虐待和针灸|瑞典针灸协会

虐待和针灸

滥用药物和针灸
有效性的证据

简报室温度的一系列证据提供了文献中的关键文件的审查，提供针灸的有效性的证据
治疗的具体条件。

将明确证据来源，从临床试验，结果研究和案例研究等。这一系列简报商誉寻求特别提出，讨论和审慎评估的证据。

滥用药物和针灸：
有效性有力证据

总结
该简报总结物质滥用针灸的有效性的证据 - 毒品，吸烟和酗酒，主要是为了限制自身对照临床研究。虽然对药物滥用针灸的有效性的研究仍处于早期阶段，证据是令人鼓舞的。足够的早期试验和实证研究结果表明，有积极的治疗效果。事实上，使用针灸的流行和方法记录为快速，安全的和潜在的有价值瘾服务（1.2）的补充。然而，在大多数的研究方法的弱点离开治疗的具体影响仍然打开的问题。酒精成瘾与可敬的证据要少得多很大，但对整个阳性;燕尾服，许多试验有助于突出如何萨米数据的癌症有不同的解释相互矛盾的结论。进一步的研究是必不可少的，需要试验应如何进行针灸进入全面滥用药物计划“如何可以最好纳入达成了共识。

介绍

既有传统的全身针刺和耳针疑问和苦恼，以诚待人，有毒品，酒精和香烟成瘾问题。进入第三件事急性停药冰比较近，耳针，温家宝和祥在香港（3,4,5）在1973年首先描述针灸在减轻戒断症状的严重程度的影响。针灸在纽约市的林肯医院的发展，在传统的药物治疗在1970年的结果（6）设置的实际应用，许多针灸方案的基础上的林肯协议建立了世界各地的各种设置。工作扩展到其他物质滥用疾患，如香烟和酒精成瘾治疗。

林肯协议相对简单。五小针（神门，“同情”，“肾”，“肝”和“肺”单耳）（7）在填上视为化学依赖（8.9）指定的点。许多针灸师不限制他们的自我耳穴，而是用身体某些点。技术室温度，以减轻戒断症状和全身放松精神和身体机能的渴求和改善。治疗最后30-40分钟和客户端的进展定期尿液分析监测。针灸治疗的客户支持通过典型症状缓解后急性和急性戒断期间的受害者。可以治疗多达50人在一小时内，并声称在挡土墙难以治疗的吸毒者即1.500裂纹编程速度相当成功

客户之间的1986年至1988年，超过80％，他们的第一次治疗后保留（林肯医院，未公布的1988）。
1985年，全国针灸戒毒协会（NADA）成立。该组织是协助医生掌握技能发育的药物和酒精方案。 NADA的方法，结合耳针，被介绍到英国约翰Tindall和冰目前在各种毒品机构的仿旧文件，特别是在伦敦核心如信托，天使药物项目，城市道路和斯托克韦尔项目。
1991年10月，国家药物滥用研究所主办的讨论针灸的疗效，治疗药物滥用（10）的技术审查。当前状态的研究，并为今后的研究方向进行了讨论。有人认为，虽然可能有用，研究提供了模棱两可的结果，由于设计，样本大小和其他因素，需要进一步研究。然而，这是不对的，针灸是一个上瘾的疾病的治疗安全，有效，价格低廉，易于管理和生产显著成效。

文献检索
搜查了在ARRCBASE和MEDLINE *，*排毒，药物滥用，药物依赖，依赖麻醉，酗酒，吸烟和烟草和进一步的文学是从获得出版物中确定的参考文献检索，利用关键词吸毒者。在所有100个引用被确定关于使用针灸和药物滥用。 ARRCBASE是一家专业针灸针灸研究资源中心建立起来的数据库。该数据库包含AMED（大英图书馆的替代医学数据库）和美国MEDLINE数据库中医药和针灸有关的文章。的检索引用，论文被排除下列原因之一：他们是在一门外语，主要是有关治疗和不治疗的评价，他们解雇了涉及针插入（11-14）和文章（15）出版两次。研究被列入审查证据，如果他们遇到的的下列准则：人类受试者上瘾无论是药品（包括13项研究），吸烟（包括20项研究）或酒精（包括4项研究），参考/对照组的使用（即对照试验设计），针，按针，订书针或电针在针灸治疗不安。此外，共检索到了27个评论文章，评论各种研究。

选定的研究，总结在表1（药），2（烟草）和3（酒精）。

药物滥用
介绍
药物治疗可分为解毒，康复和预防复发的阶段。针灸速度心疼药物治疗的各个阶段。排毒是指初始阶段，当一个客户端体验与慢性药物使用相关的药物耐受性的直接影响。治疗的目标是抵制停药的影响和个人返回到一个相对“中立”或“正常的生理状态。这个阶段通常需要约3至7天（2）治疗。康复是

