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CORK Bibliography: Acupuncture

57 citations. January 1997 to present

Prepared: March 2008

Ashenden R; Silagy CA; Lodge M; Fowler G. A meta-analysis of the effectiveness of acupuncture in smoking cessation. Drug and Alcohol Review 16(1): 33-40, 1997. (21 refs.)

The role of acupuncture in facilitating smoking cessation is controversial. A systematic review was undertaken, incorporating meta-analytic techniques, of all the available randomized controlled trials examining the effectiveness of acupuncture in smoking cessation. Based on the data from nine trials involving 2707 patients, the odds ratio of abstinence at 6-12 months' follow-up is 1.48 (95% confidence interval 1.13-1.94) with acupuncture compared to no acupuncture or sham acupuncture. The odds of quitting were higher in comparisons between acupuncture and no acupuncture (OR 2.41, CI: 1.52 to 3.83) than between acupuncture and sham acupuncture (OR 1.16, CI: 0.90 to 1.49), Many of the included trials were small and had methodological shortcomings. Therefore, while acupuncture appears promising, there is insufficient evidence at this point, without further research, to recommend it as an effective form of therapy.

Avants SK; Margolin A; Holford TR; Kosten TR. A randomized controlled trial of auricular acupuncture for cocaine dependence. Archives of Internal Medicine 160(15): 2305-2312, 2000. (42 refs.)

Background: Partly because of a lack of a conventional, effective treatment for cocaine addiction, auricular acupuncture is used to treat this disorder in numerous drug treatment facilities across the country for both primary cocaine-dependent and opiate-dependent populations. Objective: To evaluate the effectiveness of auricular acupuncture for the treatment of cocaine addiction. Methods: Eighty-two cocaine-dependent, methadone-maintained patients were randomly assigned to 1 of 3 conditions: auricular acupuncture, a needle-insertion control condition, or a no-needle relaxation control. Treatment sessions were provided 5 times weekly for 8 weeks. The primary outcome was cocaine use assessed by 3-times-weekly urine toxicology screens. Results: Longitudinal analysis of the urine data for the intent-to- treat sample showed that patients assigned to acupuncture were significantly more likely to provide cocaine-negative urine samples relative to both the relaxation control (odds ratio, 3.41; 95% confidence interval, 1.33-8.72; P=.01) and the needle-insertion control (odds ratio, 2.40; 95% confidence interval, 1.00-5.75; P=.05). Conclusions: Findings from the current study suggest that acupuncture shows promise for the treatment of cocaine dependence. Further investigation of this treatment modality appears to be warranted.

Berman AH; Lundberg U. Auricular acupuncture in prison psychiatric units: A pilot study. Acta Psychiatrica Scandinavica 106(Supplement 2): 152-157, 2002. (12 refs.)

Objective: The study explores whether auricular acupuncture can be a viable treatment form for inmates in prison psychiatric units. Method: Inmates in a prison psychiatric unit and in a support unit for violent behavior were offered group treatment with auricular acupuncture three times a week over a period of 9 months. Another prison psychiatric unit served as a control group. Results: Twenty-two inmates received treatment, and 11 inmates received treatment for over 8 weeks. Cortisol levels were higher for inmates in the support unit than for the other two groups. Inmates treated at least 25 times were prescribed fewer psycholeptic drugs than controls. Perceived autonomy increased for treated inmates in the psychiatric unit. Inmates treated for over 8 weeks experienced improved inner harmony and calm and better clarity over future plans. Conclusion: Acupuncture is a non-verbal form of treatment appropriate for prison psychiatric units. The treatment facilitates contact and complements other psycho-social treatment forms.

Berman AH; Lundberg U; Krook AL; Gyllenhammar C. Treating drug using prison inmates with auricular acupuncture: A randomized controlled trial. Journal of Substance Abuse Treatment 26(2): 95-102, 2004. (41 refs.)

This study tested the viability of auricular acupuncture in prisons for alleviating inmates' symptoms of psychological and physical discomfort and reducing their drug use. The experimental NADA-Acudetox protocol was compared with a non-specific helix control protocol in a randomized trial. Over a period of 18 months, a 4-week, 14-session auricular acupuncture treatment program was offered in two prisons to 163 men and women with self-reported drug use. Among treatment completers, no differences by method were found in self-reported symptoms of discomfort. Drug use occurred in the NADA group but not in the helix group. In contrast, confidence in the NADA treatment increased over time while it decreased for the helix treatment. No significant negative side effects were observed for either method. Participants in both groups reported reduced symptoms of discomfort and improved nighttime sleep. Future research should compare auricular acupuncture to a non-invasive control in order to attempt to disentangle active effects from placebo.

Bier ID; Wilson J; Studt P; Shakleton M. Auricular acupuncture, education, and smoking cessation: A randomized, sham-controlled trial. American Journal of Public Health 92(10): 1642-1647, 2002. (21 refs.)

Objectives. This study examined the effect of acupuncture alone and in combination with education on smoking cessation and cigarette consumption. Methods. We prospectively studied 141 adults in a quasi-factorial design using acupuncture, sham acupuncture, and education. Results. All groups showed significant reductions in smoking and posttreatment cigarette consumption, with the combined acupuncture- education group showing the greatest effect from treatment. The trend continued in follow-up; however, significant differences were not maintained. Greater pack-year history (i.e. the number of years smoking multiplied by baseline number of cigarettes smoked per year, divided by 20 cigarettes per pack) negatively correlated with treatment effect. Trend analysis suggested 20 pack-years as the cutoff point for this correlation. Conclusions. Acupuncture and education, alone and in combination, significantly reduce smoking; however, combined they show a significantly greater effect, as seen in subjects with a greater pack-year history.

Birch S; Hesselink JK; Jonkman FAM; Hekker TAM; Bos A. Clinical research on acupuncture: Part l. What have reviews of the efficacy and safety of acupuncture told us so far? Journal of Alternative and Complementary Medicine 10(3): 468-480, 2004. (174 refs.)

Overview and methods: This paper discusses those medical conditions in which clinical trials of acupuncture have been conducted, and where meta-analyses or systematic reviews have been published. It focuses on the general conclusions of these reviews by further examining official reviews conducted in the United States, United Kingdom, Europe, and Canada each of which examined available systematic reviews. While all reviews agree that the methodological rigor of acupuncture clinical trials has generally been poor and that higher quality clinical trials are necessary, this has not completely hampered the interpretation of the results of these clinical trials. In some conditions the evidence of efficacy has clearly reached a sufficient critical mass from enough well-designed studies to draw clear conclusions; for the rest, the evidence is difficult to clearly interpret. This paper also examines conclusions from the same international reviews on the safety and adverse effects of acupuncture. Here, conclusions are more easily drawn and there is good agreement about the safety of acupuncture. Results and conclusions: General international agreement has emerged that acupuncture appears to be effective for postoperative dental pain, postoperative nausea and vomiting, and chemotherapy-related nausea and vomiting. For migraine, low-back pain, and temporomandibular disorders the results are considered positive by some and difficult to interpret by others. For a number of conditions such as fibromyalgia, osteoarthritis of the knee, and tennis elbow the evidence is considered promising, but more and better quality research is needed. For conditions such as chronic pain, neck pain, asthma, and drug addiction the evidence is considered inconclusive and difficult to interpret. For smoking cessation, tinnitus, and weight loss the evidence is usually regarded as negative. Reviews have concluded that while not free from serious adverse events, they are rare and that acupuncture is a relatively safe procedure.

Bullock ML; Kiresuk TJ; Pheley AM; Culliton PD; Lenz SK. Auricular acupuncture in the treatment of cocaine abuse: A study of efficacy and dosing. Journal of Substance Abuse Treatment 16(1): 31-38, 1999. (24 refs.)

A single-blind, randomized, placebo-controlled study was performed to evaluate auricular acupuncture (AAc) in the treatment of cocaine addiction. Two linked but concurrent studies were done. In Study I, residential clients (N = 236) were randomized to true acupuncture (Ac), sham Ac, and conventional treatment without Ac. Treatment group subjects received Ac at three ear points considered to be specific for the treatment of substance abuse (SA). Control subjects received three nonspecific (sham) points. In Study 2, day treatment clients (N = 202) were randomized to one of three dose levels of true Ac (28, 16, or 8 treatments). Subjects received Ac at five, rather than three, specific ear points. Nonspecific (sham) points were not used in Study 2. With rare exception, the data failed to identify significant treatment differences among the true and sham Ac, and psychosocial groups. Furthermore, no differences were observed among the three dose levels of true Ac.

Bullock ML; Kiresuk TJ; Sherman RE; Lenz SK; Culliton PD; Boucher TA; Nolan CJ. A large randomized placebo controlled study of auricular acupuncture for alcohol dependence. Journal of Substance Abuse Treatment 22(2): 71-77, 2002. (19 refs.)

