Acupuncture for drug and alcohol dependence has been tested in two bodies of trials. The first, mostly in the United States and Europe between the late 1980s and 2002, tested ear acupuncture against needles at other sites or against usual care, and its two largest trials, in cocaine and alcohol, found no difference between groups. The second, mostly in China, tested body acupuncture, electroacupuncture and ear acupuncture for withdrawal symptoms, craving, anxiety and depression in people dependent on opioids or methamphetamine, and the reviews that pooled it report benefits from trials they rate as low quality or at high risk of bias. This page covers opioids, alcohol, cocaine and methamphetamine; Smoking cessation covers tobacco.
What was tested
Most of the Western trials used the protocol of the National Acupuncture Detoxification Association (NADA), which the 2006 Cochrane review by Simon Gates and colleagues describes as needles at five points in the ear, developed at Lincoln Hospital in New York in the 1970s. The five are Sympathetic (IAC03), Shenmen (TF10), Kidney (CYC11), Liver (CYC08) and Lung (CVC02). A 2016 review by Elizabeth Stuyt and Claudia Voyles, both NADA trainers, describes the protocol as three to five points given to a group, several times a week for several weeks, always alongside psychosocial or medical care. Ear acupuncture sets out the protocol’s history and how the catalogue codes ear points.
A sham in these trials was usually needles at other points on the ear. Sham acupuncture explains why a comparison with sham and a comparison with usual care answer different questions.
Cocaine
The Cochrane review included 7 trials with 1,433 participants, searched to October 2004, and judged all of them of generally low methodological quality. Six compared ear acupuncture with sham and three also had a group given no acupuncture. It counted anyone who left a trial as still using cocaine. It found no difference between acupuncture and sham, or between acupuncture and no acupuncture, in drop-out (risk ratio 1.05 against sham, 95% CI 0.89 to 1.23) or in any measure of cocaine or other drug use, and no trial reported side effects. The authors concluded that there was no evidence that ear acupuncture is effective for cocaine dependence, that the evidence was not of high quality and was inconclusive, and that too few participants reached the analyses to rule out a moderate benefit or harm. No later version of the review has been published.
Two trials by the same research group tested the protocol in cocaine dependence. In a 2000 trial, Avants and colleagues randomised 82 people dependent on cocaine and receiving methadone to ear acupuncture, needles at other ear sites, or relaxation, five times a week for eight weeks. The acupuncture group gave more cocaine-free urine samples than either control. Margolin and colleagues then ran the same three arms at six US clinics in a 2002 trial of 620 people, 208 of them also receiving methadone, with drug counselling offered to all. Cocaine use fell across all three groups and did not differ between them, and 44% to 46% of each group stayed for the full eight weeks. The authors concluded that their trial did not support acupuncture as a stand-alone treatment for cocaine addiction, or where patients receive little other psychosocial treatment.
Opioids
Cochrane has no review for opioids. A protocol for one, on ear acupuncture for opiate dependence, was published in 2009 and withdrawn in 2017. A 2006 review by Jordan, of 33 years of literature in Western journals, found that supportive evidence came mostly from uncontrolled, unblinded studies, and that well-designed trials found acupuncture no more effective than controls. A 2016 review by Baker and Chang found four randomised trials of the NADA protocol for opioid use disorder and reported that it may not reduce acute craving or withdrawal but may keep people in treatment and lower methadone doses; the authors called their conclusions tentative.
| Review | Trials and participants | Comparison | What it reported |
|---|---|---|---|
| Chen and colleagues 2018, searched to December 2017 | 9 trials, 1,063 people, in China, the UK and the US | No treatment or sham, pooled; sham electroacupuncture | Less craving and depression than no treatment, at low certainty (GRADE); no difference from sham in retention (low certainty); most ratings very low to low, and no trial reported adverse effects |
| Wen and colleagues 2021, network meta-analysis, searched to August 2020 | 20 trials, 1,997 people receiving methadone maintenance, all in China | Four kinds of acupuncture, Western drugs and Chinese herbal medicine, each added to methadone, against each other | No difference in the share who completed detoxification; lower withdrawal scores with manual acupuncture than with drugs, electroacupuncture or electrical stimulation at the points; no trial at low risk of bias |
| Ding and colleagues 2023, searched to March 2022 | 28 trials, 2,463 people, 27 in China | Sham (5 trials), drugs (7), no treatment (3) | Lower protracted withdrawal scores in all three comparisons, with high heterogeneity; 3 trials at low risk of bias overall |
The Ding review defines protracted withdrawal as the long-term physical and mental symptoms that follow detoxification, which it names as an important cause of relapse.
