---
title: "Smoking cessation"
url: "https://acuiq.com/wiki/evidence/smoking-cessation"
updated: 2026-10-09
last_verified: 2026-10-09
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-09"
reading_minutes: 6
sources: 6
---

# Smoking cessation

_What the Cochrane review of 38 studies, two later meta-analyses, a sham-controlled trial and NICE's tobacco guideline report on acupuncture, acupressure, laser and electrical stimulation for stopping smoking._

The [2014 Cochrane review](https://doi.org/10.1002/14651858.CD000009.pub4) by Adrian White and colleagues, the most recent version of a review first published in 2000, counts how many people are still not smoking at two points: soon after treatment, and six months to a year later, confirmed by a biochemical test where one was done. It found effects at the first point that did not persist to the second, and later reviews have mostly reported the first.

## What was tested

The Cochrane review covered needle acupuncture on the body and the ear, acupressure, laser stimulation and electrical stimulation, each compared with sham treatment, no treatment or an established method such as nicotine replacement therapy (NRT). Many trials stimulated the ear continuously between sessions, with needles left in place or with acupressure, which the review calls continuous auricular stimulation. [Ear acupuncture](/wiki/techniques/ear-acupuncture) describes the methods and [the auricular points](/meridians/auricular-points) lists the ear points in the catalogue.

## The Cochrane review

The review included 38 studies searched to October 2013, with four Chinese databases. It counted anyone lost to follow-up as still smoking and used the strictest definition of abstinence each trial reported. Short term means before six weeks; long term means six months to a year.

| Comparison | Short term, risk ratio (95% CI) | Long term, risk ratio (95% CI) |
| --- | --- | --- |
| Acupuncture against sham acupuncture | 1.22 (1.08 to 1.38); 19 comparisons, 2,588 people | 1.10 (0.86 to 1.40); 11 comparisons, 1,892 people; moderate quality |
| Acupuncture against waiting list | – | 1.79 (0.98 to 3.28); 3 studies, 393 people |
| Acupressure against sham acupressure | 2.54 (1.27 to 5.08); 3 trials, 325 people | No trial reported it |
| Continuous ear stimulation against sham | 1.69 (1.32 to 2.16); 14 trials, 1,155 people | 1.47 (0.79 to 2.74); 5 trials, 570 people |
| Electrical stimulation against sham | 1.13 (0.87 to 1.46); 6 trials, 634 people | 0.87 (0.61 to 1.23); 2 trials, 405 people |

A risk ratio above 1 means more people stopped smoking with the treatment; a confidence interval that crosses 1 means the trials could not distinguish the result from no difference. Within continuous ear stimulation, acupressure showed a short-term effect (risk ratio 2.73; 7 studies, 496 people) and needles left in the ear did not (1.24; 6 studies, 659 people). The two laser trials disagreed and could not be combined. In two studies with 814 people acupuncture was less effective than NRT, and the review found no evidence that it beat psychological interventions such as counselling.

The authors judged no study free of bias. A funnel plot, which checks whether small trials report larger effects than large ones, was asymmetrical, with the larger studies showing smaller effects. They concluded that there was no consistent, bias-free evidence of a benefit lasting six months or more for acupuncture, acupressure or laser, that the lack of evidence meant no firm conclusion could be drawn, and that electrical stimulation was not effective. They called for well-designed research because the methods are popular and safe when correctly applied, and expected acupuncture alone to be less effective than proven methods such as NRT.

## Later reviews

A [2019 meta-analysis](https://doi.org/10.18332/tid/109195) by Wang and colleagues, of 24 trials with 3,984 participants searched to February 2017, rated the trials’ quality as generally low. Body acupuncture combined with ear acupressure did better than sham versions of both, at the short-term point (risk ratio 2.50; 3 trials) and the long-term one (3.61; 2 trials). Acupuncture combined with counselling, a cessation education programme or moxibustion did better than acupuncture alone.

