虐待和針灸|瑞典針灸協會

虐待和針灸

濫用藥物和針灸
有效性的證據

簡報室溫度的一系列證據提供了文獻中的關鍵文件的審查，提供針灸的有效性的證據
治療的具體條件。

將明確證據來源，從臨床試驗，結果研究和案例研究等。這一系列簡報商譽尋求特別提出，討論和審慎評估的證據。

濫用藥物和針灸：
有效性有力證據

總結
該簡報總結物質濫用針灸的有效性的證據 - 毒品，吸煙和酗酒，主要是為了限制自身對照臨床研究。雖然對藥物濫用針灸的有效性的研究仍處於早期階段，證據是令人鼓舞的。足夠的早期試驗和實證研究結果表明，有積極的治療效果。事實上，使用針灸的流行和方法記錄為快速，安全的和潛在的有價值癮服務（1.2）的補充。然而，在大多數的研究方法的弱點離開治療的具體影響仍然打開的問題。酒精成癮與可敬的證據要少得多很大，但對整個陽性;燕尾服，許多試驗有助於突出如何薩米數據的癌症有不同的解釋相互矛盾的結論。進一步的研究是必不可少的，需要試驗應如何進行針灸進入全面濫用藥物計劃“如何可以最好納入達成了共識。

介紹

既有傳統的全身針刺和耳針疑問和苦惱，以誠待人，有毒品，酒精和香煙成癮問題。進入第三件事急性停藥冰比較近，耳針，溫家寶和祥在香港（3,4,5）在1973年首先描述針灸在減輕戒斷症狀的嚴重程度的影響。針灸在紐約市的林肯醫院的發展，在傳統的藥物治療在1970年的結果（6）設置的實際應用，許多針灸方案的基礎上的林肯協議建立了世界各地的各種設置。工作擴展到其他物質濫用疾患，如香煙和酒精成癮治療。

林肯協議相對簡單。五小針（神門，“同情”，“腎”，“肝”和“肺”單耳）（7）在填上視為化學依賴（8.9）指定的點。許多針灸師不限制他們的自我耳穴，而是用身體某些點。技術室溫度，以減輕戒斷症狀和全身放鬆精神和身體機能的渴求和改善。治療最後30-40分鐘和客戶端的進展定期尿液分析監測。針灸治療的客戶支持通過典型症狀緩解後急性和急性戒斷期間的受害者。可以治療多達50人在一小時內，並聲稱在擋土牆難以治療的吸毒者即1.500裂紋編程速度相當成功

客戶之間的1986年至1988年，超過80％，他們的第一次治療後保留（林肯醫院，未公佈的1988）。
1985年，全國針灸戒毒協會（NADA）成立。該組織是協助醫生掌握技能發育的藥物和酒精方案。 NADA的方法，結合耳針，被介紹到英國約翰Tindall和冰目前在各種毒品機構的仿舊文件，特別是在倫敦核心如信託，天使藥物項目，城市道路和斯托克韋爾項目。
1991年10月，國家藥物濫用研究所主辦的討論針灸的療效，治療藥物濫用（10）的技術審查。當前狀態的研究，並為今後的研究方向進行了討論。有人認為，雖然可能有用，研究提供了模棱兩可的結果，由於設計，樣本大小和其他因素，需要進一步研究。然而，這是不對的，針灸是一個上癮的疾病的治療安全，有效，價格低廉，易於管理和生產顯著成效。

文獻檢索
搜查了在ARRCBASE和MEDLINE *，*排毒，藥物濫用，藥物依賴，依賴麻醉，酗酒，吸煙和煙草和進一步的文學是從獲得出版物中確定的參考文獻檢索，利用關鍵詞吸毒者。在所有100個引用被確定關於使用針灸和藥物濫用。 ARRCBASE是一家專業針灸針灸研究資源中心建立起來的數據庫。該數據庫包含AMED（大英圖書館的替代醫學數據庫）和美國MEDLINE數據庫中醫藥和針灸有關的文章。的檢索引用，論文被排除下列原因之一：他們是在一門外語，主要是有關治療和不治療的評價，他們解僱了涉及針插入（11-14）和文章（15）出版兩次。研究被列入審查證據，如果他們遇到的的下列準則：人類受試者上癮無論是藥品（包括13項研究），吸煙（包括20項研究）或酒精（包括4項研究），參考/對照組的使用（即對照試驗設計），針，按針，訂書針或電針在針灸治療不安。此外，共檢索到了27個評論文章，評論各種研究。

