To review the evidence on how acupuncture works and to review the use of acupuncture for treatment of different drug dependencies.

Searches for published articles in the English language were made of MEDLINE, from 1976 to 1995 and of PsycLIT from 1990 to 1995, using the following search terms: 'alternative medicine' (exploded), 'acupuncture' (exploded), 'acupuncture therapy', 'acupuncture points', 'substance withdrawal syndrome', 'substance use disorders', 'addictive behaviour', 'substance abuse treatment centres' and 'substance dependence'. Bibliographies of published reviews on drug treatment and acupuncture were also searched.

Study designs of evaluations included in the review

Controlled trials of acupuncture were included.

Specific interventions included in the review

The following types of acupuncture were studied: electro acupuncture, stud acupuncture, sutured bead, non-stimulated and laser. Control therapies included the following: methadone, counselling, sham acupuncture and sham electro acupuncture, ankle placebo, relaxation acupuncture, group therapy, laser probe placed near skin, placebo pill and no treatment.

Participants included in the review

The participants studied were receiving treatment for opiate, alcohol, cocaine or tobacco dependency.

Outcomes assessed in the review

The following outcomes were assessed: urine drug screen, Profile of Mood State, withdrawal symptoms, craving scale, self report on addictive behaviour, attendance for treatment, relapse rate, detoxification admission rate, drinking episodes, cigarette smoking and abstinence.

How were decisions on the relevance of primary studies made?

The author does not state how the papers were selected for the review, or how many of the reviewers performed the selection.

The author does not state that they assessed validity.

The author does not state how the data were extracted for the review, or how many of the reviewers performed the data extraction.

How were the studies combined?

The studies were combined in a narrative review.

How were differences between studies investigated?

The author does not state how differences between the studies were investigated.

Three studies including one randomised controlled trial (RCT) were used to assess the effectiveness of acupuncture for opiate treatment (595 patients).

Two studies including one RCT were used to assess the effectiveness of acupuncture for alcohol treatment (136 patients).

Eight studies including 6 RCTs were used to assess the effectiveness of acupuncture for nicotine treatment (1,263 patients).

One RCT was used to assess the effectiveness of acupuncture for cocaine treatment (108 patients).

Opiate treatment: all of the trials had unacceptably high drop-out rates (ranging from 69 to 91%). The trials had variable lengths of follow-up and few defined what stage of treatment the study was to address.

Alcohol treatment: the results were variable. The drop-out rates ranged from 47 to 100%.

Nicotine treatment: none of the studies presented clear and consistent proof of the efficacy of acupuncture in smoking cessation. No study used biochemical markers to verify self-report of smoking abstinence.

Cocaine treatment: the single study reported no significant difference between intervention groups. The drop-out rates were 80% at two weeks.

The evidence for efficacy of acupuncture in drug treatment is very encouraging. Since acupuncture is quick, inexpensive and relatively safe, acupuncture treatment may establish itself as an important addition to addiction services in the future.

The discussion includes mention of some problems with the primary studies including: lack of assessment of outcomes such as withdrawal symptoms, relaxation or improvement in dysphoria; lack of comparison with conventional treatment; problems with the use of sham acupuncture as a control; and the use of variable doses and types of acupuncture. Some relevant details of the included studies are clearly presented in tabular format.

By limiting the literature search to English language studies in two databases some relevant studies may have been omitted. No details are given of the methods used to select primary studies or to extract data. The inclusion criteria do not include a definition of the 'drug dependent' patient. It is not clear what criteria were used to select studies on nicotine treatment. The high drop-out rates reported are only mentioned relating to studies on opiate treatment and it is not clear if the data were analysed on an intention-to-treat basis.

Given the lack of assessment of validity, the lack of clarity in the methods used to select primary studies and the high drop-out rates, the author's conclusions cannot be considered supported by the evidence given in this review.

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.