents participate, under the guidance of nursing staff, in a series of recovery, support and relapse-prevention groups. It is delivered by a staff of 23 full time employees. Detox is available to all individuals residing within the Capital Health district with 15 in-patient beds dedicated to this program. The Detox program integrates a variety of evidence-based pharmacological and biopsychosocial approaches including, but not limited to, behavioral therapy (Wanberg & Milkman, 2002), structured relapse prevention and motivational interviewing (Burke et al., 2003). The participants of the Detox program generally reach their immediate goals, although the process of recovery itself is a difficult one, often exacting an emotional and physical toll. Among the many common and troublesome side effects of the withdrawal process are the development of acute anxiety, sleep disturbances (problems falling asleep or waking frequently) and slight depression (feeling down) which, if left unmanaged, may detrimentally influence the recovery process as well as the ability to engage in further addiction treatment programs.