物质依赖治疗的第二阶段，并开始戒毒后。这涉及到一个程序，旨在教育有关毒品和酒精的负面影响病人组合的国家，激励个人承认药物滥用问题和发展的有效策略持续的行为改变。这个阶段会有所不同，从15-90天或更长时间的治疗时间和设置。预防复发是治疗的第三阶段和附近的康复阶段的开始。目标是保持所取得的成果，抵制诱惑，在未来使用的药物（10）的治疗和发展战略的面包屑阶段。在治疗药物滥用复发冰（其预防和管理）（1）最大的挑战。文献中针灸的成功，在几乎所有的治疗阶段，在几乎所有的吸毒成瘾的客户有很多传闻证据。排毒，针灸速度心疼地缓解身体的戒断症状。在康复阶段，针灸是心疼地减少烦躁和诱导放松的状态一般。为预防复发，网络速度心疼地鼓励松弛，减轻或药物的渴求（10）的preventDefault症状。

具体研究
温家宝在针灸和药物滥用的初步研究，鸦片成瘾者接收电
针灸作为术后镇痛经历了从救济戒断症状（3.4）。
随后的研究仿旧电针和纳洛酮（镇痛药）和
调整后的病人，他们的自我刺激（16）。在为期一年的随访，51％的受试者
在治疗组无毒品。治疗的人数，根据不同的
戒断症状，个别病人和救灾的需要和反应是
常见的。研究方法，然而，缺乏严谨性。波默朗茨报告了5
全双工复制温家宝的结果（17）。史密斯的研究在20世纪70年代末，是导致
由于他的报告与许多临床经验，建立标准治疗
例（8）。

可卡因
在为期六周，单盲研究针灸在美沙酮依赖可卡因
维持病人，40例患者被随机分配在三个接收每日针灸
耳廓网站和一个身体部位（李4），或控制在2-3毫米的四个活动地点
网站（18）。使用可卡因的困扰组患者显着下降。只有统计的
穿刺针两种类型之间的差异是渴望评级
计算表明，将需要非常大的样本量检测治疗
差异。马戈林等（1993）在之前的研究中，有心疼的单盲研究设计
（n = 48）进行比较的感觉，经历当针假插入到真正的和
耳针（19分）。两只耳朵被针刺，一个假网站和其他
可卡因成瘾的活性中心。受试者完成的感受问卷评级
耳和耳识别收到了真正的针灸治疗。实际点被认为
以上选项假点，但这个结果是痛苦的，只是可能出现
机会。
耳针减少可卡因/裂纹的渴求和消费的影响是由一个单盲，安慰剂组150人寻求治疗可卡因成瘾（20）试验研究。利普顿等人（1994）建议，辅导应以影响的心理因素，可能导致复发，被列入。被随机分配的患者是在门诊提供的实验治疗或安慰剂针灸

1个月。安慰剂治疗涉及针插入点在不使用药物治疗。成果的措施，包括药物的使用报告，考勤，尿液药物屏幕和成瘾严重性指数测量每个疗程。治疗组在两个星期内，在他们的血液相对对照组的可卡因水平显着降低。治疗保留为萨米。
另一项随机对照试验是在1995年进行了98科目滥用可卡因
（21）。五针NADA的协议长期效果优于一个耳针治疗的效果。这项研究还表明，在这样一个方案的综合治疗方法的好处。

奥托等人，于1998年，有36个可卡因依赖病人在滥用药物治疗单位进行了耳针单盲研究，以确定是否治疗可能有助于减少渴求，增加治疗的保留和复发的preventDefault（22）。有烦心事治疗组和对照组进行定期评估，但该研究未能显示出显着的差异eventhough组接受针灸治疗比那些没有针灸方面收到的仍然。

在1999年，单盲，随机，placebocontrolled设计使用可卡因成瘾的治疗进行了评估使用两个相连但同时研究。第一个随机236进入三组，真正的针灸，假针灸和常规治疗无针（23）住宅客户。针灸治疗组在药物滥用视为指定三点。对照组分别用三个非特异性假点。第二个研究随机进入一个真正的针灸三个剂量水平（28.16或8个疗程）的二○二个日间病人。受试者在针灸方面，在5比三个特定的耳穴ratherkool。在第二项研究中没有使用假点。数据未能显示在第一项研究的三组，在第二项研究中的三个真正的针灸治疗水平之间无显着差异之间的任何显着的差别待遇。然而，相对前处理使用，困扰研究组报道了可卡因消费量显着减少。