We report clinical data on the efficacy of acupuncture for alcohol dependence. 503 patients whose primary substance of abuse was alcohol participated in this randomized, single blind, placebo controlled trial. Patients were assigned to either specific acupuncture, nonspecific acupuncture, symptom based acupuncture or convention treatment alone. Alcohol use was assessed, along with depression, anxiety, functional status, and preference for therapy. This article will focus on results pertaining to alcohol use. Significant improvement was shown on nearly all measures. There were few differences associated with treatment assignment and there were no treatment differences on alcohol use measures, although 49% of subjects reported acupuncture reduced their desire for alcohol. The placebo and preference for treatment measures did not materially effect the results. Generally, acupuncture was not found to make a significant contribution over and above that achieved by conventional treatment alone in reduction of alcohol use.

Cabioglu MT; Ergene N; Tan U. Smoking cessation after acupuncture treatment. International Journal of Neuroscience 117(5): 571-578, 2007. (30 refs.)

Acupuncture is applied, especially in treatment of pain, hemiplegia, obesity, and psychological illnesses including addiction. Recently, ear and body acupuncture have been frequently used in the treatment of smoking. An increase in levels of endorphin, enkephalin, epinephrine, norepinephrine, serotonin, and dopamine in the central nervous system and plasma has been reported as the most important mechanism of acupuncture. That is, acupuncture application may increase the levels of endorphin, enkephalin, epinephrine, norepinephrine, serotonin, and dopamine in the central nervous system and plasma. The authors think that acupuncture application provides the patients with deterioration in the taste of smoking, decrease in desire of smoking, and the obstruction of psychological symptoms that appear as a result of smoking cessation. Because of these effects it is presumed that acupuncture application may be used as an important method for smoking cessation treatment.

Chen HH; Yeh ML; Chao YH. Comparing effects of auricular acupressure with and without an Internet-assisted program on smoking cessation and self-efficacy of adolescents. Journal of Alternative and Complementary Medicine 12(2): 147-152, 2006. (29 refs.)

Objectives: This study aimed to develop an Internet-assisted smoking cessation program accompanied with auricular acupressure, and compare the quit rate and self-efficacy of youth smokers receiving auricular acupressure with and without the Internet-assisted smoking cessation program. Design: A Website was Constructed on IBM Websphere 5.0 and DB2 database using HTML, Javascript, and JSP. A quasiexperimental research design was adopted. Subjects were assigned nonrandomly to two groups. Group 1 received auricular acupressure plus the Internet-assisted smoking cessation program, whereas group 2 received auricular acupressure only. Measurements: The data of demographic factors, serum cotinine, quitting rate, nicotine dependence, and self-efficacy of subjects were collected before and after a 4-week intervention. Results: After intervention, the quit rate was 15.78% in group 1 and 2.56% in group 2. Nicotine dependence was significantly lowered in group 1, but remained unchanged in group 2. The improvement of self-efficacy between groups 1 and 2 was significantly different. Conclusions: The combination of auricular acupressure and Internet-assisted smoking cessation program was more efficacious than auricular acupressure alone in terms of quit rate.

Clavel-Chapelon F; Paoletti C; Benhamou S. Smoking cessation rates 4 years after treatment by nicotine gum and acupuncture. Preventive Medicine 26(1): 25-28, 1997. (15 refs.)

Background. This study was done to estimate the smoking cessation rates 4 years after treatment with acupuncture and nicotine gum. Methods. Participants were randomized in a 2 x factorial design to four groups: double active treatments (nicotine gum and acupuncture), double placebo, and the combination of one active treatment and placebo. Results. The success rates were quite similar in the four groups at the different points of follow-up. They sharply decreased between month (around 23%) and 1 year (around 10%). The decrease slowed down thereafter to around 6% at 4 years. Conclusion. Results from our study suggest that the two treatments did not offer any long-term improvement over placebo. Additional investigations are necessary to estimate the magnitude of their long-term success rate.

Courbasson CMA; de Sorkin AA; Dullerud B; Van Wyk L. Acupuncture treatment for women with concurrent substance use and anxiety/depression: An effective alternative therapy? Family & Community Health 30(2): 112-120, 2007. (41 refs.)

This exploratory study evaluated the benefits of adding auricular acupuncture to a 21-day outpatient structured psychoeducational treatment program for women with concurrent substance use problems, anxiety, and depression. Women receiving acupuncture (n = 185) reported having reduced physiological cravings for substances, felt significantly less depressed, less anxious, and were better able to reflect on and resolve difficulties than women in the control group (n = 101). It was found that auricular acupuncture, as an adjunct therapy to a comprehensive psychoeducational treatment program for women with addictions, shows promise in being an effective, more viable treatment alternative to anxiolytics.

D'Alberto A. Auricular acupuncture in the treatment of cocaine/crack abuse: A review of the efficacy, the use of the national acupuncture detoxification association protocol, and the selection of sham points. (review). Journal of Alternative and Complementary Medicine 10(6): 985-1000, 2004. (59 refs.)

Background: The United Kingdom has had a significant increase in addiction to and use of cocaine among 16-29-year olds from 6% in 1998 to 10% in 2000. In 2000, the United Kingdom had the highest recorded consumption of "recent use" cocaine in Europe, with 3.3% of young adults. Acupuncture is quick, inexpensive, and relatively safe, and may establish itself as an important addiction service in the future. Aim: To select investigations that meet the inclusion criteria and critically appraise them in order to answer the question: "Is acupuncture effective in the treatment of cocaine addiction?" The focus shall then be directed toward the use of the National Acupuncture Detoxification Association (NADA) protocol as the intervention and the selection of sham points for the control group. Data sources: The ARRC database was accessed from Trina Ward (M. Phil. student) at Thames Valley University. AMED, MEDLINE(R) and Embase were also accessed along with "hand" searching methods at the British library. Inclusion and exclusion criteria: People addicted to either cocaine or crack cocaine as their main addiction, needle-acupuncture, single-double-blinded process, randomized subjects, a reference group incorporating a form of sham points. Exclusion criteria: use of moxibustion, laser acupuncture, transcutaneous electrical nerve stimulation (TENS) electroacupuncture or conditions that did not meet the inclusion criteria. Quality assessment: The criteria set by ter Riet, Kleijnen and Knipschild (in 1990); Hammerschlag and Morris (in 1990); Koes, Bouter and van der Heijden (in 1995), were modified into one set of criteria consisting of 27 different values. Results: Six randomized controlled trials (RCTs) met the inclusion criteria and were included in this review. All studies scored over 60 points indicating a relatively adequate methodology quality. The mean was 75 and the standard deviation was 6.80. A linear regression analysis did not yield a statistically significant association (n = 6, p = 0.11). Conclusions: This review could not confirm that acupuncture was an effective treatment for cocaine abuse. The NADA protocol of five treatment points still offers the acupuncturist the best possible combination of acupuncture points based upon Traditional Chinese Medicine. Throughout all the clinical trials reviewed, no side-effects of acupuncture were noted. This paper calls for the full set of 5 treatment points as laid out by the NADA to be included as the treatment intervention. Points on the helix, other than the liver yang points, should be selected as sham points for the control group.

2004, Mary Ann Liebert Inc.

Dean AJ. Natural and complementary therapies for substance use disorders. Current Opinion in Psychiatry 18(3): 271-276, 2005. (54 refs.)

Purpose of review: To review recent studies that have examined the efficacy of natural and complementary therapies as treatments for substance use disorders and their complications. Recent findings Despite increasing interest in natural and complementary therapies for substance use disorders, rigorous clinical studies in this area are few in number. Recent clinical studies, although preliminary, have reported potential therapeutic effects for hypericum in the treatment of smoking cessation, for prickly pear extract in the prevention of alcohol hangover and magnesium supplementation as an adjunct to methadone treatment. Other clinical studies have reported negative findings for ginkgo as an adjunctive treatment for cocaine dependence, for artichoke in prevention of alcohol hangover, and acupuncture for alcohol withdrawal. Relevant findings from animal studies are also discussed. Neither vitamin E nor Liv 52 had a useful effect in alcohol-related liver disease. A study of silymarin in baboons, which was undertaken in an attempt to untangle the conflicting findings of human studies, reported a potential for this compound to prevent liver injury. There is increasing awareness of safety issues associated with complementary therapies. Safety issues pertinent to substance use treatment are discussed in this review. Summary: Several pharmacological and psychosocial treatments for substance use disorders are solidly evidence-based and improve both individual and public health outcomes. At this stage, there remains insufficient evidence to support the use of natural and complementary therapies as a primary intervention for substance use disorders. Further clinical trials are required to clarify the potential role of particular agents.

Gates S; Smith LA; Foxcroft DR. Auricular acupuncture for cocaine dependence. Cochrane Database of Systematic Reviews 1: art. CD005192, 2006. (39 refs.)

