Aug. 14, 2000 -- An ancient Chinese practice may help with a modern day affliction.
Partly because there are few effective conventional treatments for cocaine dependence, treatment centers have turned to alternative therapies, including acupuncture. But there is little hard, scientific evidence to show whether these types of therapies are effective.
"Acupuncture is being used in hundreds of treatment facilities around the country without a clear database underpinning its efficacy or telling us the best way to use it. This is the first clear clinical trial, and it is suggesting that acupuncture may be a viable treatment and we should pursue it further," Alan I. Leshner, PhD, tells WebMD. Leshner, the director of the National Institute on Drug Abuse (NIDA), which funded the study, was not involved in the study. "It is not the most dramatically definitive study, but it is certainly a strong study, and it does say that acupuncture may well have some merit."
Researchers, led by S. Kelly Avants, PhD, from the division of substance abuse in the department of psychiatry at Yale University, divided 82 cocaine addicts -- who were also receiving methadone treatment for heroin addiction -- into three groups. One-third received acupuncture at four specific points around the outer ear, another third received "sham" acupuncture at sites on the ear that would be ineffective, and the last third received relaxation therapy consisting of viewing a relaxing video. Treatment sessions were five times a week for eight weeks. The subjects' urine was tested three times a week for traces of cocaine.
"We found that patients ... assigned to receive true acupuncture had less cocaine use compared to the two [other] groups," principal investigator Arthur Margolin, PhD, tells WebMD. "And there was a higher percentage of patients in the acupuncture group who were clean from cocaine use in the last week of the study compared to the two [other] groups as well."
In fact, patients who received real acupuncture were three and a half times more likely than those who received relaxation therapy, and two and a half times more likely than those who received sham acupuncture, to test negative for cocaine. Over half of those receiving acupuncture had three consecutive cocaine-free urine samples in the final week of the study, compared to 24% of those getting sham acupuncture and 9% of those getting only relaxation therapy.
Margolin explains that they don't understand exactly how the acupuncture works or what physical changes occur. There are some ideas that inserting needles into the ear releases substances in the body that cause a pleasant sensation. Another theory is that it stimulates relaxation.
Michael O. Smith, MD, the director of substance abuse for Lincoln Hospital in the South Bronx, New York, has been using acupuncture on patients and teaching it to health care providers for more than a quarter century. "It involves putting three to five needle on the outside of the ear and leaving them in place for 45 minutes," says Smith, noting that it is used in conjunction with counseling -- both individual and group therapy -- and medication.
"It isn't just a question of relaxation and sedation," Smith says of acupuncture's effects. "It is a question of the mind not being scattered and disjointed ... If you have a person coming in on crack cocaine and they are bouncing off the walls, it's not easy to think they would be relaxed and alert. If a person is able to listen, that means they are not so distractible, they are not so needy, they can take things in and they have an easier internal mental process. And it is valuable as part of a treatment package."
"The drug abuse field is not an easy field to find solutions, and numbers like 54% are not numbers you give too often," says Smith, taking a glass-half-full view of acupuncture's success rate in the study. "This is a chronic relapsing condition; there are lots of reasons people become addicts, and acupuncture helps the person help themselves."
"This is by no means the last word on the subject, but it suggests promising findings for acupuncture. We need more research on it," says Margolin. "It also suggests we can conduct rigorous trials of complementary medicine that will be published in reputable medical journals and that subjecting these treatments to [rigorous medical studies] does not necessarily place them at a disadvantage, as some practitioners may feel."