選定的研究，總結在表1（藥），2（煙草）和3（酒精）。

藥物濫用
介紹
藥物治療可分為解毒，康復和預防復發的階段。針灸速度心疼藥物治療的各個階段。排毒是指初始階段，當一個客戶端體驗與慢性藥物使用相關的藥物耐受性的直接影響。治療的目標是抵制停藥的影響和個人返回到一個相對“中立”或“正常的生理狀態。這個階段通常需要約3至7天（2）治療。康復是

物質依賴治療的第二階段，並開始戒毒後。這涉及到一個程序，旨在教育有關毒品和酒精的負面影響病人組合的國家，激勵個人承認藥物濫用問題和發展的有效策略持續的行為改變。這個階段會有所不同，從15-90天或更長時間的治療時間和設置。預防復發是治療的第三階段和附近的康復階段的開始。目標是保持所取得的成果，抵制誘惑，在未來使用的藥物（10）的治療和發展戰略的麵包屑階段。在治療藥物濫用復發冰（其預防和管理）（1）最大的挑戰。文獻中針灸的成功，在幾乎所有的治療階段，在幾乎所有的吸毒成癮的客戶有很多傳聞證據。排毒，針灸速度心疼地緩解身體的戒斷症狀。在康復階段，針灸是心疼地減少煩躁和誘導放鬆的狀態一般。為預防復發，網絡速度心疼地鼓勵鬆弛，減輕或藥物的渴求（10）的preventDefault症狀。

具體研究
溫家寶在針灸和藥物濫用的初步研究，鴉片成癮者接收電
針灸作為術後鎮痛經歷了從救濟戒斷症狀（3.4）。
隨後的研究仿舊電針和納洛酮（鎮痛藥）和
調整後的病人，他們的自我刺激（16）。在為期一年的隨訪，51％的受試者
在治療組無毒品。治療的人數，根據不同的
戒斷症狀，個別病人和救災的需要和反應是
常見的。研究方法，然而，缺乏嚴謹性。波默朗茨報告了5
全雙工複製溫家寶的結果（17）。史密斯的研究在20世紀70年代末，是導致
由於他的報告與許多臨床經驗，建立標準治療
例（8）。

可卡因
在為期六週，單盲研究針灸在美沙酮依賴可卡因
維持病人，40例患者被隨機分配在三個接收每日針灸
耳廓網站和一個身體部位（李4），或控制在2-3毫米的四個活動地點
網站（18）。使用可卡因的困擾組患者顯著下降。只有統計的
穿刺針兩種類型之間的差異是渴望評級
計算表明，將需要非常大的樣本量檢測治療
差異。馬戈林等（1993）在之前的研究中，有心疼的單盲研究設計
（n = 48）進行比較的感覺，經歷當針假插入到真正的和
耳針（19分）。兩隻耳朵被針刺，一個假網站和其他
可卡因成癮的活性中心。受試者完成的感受問卷評級
耳和耳識別收到了真正的針灸治療。實際點被認為
以上選項假點，但這個結果是痛苦的，只是可能出現
機會。
耳針減少可卡因/裂紋的渴求和消費的影響是由一個單盲，安慰劑組150人尋求治療可卡因成癮（20）試驗研究。利普頓等人（1994）建議，輔導應以影響的心理因素，可能導致復發，被列入。被隨機分配的患者是在門診提供的實驗治療或安慰劑針灸

1個月。安慰劑治療涉及針插入點在不使用藥物治療。成果的措施，包括藥物的使用報告，考勤，尿液藥物屏幕和成癮嚴重性指數測量每個療程。治療組在兩個星期內，在他們的血液相對對照組的可卡因水平顯著降低。治療保留為薩米。
另一項隨機對照試驗是在1995年進行了98科目濫用可卡因
（21）。五針NADA的協議長期效果優於一個耳針治療的效果。這項研究還表明，在這樣一個方案的綜合治療方法的好處。

奧托等人，於1998年，有36個可卡因依賴病人在濫用藥物治療單位進行了耳針單盲研究，以確定是否治療可能有助於減少渴求，增加治療的保留和復發的preventDefault（22）。有煩心事治療組和對照組進行定期評估，但該研究未能顯示出顯著的差異eventhough組接受針灸治療比那些沒有針灸方面收到的仍然。

