Substance abuse and acupuncture: the evidence for effectiveness
Page 1 of 12
This briefing paper summarises the evidence for the effectiveness of acupuncture in substance misuse – drugs, smoking and alcohol, restricting itself mainly to controlled clinical studies. Although research on the effectiveness of acupuncture for drug misuse is still at an early stage, the evidence is encouraging. Sufficient early trial and empirical findings suggest that there are positive treatment effects. Indeed, the use of acupuncture is popular and the method documented as quick, safe and potentially valuable as an addition to addiction services (1,2). However, methodological weaknesses in most of the research leave the specific effects of the treatment still open to question. The evidence with respect to alcohol addiction is much less substantial, though on the whole positive; for smoking, the many trials have served to highlight how different interpretations of the same data can result in conflicting conclusions. Further research is essential, and a consensus needs to be reached on how trials should be conducted and how acupuncture can be best incorporated into comprehensive substance abuse programmes.
The Evidence Series of Briefing Papers aims to provide a review of the key papers in
the literature, which provide evidence of the effectiveness of acupuncture in the
treatment of specific conditions. The sources of evidence will be clearly identified
ranging from clinical trials, outcome studies and case studies. In particular this series of
briefing papers will seek to present, discuss and critically evaluate the evidence.
Introduction
Both traditional whole body acupuncture and auricular acupuncture have been used to treat
people who have problems with addictions to drugs, alcohol and cigarettes. The use of
auricular acupuncture in treating acute drug withdrawal is relatively recent, with Wen and
Cheung in Hong Kong in 1973 (3,4,5) first describing the effects of acupuncture in
alleviating the severity of opiate withdrawal symptoms. The practical application of
acupuncture in the traditional drug treatment setting evolved at New York’s City Lincoln
Hospital during the 1970’s.(6) As a result, many acupuncture programs based on the Lincoln
protocol were established world wide in a variety of settings. The work was extended to the
treatment of other substance misuse disorders such as addiction to cigarettes and alcohol.
The Lincoln protocol is relatively simple. Five small needles (shenmen, ‘sympathetic’
‘kidney’, ‘liver’ and ‘lung’ on each ear) (7) are inserted at points regarded as specific for
chemical dependency (8,9). Many acupuncturists do not restrict themselves to ear points, but
use certain body points as well. The technique aims to relieve withdrawal symptoms and
craving and to improve general relaxation and mental and physical functioning. Treatments
last 30-40 minutes and client progress is monitored by regular urine analysis. Acupuncture
treatment offers the client support during acute and post acute withdrawal through the relief
of classic symptoms. Up to 50 people can be treated in one hour and the programme has
claimed considerable success in retaining difficult to treat drug users i.e. out of 1,500 crack
clients between 1986-1988, more than 80% were retained after their first treatment (Lincoln
Hospital unpublished 1988).
In 1985, the National Acupuncture Detoxification Association (NADA) was formed. The
organisation was to assist practitioners to acquire the skills to develop Drug and Alcohol
programmes. The NADA approach, incorporating auricular acupuncture, was introduced into
the UK by John Tindall and is currently used in various drug agencies, particularly in London
e.g. Core Trust, Angel Drug Project, City Roads and the Stockwell Project.
In October 1991, the National Institute on Drug Abuse sponsored a technical review to
discuss the efficacy of acupuncture for the treatment of substance abuse (10). The current
status of research and directions for future study were discussed. It was agreed that although
potentially useful, studies provided equivocal results because of design, sample size and other
factors and that further research was needed. However, it was felt that acupuncture was a
safe, effective and inexpensive treatment for addictive diseases, being easily administered
and producing significant results.
Literature Search
A search was made on ARRCBASE and Medline using the key words addict*, detox*,
substance abuse, substance dependence, narcotic dependence, alcohol, smoking and tobacco
and further literature was retrieved from the references identified in the publications obtained.
In all, 100 references were identified concerning use of acupuncture and substance misuse.
ARRCBASE is a specialist acupuncture database built up by the Acupuncture Research
Resource Centre. The database contains articles relevant to Chinese Medicine and
acupuncture from the British Library’s AMED (Alternative Medicine Database) and the
American Medline databases. Of the references retrieved, papers were excluded for one of
the following reasons: they were in a foreign language, were predominantly related to
treatment and not treatment evaluation, they did not involve insertion of needles (11-14) and
one article (15) was published twice. Studies were included in the evidence review if they
met the following criteria: human subjects addicted to either drugs (13 studies included),
cigarette smoking (20 studies included) or alcohol (4 studies included), a reference/control
group was used (i.e. controlled trial design), and needles, press needles, staples or electro
acupuncture were used in the acupuncture treatment. In addition, a total of 27 review articles
were retrieved which commented on various studies.
Selected studies are summarised in tables 1 (drugs), 2 (tobacco) and 3 (alcohol).
