In spite of the fact that findings of most controlled trials on smoking have been negative or equivocal, acupuncture is widely used in the United States and in Western Europe to facilitate smoking cessation and to lessen symptoms of nicotine withdrawal. Initial open trials of acupuncture for smoking cessation were very promising29; however, more recent sham-controlled trials have yielded equivocal results. Significant differences in the severity of withdrawal symptoms were not found in nicotine-dependent patients who were randomized to an accepted protocol of electroacupuncture versus a sham procedure.30 Two hundred thirty-eight high school students who smoked cigarettes were randomized to weekly auricular acupuncture treatment based on a well-defined protocol for smoking reduction versus a nonspecific protocol. By the end of the 4-week study, only 1 student had stopped smoking and there were no significant differences between the 2 groups in terms of nicotine craving; however, students who completed the smoking cessation protocol smoked fewer cigarettes per day than students in the sham group.31

A Cochrane systematic review and meta-analysis of 22 sham-controlled studies and more than 2000 patients on the efficacy of acupuncture for smoking cessation found no evidence of therapeutic efficacy. Sham-controlled studies on conventional acupuncture, acupressure, electroacupuncture, and laser acupuncture were included in the meta-analysis.32 Because most studies to date are relatively short and do not specify the acupuncture protocol used, longer sham-controlled studies are needed to determine whether optimizing the frequency, duration, and type of acupuncture treatment may be beneficial for smoking cessation.

Negative findings from a Cochrane systematic review and a separate independent review support the conclusion that both conventional acupuncture and electroacupuncture are ineffective in reducing symptoms of nicotine withdrawal and in controlling cocaine addiction.33,34 Nevertheless, persons who use cocaine frequently report subjective calming and diminished craving after only 1 or 2 acupuncture treatments, and this effect is apparently sustained with repeated treatment.

A study comparing 3 auricular acupuncture protocols for relapse prevention in persons abusing cocaine and other narcotics concluded that auricular acupuncture reduced drug craving regardless of the protocol used.35 In an 8-week controlled study comparing acupuncture with conventional drug therapies and placebo in persons using cocaine who were being treated with methadone (Dolophine, Methadose) maintenance therapy, half of the enrolled subjects dropped out, but almost 90% of those who completed the study achieved abstinence after 8 weeks of treatment.36 Patients who successfully achieved abstinence reported diminished narcotics craving and improved mood.

In the first part of this column (Psychiatric Times, February 2007), I reviewed treatments whose beneficial effects are probably achieved through a discrete biological or pharmacological mechanism of action. These included dietary modifications; supplementation with specific vitamins, minerals, and amino acids; and medicinal herbs. In this part, I will review the evidence for approaches that reduce the risk of relapse, diminish craving, or mitigate withdrawal symptoms but for which there is no evidence for direct biological or pharmacological effect. These include exercise, mindfulness training, virtual reality graded exposure therapy (VRGET), cranio- electrotherapy stimulation (CES), dim light exposure,electroencephalogram (EEG) and electromyogram biofeedback, acupuncture, and qigong. Persons receiving conventional pharmacological treatments that seek to reduce the risk of relapse, diminish craving, and mitigate withdrawal symptoms may safely use these and other nonbiological therapies.

Qigong

Findings of sham-controlled trials suggest that external qigong treatment—which must be provided by a qigong healer/master—reduces the severity of withdrawal symptoms in persons who are addicted to heroin.37 Animal studies suggest that external qigong applied to morphine-dependent mice lessens the behavioral symptoms of withdrawal following pharmacological blockade of morphine at the level of brain receptors.38 Regular qigong treatments may provide a useful adjunct to conventional pharmacological and behavioral management of detoxification and withdrawal from heroin and other opiates. The unskillful practice of qigong can potentially result in agitation or psychosis in patients. Persons with an addiction disorder who are interested in qigong should work with a skilled qigong instructor or medical qigong therapist.

Pages: 1  2  3