海洛因
第一次试验之一，进行了由温家宝和张志贤和耳针组和美沙酮组相比，药物戒断。针刺组的近两倍的可能性是在一年的免费的药物，但没有被统计（16）。

男子和闯在1980年的就业对照试验方法，比较电针与美沙酮，但没有说是否是随机分配到两个疗程（24）。戒断症状进行了评估，但与83％的辍学率被遗弃的后续评估。

Newmeyer等人科目电研究被允许挑选他们想要的治疗。针灸或药物，或两者（25）问卷分析主题“情绪状态，在审判过程中几次。有少有关，如抑郁，烦躁或焦虑的痛苦和心理状态的针刺组的戒断症状。也有少使用药物的证据，在该组中的尿液屏幕。

克拉克的鸦片解毒试验与美沙酮相比，针灸及未能出示两组之间的显着性差异，但针刺组更可能是在90天的随访（26）药物无尿。
geijer（1987）与治疗效果65嵌顿相比，阿片类药物成瘾的个体随机分配是单独用针刺或美沙酮美沙酮戒毒。（31）显着报道针刺组，他们少抽烟（98％相比，只有美沙酮组的35％）的报道也较少的戒断症状。请注意，没有安慰剂针灸的控制条件是痛心和减少戒断症状可能是由于一种安慰剂效应。
一个解毒的瘾，以海洛因随机分配的对照研究100到1单盲设计（27）的标准耳穴针灸治疗仿旧成瘾，或1用点假针灸治疗这被地理上接近的标准分成瘾的人。减员是困扰组（只有20个科目完成的研究），这些分配是的标准针灸治疗出席了针灸诊所多天，报告减少海洛因的使用，减少尿液药物屏幕药物使用的证据和治疗停留更长比那些分配是假治疗。药物使用频率自我报告建议，发现这些打火机的习惯（使用海洛因，每天一次或更少）的治疗方法更有帮助。虽然这是一个令人鼓舞的初步研究，样本量小和成果的措施自我报告的性质排除了任何明确的结论。

多药物滥用
到精神科病房收治了11个月内的药物滥用问题的患者提供了耳针（28）。出的77例患者提供治疗，30拒绝或少于选项处理（对照组）和47个针灸五个或更多的时间（治疗组）。治疗组也明显比对照组75％和20％的精神/物质滥用治疗的遵守。平均住院天数为22天治疗组与对照组16天相比，。治疗组也更可能留在后续治疗至少4个月低于对照组，即58％和26％。这项研究显然加快了固有的偏见，由于对照组的选择。

审查和Meta分析
捷尔Riet（29），于1990年确定了五个控制使用海洛因的临床研究（16,24,25,30，31）。虽然4个报告阳性结果（16,25,30,31），他们的方法学质量被评为差，这是不对的，该研究并不支持针灸的疗效，在治疗药物滥用。报告的缺点是：参考群体向所有收到假针灸治疗，病人不盲目治疗，也不是他们随机分配到治疗组。

结论
自温家宝和祥的初步报告，大量的描述性研究援引针灸和/或电针作为阿片类药物成瘾的戒毒治疗的有效性已经出现在文学（32-45）。许多研究，包括温家宝和长（3-5）的速度受到严厉批评了各种方法的原因，以前的评论：缺乏充分的实验控制组和对照组（10,14,46,47），恰当选择和安慰剂的双盲程序（10）。继在捷尔Riet等1990（29），Brewington等人1994（48）进行全面检讨的针灸治疗药物滥用和得出的结论这一结果也支持作为辅助治疗药物滥用针灸的作用荟萃，分析。他们的审查包括传闻，动物实验中，研究人类的海洛因，可卡因和酒精的用户，其中一些安慰剂的形式是心疼，在阿片类药物成瘾者的美沙酮戒毒针灸比较，针刺镇痛作用的研究。

虽然针灸的速度在各种药物治疗部分被纳入
成瘾超过20年计划，其疗效的速度没有被证明在大型
对照试验。在CH审判将要解决的关键问题，包括选择
适当的控制，进针点的位置，致盲和偏见检查的程度。
马戈林等1998有一个随机规划他们的文章中讨论这些问题，
可卡因成瘾针灸对照试验（86）。然而，上述研究
这可能表明针灸产生疗效显着，在治疗保留的条款
当与假或安慰剂程序，还较轻的用户可能会响应
比沉重的更好更频繁地参加门诊，并在一个较长的一段时间。
许多这些研究的限制是针对所有群体的高流失率和清漆
资源进行长期追踪案件。进一步的研究是到需要
确定如何最好的针灸可分为综合药物滥用
治疗方案。