Background: Auricular acupuncture (insertion of acupuncture into a number, usually five, of specific points in the ear) is a widely-used treatment for cocaine dependence. Objectives: To determine whether auricular acupuncture is an effective treatment for cocaine dependence, and to investigate whether its effectiveness is influenced by the treatment regimen. Search strategy We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (January 1966 to October 2004), EMBASE (January 1988 to October 2004); PsycInfo (1985 to October 2004); CINAHL (1982 to October 2004); SIGLE (1980 to October 2004) and reference lists of articles. Selection criteria Randomised controlled trials comparing a therapeutic regimen of auricular acupuncture with sham acupuncture or no treatment for reduction of cocaine use in cocaine dependents. Data collection and analysis Two authors independently extracted data from published reports and assessed study quality using the Drug and Alcohol CRG checklist. All authors were contacted for additional information; two provided data. Separate meta-analyses were conducted for studies comparing auricular acupuncture with sham acupuncture, and with no treatment. For the main cocaine use outcomes, analyses were conducted by intention to treat, assuming that missing data were treatment failures. Available case analyses, using only individuals who provided data, were also conducted. Main results Seven studies with a total of 1,433 participants were included. All were of generally low methodological quality. No differences between acupuncture and sham acupuncture were found for attition RR 1.05 (95% CI 0.89 to 1.23) or acupuncture and no acupuncture: RR 1.06 (95% CI 0.90 to 1.26) neither for any measure of cocaine or other drug use. However, the number of participants included in meta-analyses was low, and power was limited. Moderate benefit or harm is not ruled out by these results. Methodological limitations of the included studies may have also made the results open to bias. Authors' conclusions: There is currently no evidence that auricular acupuncture is effective for the treatment of cocaine dependence. The evidence is not of high quality and is inconclusive. Further randomised trials of auricular acupuncture may be justified.

Georgiou AJ; Spencer CP; Davies GK; Stamp J. Electrical stimulation therapy in the treatment of cigarette smoking. Journal of Substance Abuse 10(3): 265-274, 1998. (28 refs.)

In this study electrical stimulation therapy (EST) is explored as a possible new treatment for smoking cessation within a randomized controlled trial. The investigation follows reports of several authors that electrical stimulation applied to specific acupuncture points is effective in treating a variety of drug dependencies, including cigarette smoking. Three key features of treatment (electrical stimulation, frequency modulation, and electrode placement), were investigated in a 2 x 2 x 2 factorial design, resulting in eight treatment combinations Out of 265 smokers recruited into the trial 216 completed the one-week treatment. Outcome was assessed in terms of complete abstinence from smoking and symptomatic relief of withdrawal symptoms. Smokers receiving active electrical stimulation obtained higher abstinence rates than those in the inactive groups although the difference did not achieve statistical significance (all active vs. all placebo groups: lambda(1,1)(2) = 0.50 p > 0.10, 95% confidence interval = - 8.04 to + 17.44%; most effective vs. least effective group. lambda(1,1)(2) = 3.11, p = 0.08 CI0.95 = - 2.2 to + 48.8%). The efficacy of electrical stimulation therapy for smoking is not supported.

Gurevich MI; Duckworth D; Imhof JE; Katz JL. Is auricular acupuncture beneficial in the inpatient treatment of substance-abusing patients? A pilot study. Journal of Substance Abuse Treatment 13(2): 165-171, 1996. (12 refs.)

Patients with comorbid substance abuse problems who were admitted to a psychiatric unit of a general hospital over an 11-month period were offered treatment with auricular acupuncture. Subsequently and retrospectively, the medical records of these patients were examined to assess compliance, side effects, impact on course, and acceptance of discharge recommendations. Patient's continuation of treatment in destination programs was also followed. Seventy-seven patients were offered acupuncture: 30 patients refused or had four or fewer treatments (control group), and 47 had acupuncture five or more times (treatment group). The treatment group did significantly better than the control group as indicated by the following findings: compliance with psychiatric/substance abuse treatment on the unit was 75% in the treatment group vs. 20% in the control group, noncompliance or AMA discharge rate was 2% in the treatment group vs. 40% in the control group, acceptance of staffs discharge recommendations was 77% in the treatment group vs. 37% in the control group, and 58% of the treatment group patients remained in follow-up treatment for at least 4 months, vs. only 26% of the control group patients. Average inpatient length of stay was 22 days for the treatment group patients compared to 16 days for the control group patients. Side effects in the treated patients were negligible. Auricular acupuncture thus appears to be a safe and inexpensive treatment modality that is easily administered and produces significant results. Its wider application in substance abuse treatment appears warranted.

He D; Medbo JI; Hostmark AT. Effect of acupuncture on smoking cessation or reduction: An 8-month and 5-year follow-up study. Preventive Medicine 33(5): 364-372, 2001. (27 refs.)

Background. This study was undertaken to examine whether acupuncture treatment may have a long-term effect on smoking cessation or reduction. Methods. Altogether 46 healthy men and women who reported smoking 20 +/- 6 cigarettes per day (mean +/- SD) volunteered in the study. They were randomly assigned to a test group (TG) or to a control group (CG) in which presumed anti-smoking acupoints were stimulated (TG) or acupuncture was applied to acupoints considered to have no effect on smoking cessation (CG). Before each treatment, after the last one, and 8 months and 5 years after the last one, each subject answered questionnaires about his or her smoking habits and attitudes. Blood samples for measuring variables related to smoking, i.e., serum cotinine and serum thiocyanate, were taken. Results. During the treatment period the reported cigarette consumption fell on average by 14 (TG) and 7 (CG) cigarettes per day (P < 0.001). For both groups the reported cigarette consumption rose on average by 5-7 cigarettes during the following 8 months, and there was no systematic change thereafter. Consequently, TG showed a maintained reduction in smoking; no lasting effect was seen for CG. The TG reported that cigarettes tasted worse than before the treatments, and also the desire to smoke fell. For TG the serum concentration of cotinine fell, and the values correlated with the reported smoking. Conclusions. This study confirms that adequate acupuncture treatment may help motivated smokers to reduce their smoking, or even quit smoking completely, and the effect may last for at least 5 years. Acupuncture may affect the subjects' smoking by reducing their taste of tobacco and their desire to smoke. Different acupoints have different effects on smoking cessation

Jain A. Extracts from "Best Treatments": Treating nicotine addiction. British Medical Journal 327(7428): 1394-1395, 2003. (0 refs.)

This editorial discusses nicotine addiction and examines the challenges faced by smokers who want to quit, as well as treatments available to assist those attempting to quit smoking successfully. It offers advice and focuses on three treatment categories: 1) treatments that work, including nicotine replacement therapy and bupropion; 2) treatments that need further study, including physical exercise and training health professionals to give advice, and 3) treatments that are likely to be ineffective or harmful, including acupuncture and anxiolytics.

Janssen PA; Demorest LC; Whynot EM. Acupuncture for substance abuse treatment in the downtown Eastside of Vancouver. Journal of Urban Health 82(2): 285-295, 2005. (15 refs.)

In British Columbia, Canada, the City of Vancouver's notorious Downtown Eastside (DES) represents the poorest urban population in Canada. A prevalence rate of 30% for HIV and 90% for hepatitis C makes this a priority area for public-health interventions aimed at reducing the use of injected drugs. This study examined the utility of acupuncture treatment in reducing substance use in the marginalized, transient population. Acupuncture was offered on a voluntary, drop-in basis 5 days per week at two community agencies. During a 3-month period, the program generated 2,755 client visits. A reduction in overall use of substances (P = .01) was reported by subjects in addition to a decrease in intensity of withdrawal symptoms including "shakes," stomach cramps, hallucinations, "muddle-headedness," insomnia, muscle aches, nausea, sweating, heart palpitations, and feeling suicidal, P < .05. Acupuncture offered in the context of a community-based harm reduction model holds promise as an adjunct therapy for reduction of substance use.

Jordan JB. Acupuncture treatment for opiate addiction: A systematic review. Journal of Substance Abuse Treatment 30(4): 309-314, 2006. (60 refs.)

A review of the efficacy of acupuncture as treatment for opiate addiction, covering 33 years of reported literature in western scientific journals. was systematically undertaken. Some abstracts from Chinese language journals were also briefly reviewed. Supportive evidence often came from noncontrolled nonblinded methodologies. When well-designed clinical trials (randomized, controlled, single-blind methodologies) were used, there was no significant evidence for acupuncture being a more effective treatment than controls. Some of the current supportive evidence for efficacy came from Chinese journals that have not been translated into English yet.

Karst M; Passie T; Friedrich S; Wiese B; Schneider U. Acupuncture in the treatment of alcohol withdrawal symptoms: A randomized, placebo-controlled inpatient study. Addiction Biology 7(4): 415-419, 2002. (25 refs.)