在1999年，單盲，隨機，placebocontrolled設計使用可卡因成癮的治療進行了評估使用兩個相連但同時研究。第一個隨機236進入三組，真正的針灸，假針灸和常規治療無針（23）住宅客戶。針灸治療組在藥物濫用視為指定三點。對照組分別用三個非特異性假點。第二個研究隨機進入一個真正的針灸三個劑量水平（28.16或8個療程）的二○二個日間病人。受試者在針灸方面，在5比三個特定的耳穴ratherkool。在第二項研究中沒有使用假點。數據未能顯示在第一項研究的三組，在第二項研究中的三個真正的針灸治療水平之間無顯著差異之間的任何顯著的差別待遇。然而，相對前處理使用，困擾研究組報導了可卡因消費量顯著減少。

海洛因
第一次試驗之一，進行了由溫家寶和張志賢和耳針組和美沙酮組相比，藥物戒斷。針刺組的近兩倍的可能性是在一年的免費的藥物，但沒有被統計（16）。

男子和闖在1980年的就業對照試驗方法，比較電針與美沙酮，但沒有說是否是隨機分配到兩個療程（24）。戒斷症狀進行了評估，但與83％的輟學率被遺棄的後續評估。

Newmeyer等人科目電研究被允許挑選他們想要的治療。針灸或藥物，或兩者（25）問卷分析主題“情緒狀態，在審判過程中幾次。有少有關，如抑鬱，煩躁或焦慮的痛苦和心理狀態的針刺組的戒斷症狀。也有少使用藥物的證據，在該組中的尿液屏幕。

克拉克的鴉片解毒試驗與美沙酮相比，針灸及未能出示兩組之間的顯著性差異，但針刺組更可能是在90天的隨訪（26）藥物無尿。
geijer（1987）與治療效果65嵌頓相比，阿片類藥物成癮的個體隨機分配是單獨用針刺或美沙酮美沙酮戒毒。（31）顯著報導針刺組，他們少抽煙（98％相比，只有美沙酮組的35％）的報導也較少的戒斷症狀。請注意，沒有安慰劑針灸的控制條件是痛心和減少戒斷症狀可能是由於一種安慰劑效應。
一個解毒的癮，以海洛因隨機分配的對照研究100到1單盲設計（27）的標準耳穴針灸治療仿舊成癮，或1用點假針灸治療這被地理上接近的標準分成癮的人。減員是困擾組（只有20個科目完成的研究），這些分配是的標準針灸治療出席了針灸診所多天，報告減少海洛因的使用，減少尿液藥物屏幕藥物使用的證據和治療停留更長比那些分配是假治療。藥物使用頻率自我報告建議，發現這些打火機的習慣（使用海洛因，每天一次或更少）的治療方法更有幫助。雖然這是一個令人鼓舞的初步研究，樣本量小和成果的措施自我報告的性質排除了任何明確的結論。

多藥物濫用
到精神科病房收治了11個月內的藥物濫用問題的患者提供了耳針（28）。出的77例患者提供治療，30拒絕或少於選項處理（對照組）和47個針灸五個或更多的時間（治療組）。治療組也明顯比對照組75％和20％的精神/物質濫用治療的遵守。平均住院天數為22天治療組與對照組16天相比，。治療組也更可能留在後續治療至少4個月低於對照組，即58％和26％。這項研究顯然加快了固有的偏見，由於對照組的選擇。

審查和Meta分析
捷爾Riet（29），於1990年確定了五個控制使用海洛因的臨床研究（16,24,25,30，31）。雖然4個報告陽性結果（16,25,30,31），他們的方法學質量被評為差，這是不對的，該研究並不支持針灸的療效，在治療藥物濫用。報告的缺點是：參考群體向所有收到假針灸治療，病人不盲目治療，也不是他們隨機分配到治療組。

結論
自溫家寶和祥的初步報告，大量的描述性研究援引針灸和/或電針作為阿片類藥物成癮的戒毒治療的有效性已經出現在文學（32-45）。許多研究，包括溫家寶和長（3-5）的速度受到嚴厲批評了各種方法的原因，以前的評論：缺乏充分的實驗控制組和對照組（10,14,46,47），恰當選擇和安慰劑的雙盲程序（10）。繼在捷爾Riet等1990（29），Brewington等人1994（48）進行全面檢討的針灸治療藥物濫用和得出的結論這一結果也支持作為輔助治療藥物濫用針灸的作用薈萃，分析。他們的審查包括傳聞，動物實驗中，研究人類的海洛因，可卡因和酒精的用戶，其中一些安慰劑的形式是心疼，在阿片類藥物成癮者的美沙酮戒毒針灸比較，針刺鎮痛作用的研究。