戒烟
介绍
吸烟是最大的单变量死亡在工业化国家的preventDefault（49）的原因。
人们戒烟的活的时间比那些继续吸烟及其风险
患上肺癌，心脏疾病，中风和呼吸系统疾病的跌幅。香烟
的燕尾服然而仍然是一个很难打破的习惯，许多吸烟者试图几次
之前，他们大麻成功停止。因此，从各种各样的援助要求
专业人员。
针灸是一种流行的戒烟治疗，被认为是减少戒断症状。使用针灸起源于工作上面所述在香港的吸毒者，但成效的数据是矛盾的。不受控制的研究建议有戒烟的效果（53.50），一些研究者声称非常高的成功率（61-95％）（37，50），但是这不是阻碍健全的方法评估的基础上。

具体研究
许多戒烟的研究是没有可比性（1）。协议不同针的位置和数量，频率和持续时间的治疗，所采用的方法（钉书钉，针，激光，电刺激）和安慰剂的定义 - 这可能是自己生产的治疗效果。不顾的严重程度和吸烟行为和动机特征，缺乏长期随访和小样本大小，疑问和其他批评。

在1977年的研究，曾熏三年超过15支的92受试者随机分为两组，一个星期或留置针留置针“无效”耳穴“积极点”（肺）（肾）一个星期（51）。在一个星期内接受针灸的“主动”网站，更可能是投了弃权票，但不会持续了三个月的后续禁欲。

在萨米的一年，Lacroix和贝桑松也心疼双边面部针灸，在这种情况下，每周三个星期，并与假针灸（52）。 The method of randomisation was not stated in their paper, but they demonstrated a significant effect, with 74% of the acupuncture group stopping smoking compared with 29% of controls. No longterm follow up was reported.

Parker and Mok, also in 1977, compared electroacupuncture stimulation to 'effective'
auricular points (shenmen and lung) with 'inactive' points (shoulder and eye) over a three
week period (53). Although there were indications that the group receiving active treatment
were more likely to decrease their cigarette consumption the differences failed to achieve
significance.

Tan et al (1978) (54), treating patients three times a week, reported a significant decrease in cigarette smoking with laser acupuncture in a controlled trial.

In a study of 58 smokers, by MacHovec et al (1978) (55), acupuncture (using a sutured bead on the ear lobe at the acupuncture site for an indefinite time) was compared with hypnosis in individual and group sessions. Self reported smoking cessation was higher for both acupuncture and hypnosis groups compared with controls. Employed self-retained ear seeds. At six months, 25% of the subjects receiving correct site treatment were abstinent, compared with 0% with placebo points. 75% of the experimental group showed improvement (ie reduced use or abstinence) six months after treatment compared with 25% of the placebo group. Note that this study did not state whether subjects were randomised, nor did it present any tests of statistical significance.
A randomised trial was carried out by Lagrue in 154 smokers (56). Facial acupuncture was repeated after one week, and was compared with sham acupuncture. Although there was no significant difference between the two groups in the number of subjects achieving abstinence, there was 80% reduction in consumption at one week.
Lamontagne et al in 1980(57) compared two types of acupuncture therapy, one aimed at smoking withdrawal and the other aimed at enhancing relaxation, which made up the control group in a randomised trial. There was a decrease in cigarette use in the acupuncture group but the effect did not continue for one, three and six month follow up. This was a poor choice

of acupuncture control procedure, since the anti-smoking effect of 'relaxation' treatment cannot be ruled out.
In the first part of a two part study by Martin et al (58) 132 smokers either received three weeks of indwelling needles in 'effective' auricular points (lung and hunger) plus 20 minutes electro acupuncture to hand and ear sites, or 'ineffective' auricular points (elbow and eye). In the second part of the study 128 smokers were randomised into those receiving the 'effective' auricular points and the same 'ineffective' points. After three weeks there was no significant difference between the groups neither in either study, nor at six months follow up.

In 1982, Steiner et al carried out a randomised controlled trial in 23 subjects – people who had been smoking over 20 cigarettes/day for two consecutive years (59). Acupuncture to genuine body and ear points was given over a two-week period and compared to sham acupuncture. No significant difference in immediate cessation was observed between the two groups. Although 80% of the experimental group reported a decreased desire to smoke after treatment compared with 50% of the placebo group, the difference was not statistically significant. Again, the small sample size with this study limited its value.

