A Randomized Controlled Trial of Auricular Acupuncture for Cocaine Dependence

U SE OF cocaine continues to be a serious problem in the United States. The 1998 National Household Survey on Drug Abuse reported 1.8 million current users, with a significant increase in use among those aged 18 to 25 years relative to the previous year. At present, there are few conventional treatments with demonstrated efficacy available for the treatment of this disorder. Given the lack of conventional treatments, an alternative therapy—auricular acupuncture, as codified by the National Acupuncture Detoxification Association (NADA)—is in widespread use in drug treatment facilities across the country. Although a number of preliminary studies investigating the effectiveness of acupuncture for the treatment of cocaine addiction have reported positive results, findings from controlled studies have to date been inconclusive, with some studies reporting positive treatment effects for acupuncture, while others have reported finding no difference between acupuncture and controls. One impediment to determining the effectiveness of auricular acupuncture stems from the complexity of investigating this treatment modality in controlled studies. Acupuncture is a procedure, and developing controls for procedures and testing them under blinded conditions offers numerous problems. In planning the current study, we deemed it important to control for both nonspecific factors, such as monitoring of drug use, completion of questionnaires, and staff attention, and specific factors that necessarily attend an acupuncture treatment and that may confound interpretation of findings. For example, acupuncture treatments typically involve patients reposing in a quiet setting under relaxing conditions. Because relaxation has been associated with reduced drug craving, which may in turn reduce drug use and have other beneficial effects independent of any presumed acupuncture effects, a nonneedle relaxation protocol was developed to control for these nonspecific effects of acupuncture treatments. In addition to possible relaxation effects induced by the treatment context, insertion of needles into the body is a potentially impressive ritual that may elicit a beneficial placebo response in drug users, independent of an acupuncturespecific mechanism. To control for this aspect of the acupuncture treatment, acupuncture studies have used needle insertion into “sham” points, usually stipuORIGINAL INVESTIGATION