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Is acupuncture just an expensive placebo?

What does a treatment service do if there is no accepted medication and no specific psychosocial therapy for the particular problem presented by a client? Those dependent on cocaine are usually considered a case in point, though in fact just about any bona fide therapy helps some of these clients some of the time.

One popular solution has been to offer complementary therapies, among which acupuncture (usually at sites in the ear) is by far the most widely used in substance use treatment and for cocaine users in particular. It is also commonly used to ameliorate withdrawal symptoms from drugs including alcohol and heroin. But the faith placed in it by services and patients appears contradicted by research, which generally finds that whether the needles are placed where they are supposed to be or at sham sites makes little or no difference. In patients withdrawing from alcohol, nicotine or drugs, acupuncture does not even help keep them calm. In other words, even if acupuncture works, it does not work in the ways it is supposed to, casting doubt on whether we are seeing anything more than a placebo effect.

However, a placebo effect may itself be valuable. Offering something concrete like acupuncture (even if it is a ‘sham’ procedure) may attract people to services, and some studies have suggested that doing something clients and staff believe is worthwhile can help retain patients in treatment. If this is the case, acupuncture could indirectly improve outcomes by increasing the patient’s exposure to treatment’s active ingredients. Just such a role was specified in guidance from England’s National Treatment Agency for Substance Misuse, now subsumed in to Public Health England. These considerations may explain why despite no convincing evidence of efficacy, acupuncture has featured in many of the treatment plans developed by local partnerships responsible for commissioning treatment services in England. It will take more and different kinds of studies to determine whether even if all they are buying is a possible placebo effect, it remains a worthwhile investment.

When in 2011 the evidence in relation to alcohol treatment and withdrawal was reviewed for the UK’s National Institute for Health and Clinical Excellence, the verdict reached for this official advisory body was that conflicting evidence meant no recommendation could be made, except for more research. More research too was called for in 2006 when the respected Cochrane collaboration published an assessment of whether acupuncture at sites on the ear has helped in the treatment cocaine dependence. The unusually definite conclusion was, “There is currently no evidence that auricular acupuncture is effective for the treatment of cocaine dependence.” However, evidence was limited and from methodologically poor studies, so neither could it be said for sure that acupuncture was ineffective.

Is there something valuable here which simply has not yet been proven to work due to few and sometimes methodologically weak studies, or is trying to find proof a dead end because the technique is simply ineffective? For the evidence to date run this hot topic search.

Last revised 30 August 2015. First uploaded 01 November 2010

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