Thirty-four alcoholics were treated with acupuncture to the ear and the body in a randomized single-blind placebo-controlled design over 14 days. Orthodox points and placebo needles to orthodox points were used daily for a total of 10 treatments starting on the first day of admission as add-on therapy to standard medication with carbamazepine. The primary outcome was the Clinical Institute Withdrawal Assessment (CIWA-Ar-scale) assessed on days 1-6, 9 and 14. No initial differences were found regarding sociodemographic data, drinking history and alcohol-related data, indicating successful randomization. Longitudinal analysis of the Clinical Institute Withdrawal Assessment (CIWA-Ar-scale) data showed that patients assigned to acupuncture had a general tendency towards better outcome results and significantly fewer withdrawal symptoms on day 14 (Wilcoxon-W= 177.500, Z = -2.009, p = 0.045). No significant differences were found in the Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI X1 and X2) and Eigenschaftswoerterliste (EWL S60). We conclude that acupuncture as an adjunctive treatment to carbamazepine medication shows promise for the treatment of alcohol withdrawal symptoms. Further investigation of this treatment modality appears to be warranted.

Kim YHJ; Schiff El; Waalen J; Hovell M. Efficacy of acupuncture for treating cocaine addiction. A review paper. Journal of Addictive Diseases 24(4): 115-132, 2005

Acupuncture is being used in more than three hundred treatment facilities for treating substance abuse including cocaine addiction. Previous review papers could not evaluate the role of acupuncture for treating cocaine addiction because of lack of clinical trials at the time. Since then, several important studies were conducted in the field. This paper reviews existing clinical trials using acupuncture to treat cocaine addiction. The existing evidence fails to document the benefit of acupuncture in treating cocaine addiction as the sole treatment. Further efforts to document the efficacy of the NADA protocol to treat cocaine addiction as the sole treatment should be re-evaluated. There is a limited amount of evidence showing possible benefits of acupuncture when used as an adjunctive therapy to complement existing substance abuse treatment program. Future efforts should concentrate on systematic studies investigating the role of acupuncture as an adjunctive treatment for cocaine addiction. In addition, more formative research exploring the efficacy of different types and protocols of acupuncture treatments for cocaine addiction should be thoroughly investigated.

Kunz S; Schulz M; Lewitzky M; Driessen M; Rau H. Ear acupuncture for alcohol withdrawal in comparison with aromatherapy: A randomized-controlled trial. Alcoholism: Clinical and Experimental Research 31(3): 436-442, 2007. (25 refs.)

Background: There is increasing clinical acceptance of acupuncture as a treatment of substance-related disorders. Little is known about acupuncture as a treatment for the withdrawal syndrome in inpatient settings. We compared auricular needle acupuncture with aromatherapy in reducing the duration and severity of symptoms of alcohol withdrawal. Methods: Inpatients undergoing alcohol withdrawal were randomly allocated to needle acupuncture (n=55) and aromatherapy (n=54). Both therapies were applied daily during the first 5 consecutive treatment days. The rating scale for the assessment of the alcohol-withdrawal syndrome (AWS scale) served as the main dependent variable and was applied daily during the first 5 days of the withdrawal. Further measures included a subjective visual analog scale of craving and the Self Assessment Manikin (SAM). Results: Thirty-six of the 55 patients who received acupuncture, and 38 of the 54 patients who received aromatherapy, finished the study regularly. The groups differed in their initial self-reported arousal, which then served as a covariate in the further analyses. Neither the extent of craving nor of withdrawal symptoms differed between groups over the observation period. Self-rated arousal decreased in response to both treatments from days 1 to 2 (p < 0.001) and within single days (p < 0.001), and we found a significant interaction between pretreatment versus posttreatment and days (p < 0.001). Interactions including between-subjects effects and intervention did not achieve the significance level. Conclusion: The results do not support the assumption of a superiority of acupuncture over the control therapy in its specific effects on alcohol withdrawal symptoms.

Margolin A. Auricular acupuncture for the treatment of cocaine addiction. IN: Sorensen JL; Rawson RA; Guydish J; Zweben JE, eds. Drug Abuse Treatment through Collaboration: Practice and Research Partnerships that Work. Washington DC: American Psychological Association, 2003. pp. 37-53. (37 refs.)

Within a volume that deals with the relationship between research and practice, this chapter draws upon the experience in the use of acupuncture in the treatment of cocaine addiction, to illustrate a case of dissemination of clinical practice to research. Acupuncture is widely used, yet to date, there is little research on its efficacy. A challenge is how to develop research protocols and research designs that reflect its use in clinical settings. This chapter examines how investigators have approached this issue and how acupuncture research can be designed. The discussion includes an examination of the use of auricular acupuncture in the US, questions related to mechanisms of actions, and common research dilemmas, such as blinding, participant bias. Studies conducted at Yale Medical School are used to illustrate these points.

Margolin A; Avants SK. Acupuncture for cocaine abuse: Research findings, methodological issues, and patient-treatment matching. IN: Stine SM; Kosten TR, eds. New Treatments for Opiate Dependence. New York: Guilford Press, 1997. pp. 171-189. (51 refs.)

Acupuncture has been used in China for at least 2,000 years for treating a variety of disorders. It was first applied to drug addiction in 1972. This chapter summarizes the research findings in respect to the use of acupuncture for treatment of cocaine dependence. (There have been four controlled studies to ascertain efficacy.) The authors conclude that while showing promise, the findings have not consistently been shown to be more effective than a needle-insertion in a control. They then review the methodological issues that need to be considered when conducting research to evaluate the efficacy, including the nature of control conditions. They then describe the research protocol currently being used at Yale. The chapter concludes with a discussion of the clinical contest for the provision of acupuncture.

Margolin A; Avants SK. Should cocaine-abusing, buprenorphine-maintained patients receive auricular acupuncture? Findings from an acute effects study. Journal of Alternative and Complementary Medicine 5(6): 567-574, 1999. (32 refs.)

Objective: Buprenophrine is a synthetic opioid with mu-agonist properties currently pending Food and Drug Administration (FDA) approval as a maintenance agent for treating heroin-addicted individuals. Unlike methadone, a widely used opioid maintenance agent, buprenorphine is a k-receptor antagonist. Research linking the effects of acupuncture to the release of dynorphin, the endogenous ligand for the kappa-receptor, raised the possibility that buprenorphine may block acupuncture's effects. In this study, we sought to gather preliminary data on this issue in order to guide the clinical care of cocaine-abusing, buprenorphine-maintained patients. Design: Between-group analysis comparing buprenorphine- and methadone- maintained patients on ratings of acute effects after a single session of auricular acupuncture. Subjects: Thirty-four (34) cocaine-abusing, opioid-dependent patients, eighteen (18) maintained on buprenorphine, and sixteen (16) maintained on methadone. Intervention: A single, 40-minute session of auricular acupuncture; four needles were inserted in each auricle. Outcome measures: Acute effect ratings in four domains: pain, de qi sensations, relaxation effects, subjective experiences. Results: There were no significant differences in acute-effects ratings between the two groups. Patients in both groups reported positive effects. Conclusions: These preliminary findings are consistent with the interpretation that buprenorphine does not block auricular acupuncture, supporting the provisional recommendation that cocaine-abusing patients maintained on buprenorphine should not be excluded from receiving auricular acupuncture or from participating in clinical studies of this treatment modality. Further, controlled research on this issue, with clinical outcomes, is needed.

Margolin A; Avants SK; Arnold R. Acupuncture and spirituality-focused group therapy for the treatment of HIV-positive drug users: A preliminary study. Journal of Psychoactive Drugs 37(4): 385-390, 2005. (29 refs.)

In this study, 40 HIV-seropositive, cocaine abusing, methadone maintained drug users were randomized to either the standard five-needle National Acupuncture Detoxification Association (NADA) protocol or to a reduced, escalating dose (one to three needle) protocol. In addition to receiving their assigned acupuncture treatments, the last 15 patients also received a spirituality-focused group therapy intervention. Acupuncture treatments were offered five days per week for eight weeks, Urine samples were collected twice weekly and were analyzed for the presence of cocaine and heroin. Depression and anxiety were assessed pre- and post-treatment. Results showed no difference between the two acupuncture conditions on the number of weeks in which urine samples tested negative for illicit opiate and cocaine use. However, patients who received the spirituality-focused group therapy in addition to their assigned acupuncture treatment were abstinent from heroin and cocaine for significantly longer, and had greater reductions in depression and anxiety than did those patients not receiving spirituality-focused psychotherapy. These preliminary findings suggest that acupuncture and a spirituality-focused psychotherapy may be a synergistic combination worthwhile investigating in larger scale, controlled studies.

Margolin A; Avants SK; Birch S; Falk CX; Kleber HD. Methodological investigations for a multisite trial of auricular acupuncture for cocaine addiction: A study of active and control auricular zones. Journal of Substance Abuse Treatment 13(6): 471-481, 1996. (28 refs.)