The study by Cottraux in the following year recruited 558 subjects who had smoked 10 or
more cigarettes for two years into a study, which compared behavioural therapy, facial
acupuncture, placebo capsules and a waiting list control (60). Those in the acupuncture and
behavioural therapy groups were significantly more likely to stop smoking at 15 day follow
up than the placebo group, but this difference did not carry over to the 9 and 12 month follow
up period.
In a randomised controlled trial of 130 smokers, acupuncture (auricular and whole body) and conventional medical treatment were compared (61). Abstinence and reduction in smoking were assessed over a 12 month follow up. There was no significant difference between the two groups for either outcome. A similar conclusion was reached by Vandevenne et al, who recruited 200 self referred smokers for a randomised controlled trial where acupuncture (three auricular and two body points) and sham acupuncture were compared (63). There were no differences in immediate cessation or at 1 year follow up. Gillams (62) used an indwelling needle (replaced every week) in 81 subjects who had been smoking more than 50 cigarettes for five years. A group of subjects with an indwelling needle in the auricular point for the lung was used for a period of four weeks, and was compared with a group with a needle placed in an 'inactive' point. Group therapy was given each week to both. At three month follow up again there was no significant difference between the groups, but this is perhaps not surprising given the 'hardened' smokers that were used.
A study by Clavel in 1985 (64) demonstrated that subjects treated with either acupuncture or nicotine gum showed a better response than a control group. However, there was no difference between the two active treatments, probably as a result of insufficient numbers. Both were effective in helping smokers to stop, and although about half of these in each group subsequently relapsed, there were still significantly more ex-smokers in the treatment groups than the control at 13 months. In a later trial, Clavel (65) failed to show the efficacy of acupuncture compared with a sham control: both groups produced cessation rates after one month of the order of 22-23%. This was a large study of 996 subjects comparing the use of nicotine chewing gum and acupuncture in a randomised controlled set-up (65). The gum treatment was significantly more effective than it's control (26 v 19%). In a later 2×2 factorial design study, the same authors failed to show a difference in cessation rates between acupuncture and control and nicotine gum and control at 12 month follow up (66).

In 1991, Leung's controlled trial compared behavioural therapy with indwelling needles in auricular points in 95 subjects who had smoked for least one year. (67) Subjects were followed up at one, three and six months. The behavioural group was significantly more likely to have stopped smoking than the acupuncture or control group, but the acupuncture group was more likely to have reduced the number of cigarettes smoked.

针灸的效果减少吸烟/戒烟和特异性分
在调查的46名健康男性和女性志愿者，他们想戒烟（68）。
受试者被随机分配是两组。一组被给予有效
针灸治疗（试验组）和其他点在针灸治疗
假设没有戒烟（对照组）的影响。测量的临床结果
包括血清丁宁和血清中硫氰酸盐，最常见的不良生理
有吸烟习惯的指标。治疗期间每日吸食香烟的消费量下降
期间在困扰群体，但减少是显着试验组。共
在试验组的31％已戒烟完全在治疗结束
与对照组无。为试验组丁宁浓度
和硫氰酸盐后，在治疗期间显着减少。为困扰群体的味道
在治疗期间，烟草恶化，但效果更明显的
试验组比对照组选项。抽烟的欲望大大下降这两个组
治疗后，试验组比对照组选项和减少较大。 “
研究表明，针灸可以帮助激励吸烟者减少他们的燕尾服，甚至
完全退出。
白等人（69）在最近的电针研究，观察在两个组之间的第一天，14天针刺组（39％和42％的控制）的戒断症状分数平均减少之间没有显着性差异。在9个月，仅在14天内戒烟的人仍然不吸烟。作者得出结论认为电针发射减少尼古丁戒断症状，在一个指定的效果。
在另一项随机，安慰剂对照试验于1998年，78个吸烟者主动或安慰剂网站加自我设置（70）在一般的做法，保留了两个星期的耳朵种子在使用电针灸针的单一治疗。积极治疗组更可能有比安慰剂组在6个月停止吸烟。

审查和Meta分析
有一些疑问和几个评论，并在这一领域进行的荟萃分析，一般分析萨米论文很多，但以不同的方式使用不同的验收标准。由施瓦茨的审查（1988）（71）仿旧七项研究与假针灸模型来分析一个真正涉及翼共5000多名患者，并给了累积的结果，这表明，真正的针灸治疗工作25％的时间。假针灸几乎是同样有效，20％和25％（戒断6个月的人的百分比）之间的戒烟率。

一项荟萃分析，指出负面结果（51,53,56,57,58,59,60,61,62,63,72,74）远远超过数泰尔：Riet等人（1990）（29）（52,55,73）的积极成果。负面结果的研究方法优于分级，事实上，他们的结论，更严格的方法，更可能是有一个负面的结果，但就整体而言，研究质量较差。批评是，作者是不是针灸专家，并有可能出席会议的，包括研究，从一个角度穴位不满意。此外，他们的主要结论是，针灸没有工作，ratherkool，当研究涉及翼真正的针灸和假针灸进行了分析，差别不大可以检测之间的“真正的治疗”和“安慰剂”。此外，他们没有考虑到的点选择的特异性。
在1995年审查认为，这针灸试验中，控制受试者针刺不适当的网站，低估的影响，自刺任何地方都可能引发内啡肽的释放，这有助于缓解戒断症状（75）。 lewith得出的结论是针灸是一样有效的尼古丁替代疗法，但针插入部位似乎并不很重要。他叙述性这真正对战假针灸模型是1不适当的1对戒烟中针灸的价值，以及这1正式荟萃分析是充满了组合TION难点不同的研究，使用不同的时间点的结果和技术。他强调，针灸的效果是最好的研究恶魔吸烟与各种尼古丁替代疗法的事情撤出。