A [2024 umbrella review](https://doi.org/10.18332/tid/186147) by Zhang and colleagues, searched to December 2023, assessed 13 earlier systematic reviews and 20 trials outside them, and pooled the trials again. It rated every earlier review as low or very low quality on AMSTAR-2, a checklist for how well a review was conducted, and found 16 of the 20 trials at high risk of performance bias. Its updated analyses, all at low certainty and all for abstinence at up to six months:

- Needle acupuncture against sham: risk ratio 1.44 (95% CI 1.02 to 2.02; 9 trials, 1,358 people).
- Needle acupuncture with acupressure against nicotine patches: 0.99 (95% CI 0.74 to 1.32; 6 trials, 524 people), meaning no difference found.
- Acupressure against counselling: 1.46 (95% CI 1.14 to 1.87; 8 trials, 595 people).

Neither review found a serious adverse event, and Zhang and colleagues asked for long-term follow-up.

## Two sham-controlled trials

A [2002 trial](https://doi.org/10.2105/ajph.92.10.1642) by Bier and colleagues studied 141 adults in a design that crossed ear acupuncture, sham acupuncture and an education programme. Every group smoked less after treatment, and the group given acupuncture with education smoked least. The differences between groups did not last through follow-up.

A [2024 Chinese trial](https://doi.org/10.3389/fmed.2024.1418967) by Dai and colleagues tested acupuncture and nicotine patches together, randomising 88 smokers to real or sham acupuncture combined with a real or sham patch; 78 finished. Abstinence after 8 weeks, confirmed by exhaled carbon monoxide, differed across the four groups, and the authors concluded that acupuncture with a patch did better than either alone. They found no statistical interaction between the two treatments and no difference between groups in cigarettes smoked a day, withdrawal scores or dependence scores.

## What guidelines say

NICE’s guideline on tobacco, [NG209](https://www.nice.org.uk/guidance/ng209), published in November 2021 and last updated in February 2025, lists the stop-smoking options it says should be accessible to adults who smoke: individual and group behavioural support, very brief advice, cytisinicline, NRT, varenicline, bupropion, nicotine-containing e-cigarettes and the Allen Carr’s Easyway group seminar. Acupuncture is not on the list and is not mentioned in its recommendations on treating tobacco dependence. [Clinical guidelines](/wiki/evidence/clinical-guidelines) sets out other bodies’ positions.

## What the reviews could not settle

The Cochrane review’s long-term finding rests on moderate-quality evidence. The later reviews report mostly short-term abstinence, which the Cochrane review found did not carry through to six months, and the trials behind them are small and at high risk of bias. The Cochrane review found no trial of acupressure against sham that reported abstinence at six months or more, so whether its short-term effect lasts is untested. The Cochrane review has not been updated since 2014.

AcuiQ’s [smoking cessation](/symptoms/smoking-cessation), [nicotine dependence](/symptoms/nicotine-dependence) and [nicotine withdrawal](/symptoms/nicotine-withdrawal) pages list the protocols individual studies prescribed, each with its citation.

### Sources

1. White AR, Rampes H, Liu JP, Stead LF, Campbell J, Acupuncture and related interventions for smoking cessation, Cochrane Database of Systematic Reviews 2014 — https://doi.org/10.1002/14651858.CD000009.pub4
2. Wang JH, van Haselen R, Wang M, et al., Acupuncture for smoking cessation: a systematic review and meta-analysis of 24 randomized controlled trials, Tobacco Induced Diseases 2019 — https://doi.org/10.18332/tid/109195
3. Zhang YY, Su YZ, Tian ZY, et al., Acupuncture and related acupoint therapies for smoking cessation: an umbrella review and updated meta-analysis, Tobacco Induced Diseases 2024 — https://doi.org/10.18332/tid/186147
4. Bier ID, Wilson J, Studt P, et al., Auricular acupuncture, education, and smoking cessation: a randomized, sham-controlled trial, American Journal of Public Health 2002 — https://doi.org/10.2105/ajph.92.10.1642
5. Dai R, Ren D, Li B, Zhang Y, et al., Effects of acupuncture and nicotine patch on smoking: a multicenter, randomized, controlled, double-blind clinical trial, Frontiers in Medicine 2024 — https://doi.org/10.3389/fmed.2024.1418967
6. National Institute for Health and Care Excellence, Tobacco: preventing uptake, promoting quitting and treating dependence (NG209), published 2021, last updated February 2025 — https://www.nice.org.uk/guidance/ng209