We evaluated objective criteria for defining points for needle insertion prior to conducting a multisite clinical trial of auricular acupuncture for cocaine addiction, Thirty-Sour cocaine-abusing subjects participated in a study in which the trial's active zones (Shenmen, Liver, Lung, and Sympathetic) and control zones (located on the ear helix) were divided into quadrants and assessed along four dimensions: electrical resistance, skill discoloration, skin topography, and tenderness. Acute effects of needles inserted into points of low electrical resistance in one eat and high electrical resistance in the other were also assessed. Results showed that the active zones had lower overall electrical resistance and more subcutaneous ridges than control zones. Zones did not possess significant variability along any single dimension. Acute effects of needling high and low resistance points were similar, differing only for "fulliness." Based on these findings, and in view of the difficulty of accurately measuring electrical resistance at ear points, we do nor recommend the use of electrical devices for point determination in the multisite study. At present, there seems to be little scientific basis for the preselection of specific points for needle insertion within auricular zones. Needle placement should be based upon clinical judgement.

Margolin A; Avants SK; Holford TR. Interpreting conflicting findings from clinical trials of auricular acupuncture for cocaine addiction: Does treatment context influence outcome? Journal of Alternative and Complementary Medicine 8(2): 111-121, 2002. (15 refs.)

Objective: To compare findings from two consecutive clinical trials of auricular acupuncture for cocaine addiction conducted at the same site in order to explore consistency of treatment effects. Subjects: One hundred and sixty-five (165) cocaine-dependent, methadone-maintained patients (study 1, n = 82; study 2, n = 83). Interventions: Subjects in both studies were randomly assigned to auricular acupuncture, a needle insertion control condition, or a no-needle relaxation control. Treatment sessions were offered five times weekly for 8 weeks. The two studies were equivalent in design, except that unlike study 1, study 2 offered subject payments for attendance and did not include weekly group counseling. Outcome measures: Cocaine use assessed by three times weekly urine screens constituted the primary outcome. Secondary measures included retention in treatment, treatment attendance, treatment credibility, therapeutic alliance, and acute effects of treatments. Results: Intent-to-treat analysis showed that patients assigned to acupuncture in study 1, but not in study 2, were significantly more likely to provide cocaine-negative urine samples relative to the two control conditions. Conclusions: The positive effect for acupuncture found in study 1 was not found in study 2. Even though the two studies were similar, reasons for this inconsistency cannot be determined definitively, but may be because of differences in psychosocial context and payment contingencies between the two studies, or the lack of effectiveness of acupuncture in this application. The need to critically consider the influence of treatment context and other potential moderating variables on outcome in order to draw conclusions regarding treatment effectiveness is discussed.

Margolin A; Avants SK; Kleber HD. Rationale and design of the Cocaine Alternative Treatments Study (CATS): A randomized, controlled trial of acupuncture. Journal of Alternative and Complementary Medicine 4(4): 405-418, 1998. (65 refs.)

Acupuncture has been incorporated as a treatment component in numerous addiction treatment programs in the United States; however, its efficacy has not been demonstrated in large-scale, controlled clinical trials. In this article we discuss the background and design of the Cocaine Alternative Treatments Study (CATS), a randomized, controlled, multisite study of acupuncture that will enroll 500 cocaine-dependent individuals at 6 sites across the country, and that constitutes the largest controlled trial for the treatment of cocaine addiction undertaken to date. After presenting the background of the study, we discuss the approach taken to address several critical issues, including the choice of appropriate control conditions, point location for needle insertion, degree of blinding, and bias checks. Complementary therapies are used by a significant number of individuals, and the need to evaluate them in controlled clinical trials is an ongoing and urgent issue.

Mayer DJ. Acupuncture: An evidence-based review of the clinical literature. (review). Annual Review of Medicine 51: 49-63, 2000. (61 refs.)

This chapter reviews the experimental literature on the effects of acupuncture treatment. The review covers the 14 medical conditions for which the National Institutes of Health Acupuncture Consensus Development Panel (NIHCDP) concluded that acupuncture either is effective (2 conditions) or may be useful (12 conditions). My conclusions partially support those of the NIHCDP. There is evidence that acupuncture is effective for the treatment of postoperative and chemotherapy-induced nausea and vomiting. Also, some data indicate that acupuncture may be useful for headache, low back pain, alcohol dependence, and paralysis resulting from stroke (4 of the 12 conditions for which the NIHCDP found that acupuncture may be useful). For most of the remaining conditions, there is little evidence that acupuncture is either effective or ineffective. It is recommended that workers in the held design double blind, sham controlled trials using adequate acupuncture treatment regimens, with specific hypotheses, and sample sizes sufficient to allow both positive and negative conclusions.

Meng FQ; Luo HC; Halbreich U. Concepts, techniques, and clinical applications of acupuncture. Psychiatric Annals 32(1): 45-49, 2002. (24 refs.)

The authors discuss the history, theory, principles, and techniques of acupuncture. The clinical efficacy of acupuncture as a treatment for depression, anxiety disorders, alcoholism and substance abuse is explored. The authors argue that clinical trials according to Western standards and methods have demonstrated that the efficacy of acupuncture for treating depression and other mental disorders is comparable to that of current antidepressants. However, additional double-blind, placebo-controlled studies of Chinese and Western patients are still needed.

Mills EJ; Wu P; Gagnier J; Ebbert JO. Efficacy of acupuncture for cocaine dependence: A systematic review & meta-analysis. Harm Reduction Journal 2: e-article 4, 2005. (36 refs.)

Background: Acupuncture is a commonly used treatment option for the treatment of addictions such as alcohol, nicotine and drug dependence. We systematically reviewed and meta-analyzed the randomized controlled trials of acupuncture for the treatment of cocaine addiction. Methods: Two reviewers independently searched 10 databases. Unpublished studies were sought using , the UK National Research Register and contacting content experts. Eligible studies enrolled patients with the diagnosis of cocaine dependence of any duration or severity randomly allocated to either acupuncture or sham or other control. We excluded studies of acupuncture methods and trials enrolling patients with polysubstance use or dependence. We abstracted data on study methodology and outcomes. We pooled the studies providing biochemical confirmation of cocaine abstinence. Results: Nine studies enrolling 1747 participants met inclusion criteria; 7 provided details for biochemical confirmation of cocaine abstinence. On average, trials lost 50% of enrolled participants (range 0-63%). The pooled odds ratio estimating the effect of acupuncture on cocaine abstinence at the last reported time-point was 0.76 (95% CI, 0.45 to 1.27, P = 0.30, I2 = 30%, Heterogeneity P = 0.19). Conclusion: This systematic review and meta-analysis does not support the use of acupuncture for the treatment of cocaine dependence. However, most trials were hampered by large loss to follow up and the strength of the inference is consequently weakened.

Moner SE. Acupuncture and addiction treatment. (review). Journal of Addictive Diseases 15(3): 79-100, 1996. (49 refs.)

Acupuncture has been advocated as a safe effective treatment for addictive diseases. This review highlights clinical trials using acupuncture in drug treatment. Clinical trials selected were those conducted for efficacy of acupuncture treatment with opiate, alcohol, cocaine and nicotine dependence.

Oleson TD. Commentary on auricular acupuncture for cocaine abuse. (editorial). Journal of Alternative and Complementary Medicine 8(2): 123-125, 2002. (9 refs.)

Otto KC. Acupuncture and substance abuse: A synopsis, with indications for further research. American Journal on Addictions 12(1): 43-51, 2003. (36 refs.)

Alcoholism and drug addiction are rampant in our society. Although current treatment works better than nothing, the search for more effective interventions continues. Incorporating acupuncture into existing programs offers a promising approach. Proponents say ear acupuncture alleviates acute opiate withdrawal, reduces craving for all substances, and helps retain patients in treatment. Over 25 years of clinical experience has supported this claim, but scientific research has been sketchy, complicated by technical difficulties and often poorly designed. This article reviews the literature and offers a neurochemical model for future research.

Otto KC; Quinn C; Sung YF. Auricular acupuncture as an adjunctive treatment for cocaine addiction: A pilot study. American Journal on Addictions 7(2): 164-170, 1998. (10 refs.)

The authors conducted a single-blind study? of auricular acupuncture in 36 cocaine-dependent inpatient veterans on a substance abuse treatment unit to determine whether the treatment could help reduce craving, increase treatment retention, and prevent relapse. Acupuncture was given on a predetermined schedule to both treatment and control groups, with status assessed regularly by independent, blinded raters. The study failed to show a significant difference between treatment and control groups. However the study patients, as a whole, did remain in treatment longer than a retrospectively analyzed group who received no acupuncture.

Rabinstein AA; Shulman LM. Acupuncture in clinical neurology. (review). Neurologist 9(3): 137-148, 2003. (118 refs.)

