In considering the role of reflexology in supporting individuals who wish to make lifestyle changes, it is important to be clear that this intervention is not a substitute for high-quality smoking cessation/drug and alcohol advisory/support services. There is, however, good evidence for reflexology being a valuable touch therapy for creating deep relaxation, assistance with anxiety reduction and a safe place for disclosure of worries and concerns (see Chs 2 and 6).

Addiction has been defined as the ‘uncontrolled compulsive use of a substance, person, thought or behaviour for the purpose of changing a person’s emotional state, regardless of any potential consequences’ (Wager & Cox 2009:1). Use of addictive substances has no race, religion, gender, sexuality or age boundary. Assumptions are often made that ‘addicts’ are hopeless individuals, who rarely accept help and need to be someone else’s problem (ANSA 1997).

The reasons for onset of substance misuse are complex and varied. Introduction to the various substances may be associated with pleasure-seeking, risk-taking and peer pressure. Certain behaviours, habits and use of noxious substances often begin as a means of short-term coping with anxiety, stressful life events and ongoing psychological concerns, offering a temporary ‘high’, to pacify or even create a sense of numbness to concerns and challenging situations. However, in the long term, the continued and/or excessive use of these substances seriously compromises an individual’s physical and mental health and well-being. There are also well-documented cases of harm with a single exposure (e.g. Ecstasy).

When addiction takes hold, unfulfilled cravings can cause an individual to behave erratically and to take risks in seeking the desired substance. Addiction which spirals out of control can lead to loss of employment, relationship breakdown, homelessness, self-harm, severe illness and even loss of life (Hunkeler et al., 2001 and Lavikainen and Lintonen, 2009). Additionally, when the substance is an illegal drug or the person has no funds to finance the habit, the only option may be to turn, in desperation, to crime. As a consequence, harm to others and their property may lead to contact with the police and even imprisonment (ANSA 1997).

The burden of addiction to society and amongst individuals can be like an iceberg, with much of the problem hidden below the surface. An elderly person with arthritis living alone may combine painkillers with increasing amounts of alcohol to get through the day. An overworked business executive may increase consumption of both alcohol and cigarettes to the point where breathlessness on exertion occurs or important appointments are missed due to ‘hangovers’.

Withdrawal from addictive substances, whether optional or enforced, can leave an uncomfortable, empty space, with various physical and psychological reactions (Table 13.1). Some effects are short-term, reaching their peak after a few days; other effects last for weeks or can become chronic. The duration for which substances remain in the body varies from one person to another and between substances. For example, alcohol may still be present in the bloodstream and affect behaviour for 7 or more hours after consumption, and nicotine can take up to 48 hours to be completely excreted from the body (Heck, 2006 and Ratner et al., 2004).

Numerous local and national government-funded and voluntary support groups and specialist organisations exist to support individuals with substance misuse (see Useful Resources). In complementary therapy centres there are golden opportunities for practitioners to encourage and support smoking cessation, and for appropriately trained therapists to assist with drug and alcohol withdrawal programmes. In clinics where a variety of complementary therapies are available, an integrated approach may be appropriate, such as combining reflexology with hypnotherapy or acupuncture (see below). Evidence suggests that auricular acupuncture and clinical hypnotherapy are useful interventions for people wanting to stop smoking or to withdraw from drug and alcohol dependency (Ahijevych et al., 2000 and White et al., 2000).

Since English legislation to ban smoking in ‘enclosed and partially enclosed spaces’ came into effect in 2007, it has become more difficult for smokers to ‘light up’ in public and even in some private spaces. Similar legislation has been introduced or is being considered in numerous countries around the world, and national and international campaigns to reduce the use of tobacco products have been widely instigated. Easier access to smoking cessation advice and support, increased engagement with young people, pregnant mothers and other hard-to-reach groups has received the support and funding of governments in many countries. Disturbingly, however, there is evidence of increasing tobacco use in the Third World as Western countries start to reduce tobacco consumption, and a high incidence of illegal trafficking in tobacco products, which are often adulterated with even more noxious substances and commonly linked to criminal activities (Department of Health (DoH), 2008 and World Health Organization (WHO), 2008).

Nicotine differs from other addictive substances, because users do not have immediately obvious effects of cognitive impairment which is often witnessed with other substances, so the problems associated with consent do not usually apply. Nicotine produces widespread nervous system effects, stimulating the release of adrenaline (epinephrine), noradrenaline (norepinephrine) and dopamine, vasopressin, serotonin, arginine, γ-aminobutyric acid, beta endorphins and other neurotransmitters in the body (Hurt et al. 2009). The effects of these changes may disguise or exacerbate underlying health conditions and affect the outcome of medical treatment. Nicotine may also be mixed with other drugs, either directly (e.g. cannabis) or taken concurrently with substances such as alcohol or cocaine. These combinations may interfere with the presentation of symptoms associated with physical and psychological imbalance.

Tobacco dependence should be viewed as a ‘chronic’ medical condition often requiring repeated intervention and numerous attempts to stop (Fiore et al. 2008). In the United States, 70% of smokers would like to stop smoking, nearly half of these attempting to stop on an annual basis (Hurt et al. 2009). In the UK, statistics for tobacco use vary geographically and between social class, age and gender, with up to 26% of manual workers smoking routinely (DoH 2008). The possibility is high that many clients seeking reflexology will be smokers, so supporting clients to stop smoking makes sound health practice, as well as good business sense. Nicotine replacement therapies (NRTs) and other well-researched medical treatments are the foundation of smoking cessation intervention (Lancaster et al. 2000).

Tobacco, drugs and alcohol are major causes of preventable illness, injuries and death (DoH 2004), and clinical reflexologists can play a complementary, rather than an alternative, role in assisting individuals to manage and withdraw from addictive substances. This requires an understanding of addiction, the effects of withdrawal and a willingness to set aside assumptions and judgements about clients and why and how they became addicted. Substance misuse can create challenges for reflexologists to provide safe and sensitive treatment. For example, since many substances impair cognitive function or cause intoxication, particular care should be taken with setting boundaries between the client and the therapist, who is at liberty to stipulate that she or he wishes only to work with clients who are not under the active influence of drugs. Consent to treatment is essential, and therapists should be mindful of the alterations in social behaviour and inability to give informed consent to treatment which can result from substance misuse (see Ch. 4). Therapists may consider working within a group practice in a specialist centre with professional drug and alcohol workers on site. Working alone, particularly in this area of practice, may compromise a practitioner’s safety.

The 2006 survey by Sood et al. of 1175 smokers in the USA indicated that 27% had previously used one or more complementary therapies to help them to stop smoking, and 67% were interested in future use, with massage and relaxation being two of the top five choices. Therapeutic touch can be a valuable contribution to sustain engagement in the process of smoking cessation treatment. Hernandez-Reif et al. (1999) undertook a study (n=20) in which self-massage was taught to assist with reducing withdrawal symptoms and to facilitate adherence to treatment programmes.

The authors completed a national training programme of brief interventions for smoking cessation (NICE 2006) and a course in assessing whether clients are suitable for nicotine replacement therapies. Having received feedback from patients that reflexology helped with stopping smoking, they established a smoking cessation service within a hospital setting, offering complementary therapies, advice, support and conventional nicotine replacement therapies (NRTs) (Maycock & Mackereth 2009). The service is free at the point of delivery and available to patients, carers and staff. Referral rates are increasing all the time with more than twenty clients attending each week for advice and support (Maycock & Mackereth 2009) (see Fig. 13.1).