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.
More than 25 years ago, Wen and Cheung 1,2 were the first to describe positive effects of acupuncture in detoxification treatment of patients with drug addiction. A psychiatrist at the Lincoln Hospital in New York has been treating patients with auricular acupuncture to withdraw from cocaine or heroin use since the mid 1970s. 3 Smith (1988) developed five-point auricular acupuncture, which is the most widespread currently used acupuncture method in the treatment of addiction. 3
With regard to detoxification purposes, the termination of drug use, or relapse prevention in some control studies, positive effects were shown. 4,5 However, the effectiveness of acupuncture treatment for patients with drug addiction is not well-established and is still being discussed. The main problem is the low treatment retention, which leads to limitations regarding interpretation of the study results. This is especially true for acupuncture-based detoxification of opiates in which drop-out percentages of 71% to 83% (referring to 3-4 weeks of treatment) were described. 6-8 In a control group study by Otto et al., 9 only 4 of 36 patients with cocaine addiction completed the 12-week acupuncture treatment. Except for a better retention rate in the experimental group, there were no significant differences between experimental and control groups regarding outcome criteria drug use, cocaine craving, depressiveness, and anxiety.
However, doctors performing acupuncture treatment have observed that this rather simple and low-cost treatment succeeds in retaining many clients in a therapeutic setting and perhaps motivates them for further treatment. Acupuncture has proven especially effective in the context of inpatient withdrawal treatment. 4,10 However, this type of treatment has not been evaluated sufficiently; the possibilities and limitations of acupuncture in addiction treatment still need to be investigated.
Positive experiences with acupuncture treatment in pregnant women addicted to heroin or participating in methadone programs 11 encouraged physicians and other therapists to offer this kind of treatment in Hamburg for any drug or alcohol user. The program started in autumn 1997. The treatment agency is open 5 days a week, only between 5 and 7 pm. There is one room with 24 chairs. The treatment setting is anonymous and without any threshold except a medical examination at the beginning and documentation by questionnaires. In this treatment agency, every drug or alcohol consumer can thus try out the effects of auricular acupuncture. No agreements (or contracts) about individual goals, compliance, or treatment duration are made. Every patient must pay 10 DM for one visit. (In Germany, the costs for acupuncture treatment of patients with addiction are usually not paid by health insurance.) The treatment follows the National Acupuncture Detoxification Association protocol, i.e., three to five acupuncture points on each ear. The ear points are vegetativum, shen men, kidney, liver, and lung. It is a nonverbal approach; one visit lasts 45 minutes. For detoxification purposes, it is recommended that patients stay in treatment for 4 to 6 weeks. Except for the medical examination, no additional intervention is made. The treatment is performed by physicians or by acupuncture-trained (and -certified) assistants under physician supervision. 12,13 This outpatient acupuncture treatment is targeted at patients with drug addiction who want to reduce or terminate their consumption of heroin, cocaine, or amphetamines. Another target group are methadone patients who are not yet able to reduce their additional cocaine consumption. Alcoholics who want to control their consumption or prevent relapses may also be reached by this treatment.