BACKGROUND- A majority of people in the United States use alternative or complementary therapy at some point in their lives, and acupuncture is among the most frequently used modalities. Many United States medical schools offer courses in alternative medicine, and a growing number of insurers offer coverage for alternative therapies. This paper critically reviews our current knowledge about the safety and efficacy of acupuncture for neurologic conditions. REVIEW SUMMARY- Acupuncture is a safe procedure when performed by trained professionals. Complications from acupuncture are rare and mainly related to negligence of sterile technique. Studies of the therapeutic value of acupuncture are fraught with challenging methodologic problems, including the choice of a placebo, a suitable control treatment, and the technique of stimulation applied. Clinical trials of the use of acupuncture for pain syndromes (headache, neck, and back pain), stroke rehabilitation, Parkinson's disease, multiple sclerosis, and substance abuse are reviewed. CONCLUSIONS- Based on the current literature, no definitive recommendation can be made regarding the efficacy of acupuncture for common pain syndromes including headache, and neck and back pain. Better quality clinical trials fail to demonstrate efficacy for the use of acupuncture as part of a rehabilitation program following stroke or as a treatment for drug addiction. Acupuncture may have a role in the treatment of sleep disturbance associated with Parkinson's disease but was not efficacious for the primary symptoms of either Parkinson's disease or multiple sclerosis. In light of increasing public interest and use of alternative therapies, this review may be helpful in promoting more discussion between patients and physicians about the use of acupuncture.

Russell LC; Sharp B; Gilbertson B. Acupuncture for addicted patients with chronic histories of arrest: A pilot study of the Consortium Treatment Center. Journal of Substance Abuse Treatment 19(2): 199-205, 2000. (42 refs.)

Auricular acupuncture continues to gain popularity as an adjunct to substance abuse treatment. This report describes an outcomes study in a treatment center tailored to the needs of chronic repeat offenders. Thirty-seven patients who received acupuncture (AC) during the early weeks of treatment were followed for 180 days postadmission. Data were collected for four parameters: (1) program retention, (2) new arrests incurred, (3) drug-positive urinalysis results, and (4) number of days needed to progress from entry level to secondary level treatment. These data were compared to archived information from 49 no-acupuncture (NA) patients who had entered the program before acupuncture became available. Chi-square tests determined that AC patients exhibited significantly higher program retention than NA patients at 30 (p < 0.0001), 60 (p < .002), 90 (p < .001), 120 (p < .007), and 150 (p < .031) days. At 180 days, a higher percentage of AC patients than NA patients remained in treatment, but the difference was not significant. Kaplan-Meier survival analysis determined that AC patients had significantly higher cumulative probability of remaining in treatment than did NA patients (p < .0021). In AC patients, there were decreased numbers of new arrests, drug-positive urinalysis results, and days needed to advance in treatment, but the differences were not significant. Fifty-one percent of all patients named methamphetamine as their primary drug of choice. Regardless of treatment group, methamphetamine-addicted patients exhibited significantly lower program retention than patients addicted to all other drugs (p < .035). In methamphetamine- addicted patients, acupuncture improved program retention only up to 30 days (p < .021). These findings support addition of acupuncture to substance abuse treatment for criminal justice clients and indicate a need for acupuncture research focusing on withdrawal from methamphetamine.

Sapir-Weise R; Berglund M; Frank A; Kristenson H. Acupuncture in alcoholism treatment: A randomized out-patient study. Alcohol and Alcoholism 34(4): 629-635, 1999. (15 refs.)

Seventy-two alcoholics were treated with acupuncture to the ear in a randomized single-blind controlled design over 10 weeks. Orthodox points and incorrect points 3-5 mm from orthodox points were used. No initial differences were found regarding social characteristics, the responses to the Swedish version of the Alcohol Use Inventory and the Three-dimensional Personality Questionnaire, indicating a successful randomization. There were non-significant tendencies towards gender differential response after acupuncture treatment (P = 0.07). There was no difference in the number of drinking days or level of craving between treatment and control patients. Among females, those in the treatment group reported reduction of anxiety after 1 month, more often than those in the control group (P < 0.05). Response to acupuncture was not related to personality or drinking pattern. Patients' experience of needle placement was similar in the study and control groups. The effects of acupuncture were less pronounced than those previously reported.

Shwartz M; Saitz R; Mulvey K; Brannigan P. The value of acupuncture detoxification programs in a substance abuse treatment system. Journal of Substance Abuse Treatment 17(4): 305-312, 1999. (25 refs.)

Our purpose is to compare baseline characteristics and detoxification readmission rates of clients treated at outpatient acupuncture programs and at short-term residential programs, two options available to persons seeking substance abuse detoxification. This was a retrospective cohort study using data on clients discharged from publicly funded detoxification programs in Boston between January 1993 and September 1994. Multivariate models were used to examine the effect on 6-month detoxification readmission rates of treatment at residential detoxification programs (used by 6,907 clients) versus at outpatient acupuncture programs (used by 1,104 clients) after adjusting for baseline differences. Acupuncture clients were less likely to be readmitted for detoxification within 6 months (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.53-0.95). Similar results were found when the analysis was performed on a subsample of clients that were relatively similar in terms of baseline characteristics (OR 0.61, 95% CI 0.39-0.94). We determined that acupuncture detoxification programs are a useful component of a substance abuse treatment system.

Shi J; Liu YL; Fang YX; Xu GZ; Zhai HF; Lu L. Traditional Chinese medicine in treatment of opiate addiction. (review). Acta Pharmacologica Sinica 27(10): 1303-1308, 2006. (55 refs.)

Traditional Chinese medicine (TCM) includes Chinese medicine and acupuncture. Chinese medicine consists of natural products including plants, animals and minerals. TCM has been practiced in China for more than 2000 years, and for the past 200 years has been used in treatment of drug addiction. Ten Chinese medicines for the treatment of opiate addiction have been approved by the Chinese State Food and Drug Administration (SFDA), and at least 6 are in clinical trials. The general therapeutic principle of Chinese medicine developed was based on its unique theory of "reinforcing healthy Qi and resolving and removing effects of toxicity". Acupuncture, another essential part of TCM, which was developed based on the principle that "functions of the human body are controlled by the 'Jing-Luo' and 'Qi-Xue' system", has been used not only in China, but also in Europe, the USA and other countries, for controlling opiate addiction. There are some advantages in using TCM for opiate detoxification, including less harmful side effects, high safety and ideal effects in the inhibition of protracted withdrawal symptoms and relapse. Co-administration of TCM with modern medicine shows some synergistic effects in detoxification. Many TCM for detoxification also have efficacy in the rehabilitation of abnormal body functions induced by chronic drug use, including improving immune function, increasing working memory and preventing neurological disorder. Given that TCM is effective in the prevention of relapse and causes fewer side effects, it may be used widely in the treatment of opiate addiction.

Sorensen JL; Rawson RA; Guydish J; Zweben JE, eds. Drug Abuse Treatment through Collaboration: Practice and Research Partnerships that Work. Washington, DC,: American Psychological Association, 2003. (Chapter refs.)

This edited volume with 27 contributors addresses the reality that despite the fact that the strides in the neurosciences, pharmacology, health service delivery, there has been little more than a ripple in the clinical treatment of addictions. The authors endeavor to promote collaboration between research and practice. Following an introduction on the need for a research-practice collaboration, the book is organized into four major sections. The first section addresses the dissemination from practice to research. Individual chapters consider a range of topics: the therapeutic community, the use of acupuncture in cocaine treatment; self-help groups, syringe exchange programs; and drug courts. The second section considers the phenomenon of dissemination from research to practice. Individual chapters deal with pharmacologic therapies; relapse prevention; and motivational interviewing. Section three examines the collaborative process. Individual chapters address the "outcomes" movement; a case study of effects to mesh assessment technology with treatment; implementing outcomes research; the development and testing of community interventions; and challenges to incorporating research in treatment settings. The final section considers science based approaches to dissemination and a concluding chapter that summarizes the values of collaboration as well as the impediments to doing so.

Stine SM; Kosten TR, eds. New Treatments for Opiate Dependence. New York: Guilford Press, 1997. (Chapter refs.)

The mid-1990s marked the rise of a new and substantial epidemic of heroin abuse. This in part is considered to be the result of changes in supply, the substitution of heroin for cocaine by major distributors, and the increasing purity of heroin that made alternative, more acceptable routes of administration possible. The expanding market has introduced new challenges for treatment and new treatment approaches. This edited work with 18 authors, is organized into three sections, that contain a total of 14 chapters. Following an introduction and overview, Part I considers the foundations for new interventions, focusing upon animal models of opiate abuse and the basic neurobiology of opiate addiction. Section II considers pharmacotherapies for opiate treatment -- methadone, pharmacological agents for opiate detoxification, and naltrexone -- and also supportive services and special populations. Section III covers opiate maintenance with LAAM, the use of buprenorphine, and treatment matching.

Tian XW; Krishnan S. Efficacy of auricular acupressure as an adjuvant therapy in substance abuse treatment: A pilot study. Alternative Therapies in Health and Medicine 12(1): 66-69, 2006. (10 refs.)

