For more than a quarter century, acupuncture has been employed in the United States to help people lose their cravings for alcohol, nicotine and other addictive substances. New research published in a recent issue of the Archives of Internal Medicine1 suggests that acupuncture may also help subjects lose their addiction to a far more insidious product - cocaine.
"Our study · shows that alternative therapies can be combined with the arsenal of Western treatments for fighting addiction," said Dr. Arthur Margolin, a psychiatric research scientist at Yale University School of Medicine and the paper's lead investigator. "This promising finding suggests that further research on acupuncture in this application is warranted."
Margolin's team conducted a clinical trial on 82 adults (47 men, 36 women; average age 37) who were addicted to both cocaine and heroin. While the participants were treated with methadone to satiate their heroin addiction, they received no medication to combat their cocaine addiction.
Study subjects were randomly assigned to one of three groups. The first group received a form of auricular acupuncture following the protocols set forth by the National Acupuncture Detoxification Association, with needles inserted into the sympathetic, lung, liver and shen men zones of the ears. The second group underwent sham-type ear acupuncture using three zones not commonly used for the treatment of any disorder. The third group did not receive acupuncture, instead undergoing various audiovisual relaxation techniques.
Participants were treated 40 minutes per day each weekday for eight weeks. Urine samples were collected three times per week to assess the subject's cocaine use. In addition to treatment, the study subjects also received individual and group counseling.
Examination of the patients' urine samples at the end of the study showed that those treated with the NADA ear acupuncture were much less likely to still be using cocaine than their counterparts. More than half (54.8%) of the auricular acupuncture patients tested free of cocaine during the last week of treatment, compared to only 23.5% for the control acupuncture group and 9.1% for the relaxation group.
Those who received auricular acupuncture also appeared to stay off of cocaine for a greater amount of time once the study had concluded compared to the other groups. A followup test showed that patients who had undergone the NADA-type acupuncture "abstained from cocaine significantly longer" than the control acupuncture or relaxation groups and "were more likely to be abstinent at completion than either of the control conditions."
Study Limits and Strengths
The scientists admitted a number of limitations to the study, including the fact that the acupuncturist who delivered treatment was not blinded. They also noted that more patients dropped out of the auricular acupuncture group than the control acupuncture or relaxation groups, which they believe "may have influenced outcome in ways that are not apparent."
However, the study also demonstrated a number of strengths that lent it credibility. First, the NADA acupuncture protocol was compared favorably to two "active placebos" -- a test that many pharmaceutical products currently on the market, the scientists mentioned -- have not always passed. Second, attendance records showed that, on average, subjects in all three groups received a comparable "dose" of treatment. Third, and perhaps most importantly, since patients' urine was collected three times a week, the researchers concluded it was "unlikely that instances of cocaine use were missed, or that patients could dissemble cocaine abstinence."
"In conclusion," the researchers noted, "findings from the present study support the use of acupuncture for the treatment of cocaine addiction." Margolin's group also noted that future research, including clinical and foundational studies, should be conducted to confirm their findings.
Implications for the Profession
Although acupuncture and Oriental medicine have made great strides in the past few decades, it continues to face obstacles from other health professionals and policy makers, in part because of a lack of randomized, controlled trials that prove its effectiveness.
The Archives study, while using a relatively small patient base, has demonstrated quite clearly that acupuncture helps people control their addiction to cocaine. It has also produced just the type of clinical research the profession needs to gain more credibility among patients, insurers and legislators, and to promote further research.
"If the groundwork for these studies is carefully developed, then we can conduct tests of alternative therapies that are both fair and rigorous," noted Margolin.
The study has not gone unnoticed by those in the field of addiction control. Experts from around the country have praised the paper for its design and methods of comparison.
"This is not a definitive study, but it is a well done clinical trial that says acupuncture is a treatment approach that ought to be considered seriously," said Alan Leshner, director of the National Institute on Drug Abuse. Leshner added that acupuncture could be used in conjuction with other therapies, such as psychological counseling, to improve treatment outcomes.
Daniel Iead, a clinical coordinator at the Grant Street Partnership, an addiction services agency in New Haven, Connecticut, was even more enthusiastic.
"The results are indisputable," said Iead. "We've been doing it here for years and it works. The results are fantastic. Some of our most difficult cases have turned their lives around because of it."
Avants SK, Margolin A, Holford T, Kosten TR. A randomized controlled trial of auricular acupuncture for cocaine dependence. Archives of Internal Medicine August 14/28 2000;2305-2312.
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