一个更近的审查，于1997年由作者进行了经验丰富的针灸和审判
方法，最好的证据（76）合成的基础上。这种方法（77.78）采用
最大的内部和外部使用的未指定的标准的有效性。它有利于规模效应
以上统计的意义。在本次审查的研究被列入如果他们冰毒FOLLOWING
标准：单盲控制设计控制接收电子邮件假针刺，预分配
隐瞒随机合适的选择，控制点，超过25本集团在每个科目。测量结果是完整的持续停止吸烟后最长随访期间治疗和困扰。 16个对照试验
（51,52,53,54,56,57,59,60,61,62，63,66,74）。在两种情况下，两个独立的研究报告。分析没有发现的“主动”针灸更心疼比“安慰剂”或“假”戒烟有效。然而，他们还得出结论，
假针灸是不恰当的控制，因为它可能是有一些生理
真正的针灸治疗的效果类似。如果有显着差异要求的最佳时刻，针灸
试验应该有较大的样本量。医生致盲是另一个问题确定
虽然Lagrue（52）研究并管理为了实现这一目标。审查研究的作者认为，现在应集中在：是简单的针灸电针更全面比双工？其他的治疗方案（如不同的端点，重复求诊）更有效吗？针灸是否减少撤出
与戒烟有关的症状是什么？

In 1998 (amended, 1999) a Cochrane review summarised the data on acupuncture for smoking cessation (79), including a total of 20 trials (51,52,53,56,57,58,59,60,61,62,63,64, 65,66,67,68,69,70,72,74). The authors suggested that acupuncture was not superior compared with sham points for smoking cessation for any time point considered in the review (early after treatment, at six or at 12 months), though three studies produced strongly positive results (52,68,70). Similarly when acupuncture was compared with other anti-smoking interventions, there were no differences in outcome at any time point. Acupuncture appeared to be superior to 'no intervention' at early follow up but this difference was not sustained. The results with different techniques did not show any one particular method (ie auricular acupuncture or whole body acupuncture) to be superior to control intervention. The review concluded that acupuncture appears to act only as a placebo in smoking cessation. Future research should concentrate on using adequate stimulation and investigating whether acupuncture can lead to a reduction in nicotine withdrawal symptoms.

Conclusion
Although acupuncture has been claimed to be of enormous value in aiding smoking cessation it is likely that this assumption is based on some of the early studies involving hard drug addiction rather than smoking. Different types of acupuncture treatments can be used, the most common being the placement of a small semi-permanent needle into an acupuncture point on the ear. Sometimes this is preceded by electro-stimulation to promote endorphin release, or body acupuncture. There is however, no physiological evidence that acupuncture relieves withdrawal symptoms. The studies described do not demonstrate that acupuncture alone aids smoking cessation but it is thought that it can be a useful technique through which this can be promoted (75). Acupuncture may act as a 'placebo procedure' to help the smoker handle the addictive component of smoking, while it is suggested that, for sustained abstinence, the psychosocial aspects of smoking must be addressed. Hence counselling or behavioural therapy may be needed alongside acupuncture and, as with any smoking cessation method, motivation to quit is necessary for continued abstinence.

Whilst this is the mainstream position amongst medical researchers there have been alternative interpretations of the evidence. Some authors have not agreed with the choice of control points used by some investigators. The 'shoulder', 'kidney' and 'eye' points are not thought to be inactive by some, and others have stated that the 'elbow' and the 'eye' points may be effective as they are innervated by the vagus nerve. Further, it has been suggested that the site of needle insertion in general is unimportant, with a non-specific triggering of endorphin release, which may help withdrawal from a number of addictions including smoking (75). It therefore follows that a real-versus sham model is an inappropriate manner in which to investigate the value of acupuncture in the context of smoking cessation. (It also follows that a simple, formulaic procedure may be just as effective as anything else). Re-
analysing the trial results simply as acupuncture (whether 'active' or 'sham') versus no acupuncture indicates that its effectiveness in smoking cessation is of the order of 20-30% – as good as the recommended nicotine replacement methods (and similar to results from uncontrolled studies (87)). This size of effect holds only for the short term, but it is perhaps not unreasonable to consider initial cessation and long-term abstinence as two different outcomes, requiring different strategies. The latter may require follow-up acupuncture sessions and a more individualised regime, a proposition as yet untested by controlled research trials. Most studies have involved rather minimal amounts of treatment, while the most intensive/continuous one has produced the most compelling results (68).