雖然針灸的速度在各種藥物治療部分被納入
成癮超過20年計劃，其療效的速度沒有被證明在大型
對照試驗。在CH審判將要解決的關鍵問題，包括選擇
適當的控制，進針點的位置，致盲和偏見檢查的程度。
馬戈林等1998有一個隨機規劃他們的文章中討論這些問題，
可卡因成癮針灸對照試驗（86）。然而，上述研究
這可能表明針灸產生療效顯著，在治療保留的條款
當與假或安慰劑程序，還較輕的用戶可能會響應
比沉重的更好更頻繁地參加門診，並在一個較長的一段時間。
許多這些研究的限制是針對所有群體的高流失率和清漆
資源進行長期追踪案件。進一步的研究是到需要
確定如何最好的針灸可分為綜合藥物濫用
治療方案。

戒菸
介紹
吸煙是最大的單變量死亡在工業化國家的preventDefault（49）的原因。
人們戒菸的活的時間比那些繼續吸煙及其風險
患上肺癌，心臟疾病，中風和呼吸系統疾病的跌幅。香煙
的燕尾服然而仍然是一個很難打破的習慣，許多吸煙者試圖幾次
之前，他們大麻成功停止。因此，從各種各樣的援助要求
專業人員。
針灸是一種流行的戒菸治療，被認為是減少戒斷症狀。使用針灸起源於工作上面所述在香港的吸毒者，但成效的數據是矛盾的。不受控制的研究建議有戒菸的效果（53.50），一些研究者聲稱非常高的成功率（61-95％）（37，50），但是這不是阻礙健全的方法評估的基礎上。

具體研究
許多戒菸的研究是沒有可比性（1）。協議不同針的位置和數量，頻率和持續時間的治療，所採用的方法（釘書釘，針，激光，電刺激）和安慰劑的定義 - 這可能是自己生產的治療效果。不顧的嚴重程度和吸煙行為和動機特徵，缺乏長期隨訪和小樣本大小，疑問和其他批評。

在1977年的研究，曾熏三年超過15支的92受試者隨機分為兩組，一個星期或留置針留置針“無效”耳穴“積極點”（肺）（腎）一個星期（51）。在一個星期內接受針灸的“主動”網站，更可能是投了棄權票，但不會持續了三個月的後續禁慾。

在薩米的一年，Lacroix和貝桑松也心疼雙邊面部針灸，在這種情況下，每週三個星期，並與假針灸（52）。隨機的方法，在他們的論文中沒有說明，但他們表現出療效顯著，與針灸戒菸相比，有29％的控制組的74％。沒有長期的跟進報導。

帕克和莫，此外，在1977年相比，電針刺激“有效”
“無效”點（肩膀和眼睛）耳穴（神門，肺），超過三
一周內（53）。儘管有跡象表明，積極治療組接收
更可能是捲菸消費減少他們的分歧未能實現
意義。

Tan等（1978）（54），治療病人每週三次，激光針灸在對照試驗報告的一個顯著減少吸煙。

在研究了58吸煙者，由等MacHovec（1978）（55），針灸（針灸網站無限期的耳垂縫合珠），與個人和催眠組會議。自我報告戒菸是困擾針灸和催眠組與對照組相比更高。就業自我保留耳種子。在6個月，25％的受試者接受正確的現場處理戒斷，較安慰劑點的0％。 75％的實驗組結果顯示改善治療後6個月（即減少使用或禁慾）與安慰劑組的25％。請注意，這項研究並沒有說明是否受試者隨機，也沒有提出任何測試的統計學意義。
進行了一項隨機試驗，由Lagrue 154吸煙者（56）。面部穴位重複一個星期後，與假針灸相比。雖然沒有的實現禁慾科目數量在兩組之間的顯著性差異，有一個星期的消費量削減80％。
拉蒙塔涅等人（57）1980年相比，兩種類型的針灸療法，一個針對吸煙撤出和旨在加強放鬆，這使得在隨機試驗對照組。有一個在捲菸中使用針灸組減少，但效果並不繼續為一，三及六個月跟進。這是一個糟糕的選擇

針灸控制程序，因為反吸煙“放鬆治療效果不能被排除。
在第一部分1馬丁等人（58）2部分研究132無論是在三個星期留置在“有效”耳分（肺和飢餓），加上電針20分鐘針的手和耳朵網站收到的吸煙者，或“無效“耳穴（肘部和眼睛）。 128吸煙者在研究的第二部分是隨機到接收的“有效”耳穴和薩米“無效”點。三週後有顯著性差異之間的群體，無論是在沒有任何一項研究，也沒有在6個月跟進。