Alcohol
Bullock and colleagues ran the two best-known alcohol trials. In a 1989 study in The Lancet, 80 people with severe, repeatedly relapsing alcohol dependence received acupuncture at points specific to substance abuse or at non-specific points. Of 40 in the treatment group, 21 completed the programme, against 1 of 40 controls, and at six months the control group had more than twice as many drinking episodes and admissions to a detoxification centre. NICE’s review of the trial notes that it was not randomised. The same group’s 2002 trial randomised 503 people to specific acupuncture, non-specific acupuncture, symptom-based acupuncture or conventional treatment alone, and found no difference between groups in alcohol use, although 49% of participants said acupuncture reduced their desire to drink.
A 2009 review by Cho and Whang, of 11 trials with 1,110 people searched to June 2008 in 19 databases, found 2 trials that met all its quality criteria. Three of four sham-controlled trials found no difference in craving, and completion rates did not differ from sham or from no acupuncture. The authors concluded that the trials did not allow any conclusion. A 2016 review by Southern and colleagues at the University of York, of 15 trials with 1,378 people in English and Chinese journals, rated most of them poor and found less craving and fewer withdrawal symptoms than all controls combined, and less craving than sham (standardised mean difference −1.00, 95% CI −1.79 to −0.21, where a negative value favours acupuncture). A 2018 review by Liu and colleagues, of 11 trials with 875 people in acute or protracted alcohol withdrawal, found no difference from sham in craving or completion when acupuncture was added to medication.
Methamphetamine
A 2026 network meta-analysis by Zhao and colleagues, searched to December 2025, included 35 trials with 2,812 participants across drug types, 11 of them in methamphetamine and 22 in opioids or heroin. It found acupuncture, particularly added to usual care, associated with improvement in withdrawal, anxiety and depression, with more consistent effects on withdrawal from courses longer than 20 days, and rated the certainty of the withdrawal findings moderate to very low, mainly because treatment could not be blinded. In a sham-controlled trial published in English, Zeng and colleagues randomised 68 men in compulsory detoxification in Shanghai to electroacupuncture or sham electroacupuncture three times a week for four weeks, and reported lower psychosis, anxiety and depression scores with electroacupuncture.
What guidelines say
NICE’s guideline on opioid detoxification, CG52, published in July 2007 and last reviewed in December 2024, makes no recommendation on acupuncture. Its full guideline reviewed two randomised trials and the Jordan review, reported that the review found no evidence to support acupuncture as a standalone treatment for opioid dependence, and concluded that there was no established evidence base for acupuncture as a method of detoxification.
NICE’s alcohol guideline, CG115, published in February 2011 and last updated in October 2014, reviewed five studies with 752 participants for abstinence and drinking and, in its full guideline, found not enough evidence to confirm a benefit, so made no clinical recommendation. It asks instead, in its recommendations for research, whether acupuncture reduces alcohol consumption compared with standard care. NICE last reviewed CG115 in July 2019 and found no new evidence that affected its recommendations.
The World Health Organization’s 2009 guidelines on treating opioid dependence found opioid agonist maintenance treatment, such as methadone or buprenorphine combined with psychosocial support, the most effective of the options they examined, and do not mention acupuncture. Clinical guidelines sets out other bodies’ positions on acupuncture.
What the reviews could not settle
The two bodies of trials point in different directions and test different things. The cocaine trials compared ear acupuncture with needles elsewhere on the ear and measured drug use by urine test. The Chinese trials mostly compared acupuncture with no added treatment or with drugs and measured symptom scales, and Zhao and colleagues downgraded those findings because treatment could not be blinded. The two reviews that graded certainty, Chen’s and Zhao’s, rated their findings from moderate to very low. Stuyt and Voyles argue that trials testing the NADA protocol on its own, given individually or with too few sessions, do not measure the protocol as practised, and recommend comparing it added to accepted treatment with that treatment alone. Long-term outcomes are thin: the Cochrane review found no cocaine trial that followed participants beyond nine months, and NICE’s research question for alcohol asks for outcomes over at least 12 months.
AcuiQ’s opioid dependence, methamphetamine addiction and alcohol dependence pages list the protocols individual studies prescribed, each with its citation.