Context: Substance abuse and its related problems have become a serious public health issue, particularly in under-served border and rural communities. Conventional therapies have not always been effective. Literature regarding the use of auricular acupressure in substance abuse treatment is limited. Objective: To examine the efficacy of auricular acupressure in addition to usual care in substance abuse treatment, which has been limited. Design and Setting: This placebo-controlled pilot study was carried out in a community mental health center in a US-Mexico border city (Las Cruces) in southwestern New Mexico. Participants: A majority were Hispanic males with an average age of 32.8 years. Participants reported an average lifetime use of drug of choice of 14 years. Intervention: In addition to usual care, participants received specific acupressure treatment and placebo acupressure treatment. The acupressure treatment was offered once a week for 6 consecutive weeks. Main Outcome Measures: The Hopkins Symptom Checklist (SCL-20) Depression Scale was administered before and after 6 weeks of treatment to assess changes in emotional distress. Brief Substance Craving Scale was used at baseline and weekly for 6 weeks to assess changes in craving. Results: Both specific and placebo acupressure groups showed a significant reduction in craving at the end of treatment, with the specific acupressure group having a greater and more steady reduction in craving. Both specific acupressure and usual-care-only groups demonstrated a significant reduction in emotional stress. Conclusion: Overall, there was a positive response to the specific auricular acupressure treatment on psychological distress, craving, and drug/alcohol use measures. These encouraging preliminary results need to be duplicated in studies with larger sample sizes and longer treatment phases.

Timofeev MF. Effects of acupuncture and an agonist of opiate receptors on heroin dependent patients. American Journal of Chinese Medicine 27(2): 143-148, 1999. (8 refs.)

This study examined the influence of acupuncture and an agonist of opiate receptors (Procedol) by means of temperature in both the left and right auricular "Lung" points, and on the coefficient of interhemisphere asymmetry. Twenty heroin dependent patients participated in this research. They were evenly divided into two groups. Both groups consisted of 10 male drug addicts (18-19 years old) who had been using heroin for 8-10 months. Group 1 received 1.0 ml procedol (i. m.). Group 2 were treated with acupuncture. Temperature was measured on the acupuncture points before and after treatment. Results of this study showed that temperature increased on the left and decreased on the right acupuncture points in both the procedol and acupuncture treated groups. The net changes before and after treatment were 92.87% and 92.53% in groups 1 and 2 respectively. The therapeutic effect of acupuncture on treatment of heroin dependence is through the same pathway as the agonist on opiate receptors, 20% of patients are resisted to acupuncture.

Timofeev MF. Influence of acupuncture and pharmacotherapy on sensitivity of sensory systems to alcohol irritants in patients with alcoholism. American Journal of Chinese Medicine 24(2): 177-184, 1996. (4 refs.)

The sensitivity of an alcoholic's sensory systems (SS) to alcohol therapy is a good indication of treatment efficacy in this disease. In this study, we compare pharmacotherapy (PI-IT) and acupuncture therapy (AP) on the sensitivity of visual (VL), acoustic (AC), olfactory (OL) and taste (TS) systems to alcohol irritants (AI). The results showed that PHT changed the threshold sensitivity of SS to AI but did not cause aversion of SS to AI. In acupuncture treatment, results can be divided into four groups: Group 1, no aversion of AC was produced to AI; Group 2, no aversion of TS and OL were produced to AI; Group 3, no aversion of VL to AI; and group no aversion was recorded to AI. Supposedly, one of the sensory systems of the organism is genetically leading in organizing sensory-emotional operation of information, and other SS are subordinates. Therefore, before acupuncture treatment for alcoholism, it is necessary to cause excitation to the ethanol-dependent system (target-system) by means of irritation to the leading sensory system of the patient.

Trumpler F; Oez S; Stahli P; Brenner HD; Juni P. Acupuncture for alcohol withdrawal: A randomized controlled trial. Alcohol and Alcoholism 38(4): 369-375, 2003. (30 refs.)

Background and Aims: Previous trials on acupuncture in alcohol addiction were in outpatients and focused on relapse prevention. Rates of dropout were high and interpretation of results difficult. We compared auricular laser and needle acupuncture with sham laser stimulation in reducing the duration of alcohol withdrawal. Methods: Inpatients undergoing alcohol withdrawal were randomly allocated to laser acupuncture (n = 17), needle acupuncture (n = 15) or sham laser stimulation (n = 16). Attempts were made to blind patients, therapists and outcome assessors, but this was not feasible for needle acupuncture. The duration of withdrawal symptoms (as assessed using a nurse-rated scale) was the primary outcome; the duration of sedative prescription was the secondary outcome. Results: Patients randomized to laser and sham laser had identical withdrawal symptom durations (median 4 days). Patients randomized to needle stimulation had a shorter duration of withdrawal symptoms (median 3 days; P = 0.019 versus sham intervention), and tended to have a shorter duration of sedative use, but these differences diminished after adjustment for baseline differences. Conclusions: The data from this pilot trial do not suggest a relevant benefit of auricular laser acupuncture for alcohol withdrawal. A larger trial including adequate sham interventions is needed, however, to reliably determine the effectiveness of any type of auricular acupuncture in this condition.

Verthein U; Haasen C; Krausz M. Auricular acupuncture as a treatment of cocaine, heroin, and alcohol addiction: A pilot study. Addictive Disorders & Their Treatment 1(1): 11-16, 2002. (9 refs.)

Objectives: In the United States, outpatient acupuncture treatment of patients with drug and alcohol addictions has been provided for more than 20 years. Although positive effects were shown in control studies, the effectiveness of acupuncture treatment in drug addiction is not well-established and is still disputed. During the past few years, interest in acupuncture treatment has increased in Germany. It is occasionally provided in inpatient and outpatient settings for detoxification purposes. Methods: This longitudinal study evaluates a low-threshold outpatient acupuncture treatment project in Hamburg. During 8 months of documentation, 159 patients were included in the study-96% of all the patients being treated. The majority participated in only a few acupuncture visits. After 2 weeks, half of the patients had already finished treatment. This study focused on 30 patients who participated in at least four follow-up assessments during the treatment. Results: The results show a significant decrease of withdrawal symptoms, a slight improvement of the physical and mental state, and a reduction of alcohol and cocaine consumption. Conclusions: Because of the great number of patients who dropped out soon after the beginning of acupuncture treatment, the sample size is rather low. Therefore, this study only shows preliminary results regarding the efficiency of acupuncture treatment of patients with drug and alcohol addictions. However, there is some evidence that acupuncture might be an effective form of therapy, especially for patients with problematic cocaine use.

Villano LM; White AR. Alternative therapies for tobacco dependence. Medical Clinics of North America 88(6): 1607+, 2004. (72 refs.)

This article explores the use of acupuncture and hypnosis to treat tobacco dependence. For both hypnotherapy and acupuncture, the evidence of any effect is anecdotal. There are insufficient rigorous studies that are homogeneous in design or results to allow a reliable conclusion on whether or not these therapies are effective. At best, individual smokers who choose one of these interventions for preference should not be discouraged provided that they are informed about the state of the evidence.

2004, WB Saunders Co.

White A; Ernst E. Complementary or alternative medicine for substance misuse. IN: Petersen T; McBride A, eds. Working with Substance Misusers. London: Routledge, 2002. pp. 206-212. (25 refs.)

The use of complementary or alternative medicine (CAM) in the treatment of substance abuse is discussed. Specifically, the range of alternative therapies that have been researched and the effectiveness of various complementary therapies in the treatment of substance abuse problems are described. The author concludes that CAM therapies are increasingly popular. Some of these treatments are used as support and make no claims to treat symptoms except in a general sense of making the client more comfortable. Auricular acupuncture is the most widely used and is supported by a small amount of evidence. Mind-body therapies such as biofeedback, relaxation, and hypnotherapy are commonly used but more research is needed before their role in drug dependence management can be defined. Section headings in this book chapter include: (1) methods of literature review; (2) acupuncture; (3) biofeedback; (4) electrostimulation; (5) herbal medicine; (6) hypnotherapy; and (7) other therapies. Sham-controlled RCTs of acupuncture for alcohol dependence are presented in table format.

Public Domain

White AR; Rampes H; Campbell JL. Acupuncture and related interventions for smoking cessation. Cochrane Database of Systematic Reviews 1: art CD000009, 2006. (64 refs.)

