Context: Auricular acupuncture is widely used to treat cocaine addiction in the United States and Europe. However, evidence from controlled studies regarding this treatment's effectiveness has been inconsistent. Objective: To investigate the effectiveness of auricular acupuncture as a treatment for cocaine addiction. Design: Randomized, controlled, single-blind clinical trial conducted from November 1996 to April 1999. Setting: Six community-based clinics in the United States: 3 hospital-affiliated clinics and 3 methadone maintenance programs. Patients: Six hundred twenty cocaine-dependent adult patients (mean age, 38.8 years; 69.2% men); 412 used cocaine only and 208 used both opiates and cocaine and were receiving methadone maintenance. Intervention: Patients were randomly assigned to receive auricular acupuncture (n=222), a needle-insertion control condition (n=203), or a relaxation control condition (n=195). Treatments were offered 5 times weekly for 8 weeks. Concurrent drug counseling was also offered to patients in all conditions. Main Outcome Measures: Cocaine use during treatment and at the 3- and 6-month postrandomization toxicology screens; retention in treatment. Results: Intent-to-treat analysis of urine samples showed a significant overall reduction in cocaine use (odds ratio, 1.40; 95% confidence interval, 1.11-1.74; P=.002) but no differences by treatment condition (P=.90 for acupuncture vs both control conditions). There were also no differences between the conditions in treatment retention (44%-46% for the full 8 weeks). Counseling sessions in all 3 conditions were poorly attended. Conclusions: Within the clinical context of this study, acupuncture was not more effective than a needle insertion or relaxation control in reducing cocaine use. Our study does not support the use of acupuncture as a stand-alone treatment for cocaine addiction or in contexts in which patients receive only minimal concurrent psychosocial treatment. Research will be needed to examine acupuncture's contribution to addiction treatment when provided in an ancillary role.
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