STUDY FINDS BEATING COCAINE TAKES MORE THAN ACUPUNCTURE

Acupuncture is widely used as a treatment for cocaine addiction. But the
results of a large clinical trial suggest that when used alone without
other treatments the therapy is not effective in reducing cocaine
dependency, researchers report yesterday.

Needles inserted into four acupuncture zones in the ear that are commonly
used in treating addiction did no more to curtail cocaine use than
relaxation exercises or a sham procedure in which needles were inserted
into the rim of the ear. The study participants received the acupuncture or
the other treatments five times a week for eight weeks.

Dr. Arthur Margolin, a research scientist at Yale's School of Medicine and
the main author of the study, said that based on the findings, "the
recommendation would be that acupuncture not be used by itself as a
treatment for addiction, or in a setting where there is only minimal
counseling or therapy."

But Dr. Margolin added, "I don't think this trial shows that acupuncture is
ineffective across the board."

Some practitioners who use acupuncture to treat cocaine addiction did not
dispute the study's findings but said the technique was rarely used alone
and was usually combined with other treatments. The way that acupuncture
might work to treat addiction remains unclear.

A report on the study appeared yesterday in The Journal of the American
Medical Association.

Earlier studies of acupuncture as a treatment for cocaine dependency, one
of the most difficult forms of drug addiction to combat, have emerged with
mixed results. A smaller trial at Yale last year found the therapy to be
effective in helping some people reduce their reliance on the drug.

Experts on addiction said the new trial -- by Dr. Margolin, Dr. Herbert D.
Kleber, of Columbia University's National Center on Addiction and Substance
Abuse, and more than a dozen collaborators at six community-based drug
dependency clinics around the country -- was the largest to test
acupuncture's effectiveness for drug addiction and among the largest to
examine the method's usefulness in any medical condition.

The acupuncture procedure used in the trial followed guidelines developed
at Lincoln Medical and Mental Health Center in the Bronx and adopted by the
National Acupuncture Detoxification Association.

Of the 620 adults who initially enrolled in the trial, 208 of whom
regularly used heroin as well as cocaine, almost half dropped out before
the study's completion, as is common in studies of addiction treatment.

Those who remained showed a significant reduction in cocaine use, as
measured by urine samples. But the extent of the reduction was the same no
matter which treatment the subjects received.

And while some experts have argued that acupuncture helps people with drug
problems stay in treatment, the subjects who received acupuncture were no
more likely to finish the trial or to attend the counseling sessions
offered to participants.

Dr. Margolin said the findings were unexpected in light of the earlier,
positive results from the smaller Yale trial.

"It's not unusual when you have successive trials of similar treatments to
have different findings, but to go from a fairly strong finding for
acupuncture to no finding was surprising," he said.

In their report, Dr. Margolin and his colleagues suggest that the
difference may be explained by the fact that the subjects in the smaller
study received more intensive individual counseling and weekly group
therapy in addition to acupuncture. And unlike the subjects in the smaller
study, the participants in the national trial were paid $2 per session and
an additional $10 at the end of each week for their participation. Those
who remained in the study until the end were the most severely addicted and
the least motivated to conquer their dependency.