Thus it seems that many more questions need to be answered before the degree of effectiveness of acupuncture for smoking can be established.

Alcohol
Introduction
Alcoholism is a major health problem in society and its effects range from being a cause of road traffic accidents to increased risk of stroke and mental health problems. There have however, been few controlled trials carried out to valuate the effectiveness of acupuncture to treat people who have problems with alcoholism.

Specific Studies
Four controlled trials on the use of acupuncture in the treatment of alcohol misuse were identified (81,82,83,84). A randomised trial on 54 hardcore alcoholic recidivists was carried out to investigate whether sobriety could be achieved, and episodes of drinking and detoxification centre admissions reduced, as a result of therapy (81). Specific points for substance misuse were compared to non-specific points. Patients in the treatment group expressed less need for alcohol, and had fewer drinking episodes and admissions to the detoxification centre during the study than control patients. The majority of treated patients felt that acupuncture had a definite impact on their desire to drink, whereas, only a few control patients noted this effect.
A second placebo controlled study by Bullock in the USA investigated 80 severe recidivist alcoholics who received acupuncture either at points specific for the treatment of substance abuse (treatment group) or at non specific points (control group) (82). A total of 21 out of 40 of the treatment group completed the programme compared with 1 of the 40 controls. Significant treatment effects persisted at the end of the six-month follow-up and more control patients expressed a moderate to strong need for alcohol, and they had more than twice the number of both drinking episodes and admissions to a detoxification centre. The difference in effect size between true and sham acupuncture ranged from 24-36% depending on the measure used and the stage of treatment.

Worner et al (83) described a replication of Bullock's study (82). A total of 56 alcoholics, one third of whom had also reported illicit drug use were examined. Clients were allocated to one of three treatment groups, specific acupuncture, sham transdermal stimulation or standard care. They used rates of completion of treatment and detoxification as outcome measures. Results showed no significant differences across a number of criteria between the three groups. Once again this study suffered from small sample sizes (20 per group).

More recently Rampes et al in the UK carried out a 6-week single-blind randomised controlled trial to determine the effectiveness of auricular acupuncture in reducing the craving for alcohol (83). Groups were randomised to specific electro acupuncture treatment, non-specific electro acupuncture treatment or normal treatment. A significant reduction in craving was observed for both acupuncture groups and a 44% increase in craving for controls at week 8. By week 24, there were no such differences between the groups. Numbers in each arm of the study were however, small.

Review And Meta Analysis
Ter Riet's analysis (29) of two of the above studies (81,82) concluded that they were of insufficient quality and therefore interpretation was not meaningful. Although the results suggested that acupuncture may be helpful in breaking the cycle of alcohol misuse, the number of subjects was small (less than 50 per group) and the high dropout rate in the placebo group could have biased the results. In addition, the results were not validated with biochemical measures and self reported data on alcohol consumption.

Following Rampes article (84), Ter Riet carried out a second analysis based on the criteria used in the previous one and confirmed that the study did not provide evidence that electroacupuncture was efficacious in the treatment of addiction to alcohol (85).

结论
虽然该研究评估针灸在第三件事的人用酒精的使用
问题的疑问和有限的，他们有整体上提供积极的成果。（事实上，
迈耶（88），在最近审查，争辩说，这是布洛克等人的酒精研究
提供良好疗效的证据，药物滥用的任何地方）。有郑成功高
辍学率：未来的研究应集中在这种情况的原因，从而限制损失
起来。在本节审议了研究，从海誓山盟都非常不同。例如Wörner等除了两个耳穴，布洛克仿旧三个耳穴和他们的第一选择点（81.82）（83）仿旧几个身体点。 wörner仿旧假针灸，但布洛克发射。 wörner有一个标准的照顾唯一的治疗组，布洛克的出席简约风格AA组会议。针灸的频率和持续时间不同，治疗的长度一样。
在困扰着研究的样本规模小。这两项研究的比较典型的问题金额上升滥用药物一般针灸研究。治疗是没有可比性，研究设计，分析和样本大小分化显着的方式。
该方法的不足，使其难以解释的结果，这被认为是不确定的，当在评论和医学文献的Meta分析认为。

感谢确认为他们的工作是在准备这份简报文件尼古拉·罗宾逊和马克·博维。

针刺研究资源中心和英国针灸理事会

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Table 1. Drug misuse and acupuncture: the evidence for effectiveness