Steiner等人在1982年，在23個科目進行了一項隨機對照試驗 - 已吸煙超過20支/天（59）連續多年的人。超過兩個星期的時間內給予真正的身體和耳穴針灸和假針灸相比。觀察兩組之間沒有顯著差異，在立即停止。雖然80％的實驗組的報告下降50％，安慰劑組相比，治療後吸煙的慾望，差異無統計學意義。再次，與本研究的樣本量小，限制了它的值。

研究由Cottraux到次年聘請曾吸煙10年或558科目
兩年多的香煙進入的一項研究，比較行為療法，面部
針灸，安慰劑膠囊，等待列表控制（60）。那些在針灸和
行為治療組均顯著更可能停止吸煙在15天的
增長高於安慰劑組，但這種差異並沒有延續到9和12個月的隨訪
隨訪期間。
130吸煙者在一個隨機對照試驗，點穴（耳和全身）和常規治療相比，（61）。禁慾和減少吸煙超過12個月的隨訪評估。無論結果是兩組之間沒有顯著性差異。通過招募200吸煙者自我介別處針（耳針三，兩分體）進行了比較和假針灸（63）隨機對照試驗的Vandevenne等，達成了類似的結論。立即停止，或在1年隨訪無顯著差異。 gillams（62）仿舊留置針在81個學科，已吸煙超過50支香煙，五年（每星期更換）。 A組留置針在耳穴肺科痛心的四個星期內，並與一組放置在一個“無效”點針相比。治療組給予每個星期都。在3個月再次跟進有兩組之間無顯著差異，但是這也許並不奇怪，因為這是心疼的“硬化”煙民。
由Clavel於1985年（64）的研究表明，無論是針灸或尼古丁口香糖治療的受試者比對照組有更好的響應。然而，有兩個積極治療，可能因為人數不足的結果之間沒有區別。均有效幫助吸煙者停止，雖然其中約一半在每個組隨後復發，仍比控制在13個月的治療組顯著戒菸。在以後的試驗中，Clavel（65）未能證明針灸的療效，與假手術對照相比，這兩個群體產生22-23％的訂單一個月後的戒菸率。這是一個大型研究比較使用尼古丁口香糖和針灸在一項隨機，對照組（65）996科目。牙齦治療是它的控制（26 V 19％）明顯多於有效。在以後的2×2析因設計研究，薩米人未能顯示在停止針灸和控制，並在12個月的隨訪（66）尼古丁口香糖和控制之間的利率差。

在1991年，梁的對照試驗比較95一年最不吸煙的受試者在耳穴留置針行為療法。（67）主題在一，三及六個月隨訪。行為組顯著更可能比針灸或對照組已停止吸煙，但針刺組更可能是為了減少吸煙數量。

針灸的效果減少吸煙/戒菸和特異性分
在調查的46名健康男性和女性志願者，他們想戒菸（68）。
受試者被隨機分配是兩組。一組被給予有效
針灸治療（試驗組）和其他點在針灸治療
假設沒有戒菸（對照組）的影響。測量的臨床結果
包括血清丁寧和血清中硫氰酸鹽，最常見的不良生理
有吸煙習慣的指標。治療期間每日吸食香煙的消費量下降
期間在困擾群體，但減少是顯著試驗組。共
在試驗組的31％已戒菸完全在治療結束
與對照組無。為試驗組丁寧濃度
和硫氰酸鹽後，在治療期間顯著減少。為困擾群體的味道
在治療期間，煙草惡化，但效果更明顯的
試驗組比對照組選項。抽煙的慾望大大下降這兩個組
治療後，試驗組比對照組選項和減少較大。 “
研究表明，針灸可以幫助激勵吸煙者減少他們的燕尾服，甚至
完全退出。
白等人（69）在最近的電針研究，觀察在兩個組之間的第一天，14天針刺組（39％和42％的控制）的戒斷症狀分數平均減少之間沒有顯著性差異。在9個月，僅在14天內戒菸的人仍然不吸煙。作者得出結論認為電針發射減少尼古丁戒斷症狀，在一個指定的效果。
在另一項隨機，安慰劑對照試驗於1998年，78個吸煙者主動或安慰劑網站加自我設置（70）在一般的做法，保留了兩個星期的耳朵種子在使用電針灸針的單一治療。積極治療組更可能有比安慰劑組在6個月停止吸煙。

審查和Meta分析
There have been several reviews and meta-analyses carried out in this field, usually analysing many of the same papers but in a different way using different acceptance criteria. A review by Schwartz (1988) (71) used seven studies to analyse a real versus sham acupuncture model involving a total of over 5000 patients, and gave cumulative results, which suggested that real acupuncture works 25% of the time. Sham acupuncture was almost equally effective; cessation rates between 20% and 25% (percentages of people abstinent for 6 months).