Background: Acupuncture and related techniques are promoted as a treatment for smoking cessation in the belief that they may reduce nicotine withdrawal symptoms. Objectives The objectives of this review are to determine the effectiveness of acupuncture and the related interventions of acupressure, laser therapy and electrostimulation, in smoking cessation in comparison with no intervention, sham treatment, or other interventions. Search strategy: We searched the Cochrane Tobacco Addiction Group specialized register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, BIOSIS Previews, PsycINFO, Science and Social Sciences Citation Index, AMED and CISCOM. Date of last search January 2005. Selection criteria: Randomized trials comparing a form of acupuncture, acupressure, laser therapy or electrostimulation with either no intervention, sham treatment or another intervention for smoking cessation. Data collection and analysis We extracted data in duplicate on the type of smokers recruited, the nature of the acupuncture and control procedures, the outcome measures, method of randomization, and completeness of follow up. We assessed abstinence from smoking at the earliest time-point (before six weeks), and at the last measurement point between six months and one year. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Those lost to follow up were counted as continuing smokers. Where appropriate, we performed meta-analysis using a fixed-effect model. Main results: We identified 24 reports of studies. The only comparison for which there were sufficient studies to combine meaningfully was acupuncture compared with sham acupuncture. The fixed-effect odds ratio (OR) for the short-term effect was 1.36 (95% confidence interval 1.07 to 1.72), but the studies are heterogeneous and the result is strongly influenced by one individual positive study. The significant short-term effect was lost with the random-effects model for pooling, or by removing the outlying study that led to heterogeneity. The long-term result shows no effect of acupuncture compared with sham acupuncture. There was no consistent evidence that acupuncture is superior to no treatment, and no evidence that the effect of acupuncture was different from that of other antismoking interventions, or that any particular acupuncture technique is superior to other techniques.

White AR; Rampes H; Ernst E. Acupuncture for smoking cessation. (Cochrane Review). IN: Cochrane Library, Volume 1. Update Software: Oxford, 2003. (55 refs.)

Background: Acupuncture and related techniques are promoted as a treatment for smoking cessation in the belief that they may reduce nicotine withdrawal symptoms. Objectives: The objective of this review is to determine the effectiveness of acupuncture and the allied therapies of acupressure, laser therapy and electrostimulation, in smoking cessation in comparison with: a) sham treatment, b) other interventions, or c) no intervention. Search strategy: We searched the Cochrane Tobacco Addiction Group trials register, Cochrane Controlled Trials Register, Medline, Embase, BIOSIS Previews, PsycINFO, Science and Social Sciences Index, AMED and CISCOM. Date of last search January 2002. Selection criteria: Randomised trials comparing a form of acupuncture, acupressure, laser therapy or electrostimulation with either sham treatment, another intervention or no intervention for smoking cessation. Data collection and analysis: We extracted data in duplicate on the type of smokers recruited, the nature of the acupuncture and control procedures, the outcome measures, method of randomisation, and completeness of follow-up. We assessed abstinence from smoking at the earliest time-point (before 6 weeks), at six months and at one year or more follow-up in patients smoking at baseline. We used the most rigorous definition of abstinence for each trial, and biochemically validated rates if available. Those lost to follow-up were counted as continuing to smoke. Where appropriate, we performed meta-analysis using a fixed effects model. Main results: We identified 22 studies. We failed to detect an effect of acupuncture on smoking cessation when compared to sham acupuncture at any time point. The odds ratio (OR) for early outcomes was 1.22 (95% confidence interval 0.99 to 1.49); the OR after 6 months was 1.50 (95% confidence interval 0.99 to 2.27) and after 12 months 1.08 (95% confidence interval 0.77 to 1.52). Similarly, when acupuncture was compared with other anti-smoking interventions, we failed to find differences in outcome at any time point. Acupuncture appeared to be superior to no intervention in the early results, but this difference was not sustained. The results with different acupuncture techniques do not show any one particular method (i.e. auricular acupuncture or non-auricular acupuncture) to be superior to control intervention. Based on the results of single studies, acupressure was found to be superior to advice; laser therapy and electrostimulation were not superior to sham forms of these therapies. Conclusions: There is no clear evidence that acupuncture, acupressure, laser therapy or electrostimulation are effective for smoking cessation. Cochrane Database of Systematic Reviews 1

White AR; Resch KL; Ernst E. A meta-analysis of acupuncture techniques for smoking cessation. Tobacco Control 8(4): 393-397, 1999. (33 refs.)

Objective -- To determine the effectiveness of acupuncture for smoking cessation and to examine whether any individual aspect of trials is associated with an effect. Data sources-All randomised controlled trials of acupuncture for smoking cessation that were Listed in computerised databases or reference lists of relevant articles, Study selection -- All randomised single-blind studies that compared acupuncture with sham acupuncture. Data extraction -- Methodological data were extracted for quality assessment. Outcome data were extracted for rates of total smoking cessation at three intervals: early after treatment and after six and 12 months follow up. Data synthesis -- Results were expressed as odds ratios of success over failure in intervention over control groups. The combined odds ratio for all studies was calculated. Repeated meta-analyses were subsequently performed on subsets of studies combined according to defined characteristics: acupuncture technique, number of attendances, country of origin, status of journal, and control procedure. The overall quality of studies was poor. The combined odds ratio for smoking cessation calculated for the earliest results after the end of treatment was 1.20 (95% confidence intervals (95% CIs) = 0.98 to 1.48). The combined odds ratio for smoking cessation after six months was 1.29 (95% CI = 0.82 to 2.01), and after 12 months was 1.03 (95% CI = 0.73 to 1.46). There were no significant effects of relevance among subsets of studies grouped according to defined characteristics. Conclusions --Acupuncture was not superior to sham acupuncture for smoking cessation; no particular aspect of acupuncture technique was associated with a positive effect. The conclusions are limited by methodological inadequacies of studies and by the absence of testable hypotheses; design of future trials should avoid these deficiencies.

White AR; Resch KL; Ernst E. Randomized trial of acupuncture for nicotine withdrawal symptoms. Archives of Internal Medicine 158(20): 2251-2255, 1998. (24 refs.)

Background: Acupuncture is frequently used for smoking cessation. Positive results from uncontrolled studies have not been supported by meta-analysis of controlled trials. One possible reason for this is that the optimal acupuncture technique was not applied or that the technique was not repeated sufficiently often. Methods: A randomized, sham-controlled trial was performed with 2 parallel treatment arms; the participant and the evaluator were unaware of which treatment was received. Seventy-six adults who wanted to stop smoking received either 100-Hz electroacupuncture with needles inserted into the appropriate point in each ear or a sham control procedure over the mastoid bone. Interventions were given on days 1, 3, and 7 of smoking cessation. Nicotine withdrawal symptoms were measured by visual analog scale scores recorded in a daily diary for 14 days; smoking cessation was confirmed objectively. Results: There was no significant difference between the mean reduction of withdrawal symptom scares of the 2 groups from day 1 to day 14. Fifteen participants (39%) who received electroacupuncture and 16 participants (42%) who received a sham procedure were abstinent on day 14. Conclusion: This form of electroacupuncture is no more effective than placebo in reducing nicotine withdrawal symptoms.

Zalewska-Kaszubska J; Obzejta D. Use of low-energy laser as adjunct treatment of alcohol addiction. Lasers in Medical Science 19(2): 100-104, 2004. (30 refs.)

Auricular acupuncture is a medical method that has been used in the treatment of alcohol addiction. In our study we decided to intensify this method by additional biostimulation of the whole organism. The aim of this study was the therapy of patients with alcohol dependence syndrome. Fifty-three alcoholics were treated with two types of laser stimulation in four sessions. Each session consisted of 20 consecutive daily helium-neon laser neck biostimulations and 10 auricular acupuncture treatments with argon laser (every 2nd day). The Beck Depression Inventory-Fast Screen (BDI-FS) was used to assess their frame of mind before the session and after 2 months of treatment. Moreover, beta-endorphin plasma concentration was estimated five times using the radioimmunoassay (RIA) method. Improvement in BDI-FS and increase in beta-endorphin level were observed. These results suggest that laser therapy can be useful as an adjunct treatment for alcoholism.

Zeng X; Lei L; Lu Y; Wang Z. Treatment of heroinism with acupuncture at points of the Du Channel. Journal of Traditional Chinese Medicine 25(3): 166-170, 2005

To observe the effectiveness of acupuncture at points of the Du Channel in treating heroinism, seventy patients with heroinism were randomly divided into a treatment group (n= 35) and a control group (n=35). A 10-day decrescendo therapy of methadone and acupuncture at points of the Du Channel were adopted in the treatment group, while the 10-day decrescendo therapy of methadone was simply performed in the control group. The scoring and grading of the abstinence symptoms were recorded and evaluated for both groups. 31 cases in the treatment group and 26 cases in the control group completed the entire treatment process, and a significant difference (P<0.01) in scores of abstinence symptoms before and after treatment was noticed in the two groups. The obvious difference in scores of abstinence symptoms on the first, second, fifth, sixth, seventh, eighth, ninth and tenth day in the treatment group was superior to those in the control group (P<0.05 or P<0.01). Particularly for such symptoms as perspiration, anxiety and pain in the muscle and bone, the result in the treatment group was much better than that in the control group (P<0.05 or P<0.01). Acupuncture at points of the Du Channel has an auxiliary therapeutic effect on abstinence symptoms of heroinism, which can effectively help alleviate the abstinence symptoms.