Study Sample size Method Control Follow up Outcome Measures Results Stats
1 Wen & Cheung Electro- No control 12 mths Withdrawal symptoms Relief of withdrawal symptoms
1973 40 ear acupuncture (A) Urine analysis 51% drug free (A) P<0.05
(Opium Heroin) Single point
electrical stimulation

Avants, Margolin et 40
2 al 1995
(Cocaine)

Lipton et al 1994 150
3 (Cocaine)

4 Konefal et al 1995 98
(Various
substances)

5 Otto et al 1998 36
(Cocaine)

Bullock et al 1999
6 a) 236

b) 202

(Cocaine)
Wen & Teo 1975 35
7 (Heroin)

Ear acupuncture (A)
+ 1 body site
6 week course

Ear acupuncture (A)

Ear acupuncture (A):
5point vs 1 point.
Ear and body acupuncture. 16 wk programme
x 2 visits per wk

Ear acupuncture (A)
12 wk programme

Ear acupuncture (A)
8 wks (28 times)
3 different dosage
regimes in 8 wks:
28,16 or 8 treatments
Ear Acupuncture (A)

Placebo (C) 6 wks

Sham points (C) 1 mth

1 needle (ear) (C) 16 wks

Sham points (C) 12 mths

Sham points (C)
Standard control
Standard control

Methadone (M) 12 months

Retention
Abstinence
Urine analysis
Craving

Urine analysis

Treatment retention

Urine analysis

Craving
Treatment retention

Craving assessment
Urine analysis
Addiction Severity Index
SF36
Beck Depression Inventory

Drug abstinence

80% (A) vs 70% (C) completed
treatment
44%(A) vs 29% (C) abstinence 66%(A) vs 70% (C) positive urines at end of study
0.73 (A) vs 1.77 (C) mean craving score
a) Acupuncture group at 2 wk
significantly lower cocaine
metabolic levels
b) No significant difference at
follow-up
Treatment retention similar
for both groups

Significant difference between single needle and 5 needle protocols. Males responded better than females.
No difference between (A) and
(C)
No reduction in craving
High drop out rate – only 4 completed whole course
Craving:
a) (A) significantly worse
than
(C)
b) No differences between 3
dosage regimes

51% (A) 29% (M) free of drugs at l year

NS
NS
NS
P<0.05
P<0.05

P not
stated

P= 0.007
NS

None
provided

Table 1 (continued)

Study Sample Method Control Follow up Outcome Measures Results Stats
size
Man and 35 Electro- ear Methadone (M) Discontinued Urine analysis Only 3 patients in each group
8 Chuang 1980 acupuncture (A) Withdrawal symptoms completed the study No
(Opiates) Daily treatment Craving 83% drop out analysis
for one month
Newmeyer et 132 Electro-acupuncture (A) Medication (M) 6 mths Urine analysis 38% (A) 48% (M) heroin
9 al 1984 Electro-acupuncture & positive urine after 10 treatments
(Heroin) medication 24% (A) 36% (M) positive urine at 6 Not
months provided
Self reported heroin use Less heavy heroin use reported by
acupuncture subjects

Geijer 1987 65 Acupuncture (A) Methadone (M) Unknown Withdrawal symptoms Reduction in withdrawal symptoms P<0.05
10 (Opiates) + Methadone No placebo in acupuncture group
control Reduction in drug use 98% (A) 35% (C)
Clark 1990 84 Ear acupuncture (A) Methadone (M) 90 days Urine analysis. 31% (A) 14% (M) drug free
11 (Opiates) urines at follow-up NS
53% (A) 53% (M) with + ve urines
and heroin present NS
12 Washburn et al 100 Ear acupuncture (A) Sham points (C) 3 wks No. of days attended 4.2 (A) 2.1 (C) days attended P<0.05
1993
(Heroin) No. of days in treatment 16 (A) 4(C) no. of days staying in NS
treatment over 3 wks

Urine analysis 7.3% (A) 6.7% (C) urines clean NS
of opiates at 3 wks
13 Gurevich et al 77 Ear acupuncture (A) No ear 12mths Continuation of treatment
1996 (>5 treatments) acupuncture – Compliance with treatment 75% (A) 20% (C)
(Combined refused offer or Discharge rate 2% (A) 40% (C)
substance had <4 treatments Acceptance of staff's
abuse) (C) discharge recommendations 77% (A) 37% (C)
Remained in FU for at least 4 mths 58% (A) 26% (C)
Average inpatient stay 22days(A) 16days (C)
Immediate relapse 19% (A) 27% (C)

*A acupuncture M methadone C control NS = (statistically) non-significant

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