A meta analysis by Ter Riet et al (1990) (29) noted that the negative outcomes (51,53,56,57,58,59,60,61,62,63,72,74) exceeded by far the number of positive outcomes (52,55,73). The studies with negative outcomes were graded as methodologically superior, indeed they concluded that the more rigorous the methodology, the more likely it was to have a negative outcome, though on the whole the research was of poor quality. A criticism is that the authors were not experts in acupuncture and may therefore have included studies that were unsatisfactory from an acupuncture point of view. In addition, their main conclusion was not that acupuncture did not work, rather that when studies involving real acupuncture and sham acupuncture were analysed, little difference could be detected between the 'real treatment' and 'placebo'. Also, they failed to consider the specificity of the point selection.
A review in 1995 argued that trials in which control subjects were needled in inappropriate sites underestimated the effects of acupuncture, since needling anywhere could trigger the release of endorphins, which aid the relief of withdrawal symptoms (75). Lewith concluded that acupuncture is as effective as nicotine replacement therapy but that the site of needle insertion does not seem to be important. He stated that the real versus sham acupuncture model is an inappropriate one to investigate the value of acupuncture in the context of smoking cessation, and that a formal meta analysis is fraught with difficulties in combining the results of disparate studies, which use different time points and techniques. He emphasised that the effects of acupuncture are equal to that of the best studies demonstrating withdrawal from smoking with a variety of nicotine replacement treatments.

A more recent review in 1997 was carried out by authors experienced in acupuncture and trial
methodology, and based on a synthesis of best evidence (76). This method (77,78) employs
the greatest internal and external validity using well-specified criteria. It favours effect size
over statistical significance. In this review studies were included if they met the following
criteria; single-blind controlled design ie controls receive sham acupuncture, pre-allocation
concealment of randomisation, appropriate choice of control points, more than 25 subjects in each group. The outcome measure was complete sustained cessation of smoking both immediately after treatment and at the longest follow up period. Sixteen controlled trials were
identified (51,52,53,54,56,57,59,60,61,62, 63,66,74). In two cases, two separate studies were reported. The analysis did not find that the 'active' types of acupuncture used were more effective than 'placebo' or 'sham' for smoking cessation. However, they also concluded that
sham acupuncture was an inappropriate control, as it was likely to have some physiological
effects similar to real acupuncture. If significant differences are to be shown, acupuncture
trials should have larger sample sizes. Practitioner blinding was another problem identified
although the study by Lagrue (52) did manage to achieve this. The authors of the review suggested that research should now be concentrated on: Is electro acupuncture more successful than simple needle acupuncture? Are other treatment schedules (eg different end points, repeated attendances) more effective? Does acupuncture reduce the withdrawal
symptoms associated with smoking cessation?

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
介紹
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.

具體研究
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).

結論
雖然該研究評估針灸在第三件事的人用酒精的使用
問題的疑問和有限的，他們有整體上提供積極的成果。（事實上，
邁耶（88），在最近審查，爭辯說，這是布洛克等人的酒精研究
提供良好療效的證據，藥物濫用的任何地方）。有鄭成功高
輟學率：未來的研究應集中在這種情況的原因，從而限制損失
起來。在本節審議了研究，從海誓山盟都非常不同。例如Wörner等除了兩個耳穴，布洛克仿舊三個耳穴和他們的第一選擇點（81.82）（83）仿舊幾個身體點。 wörner仿舊假針灸，但布洛克發射。 wörner有一個標準的照顧唯一的治療組，布洛克的出席簡約風格AA組會議。針灸的頻率和持續時間不同，治療的長度一樣。
在困擾著研究的樣本規模小。這兩項研究的比較典型的問題金額上升濫用藥物一般針灸研究。 The treatments are not comparable; the study design, analysis and sample sizes differ in significant ways.
The methodological inadequacies make it difficult to interpret the results, which are thought to be inconclusive when considered in the reviews and meta-analyses of the medical literature.

Grateful acknowledgement is made to Nicola Robinson and Mark Bovey for their work in preparing this briefing paper.

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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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