Empirical research has produced mixed results regarding the effects of acupuncture on the treatment of alcohol use disorder in humans. Few studies have provided a comprehensive review or a systematic overview of the magnitude of the treatment effect of acupuncture on alcoholism. This study investigated the effects of acupuncture on alcohol-related symptoms and behaviors in patients with this disorder. The PubMed database was searched until 23 August 2016, and reference lists from review studies were also reviewed. Seventeen studies were identified for a full-text inspection, and seven (243 patients) of these met our inclusion criteria. The outcomes assessed at the last posttreatment point and any available follow-up data were extracted from each of the studies. Our meta-analysis demonstrated that an acupuncture intervention had a stronger effect on reducing alcohol-related symptoms and behaviors than did the control intervention (
Alcohol use disorder is characterized by maladaptive patterns of alcohol consumption, which lead to health and social problems [
Acupuncture emerged as a treatment for addiction in the 1970s, and the first report, from a Hong Kong study, indicated that it is a relatively safe complementary and alternative medical approach [
A substantial number of studies have suggested the efficacy of acupuncture interventions to ameliorate alcohol-related behaviors [
Potentially relevant articles were identified through a PubMed literature search using the keywords [acupuncture OR electroacupuncture OR “acupoint stimulation” OR transcutaneous OR electrostimulation AND alcohol] for articles published until 23 August 2016. Two researchers (Na Young Shin and Young Jin Lim) searched the articles independently. The reference lists of review articles were also inspected. The inclusion criteria were the following: (1) being published in a peer-reviewed English-language journal, (2) use of randomized controlled trials (RCTs), (3) assessing the effects of acupuncture on psychological variables in individuals with a primary alcohol problem, and (4) reporting statistics that could be converted to effect sizes.
The same two authors (Na Young Shin and Young Jin Lim) cross-checked the recorded variables, including year of publication, type of intervention, treatment protocol, sample size for the last intervention, mean and standard deviation of age, and psychological assessment results (mean and SD or
The statistical analysis was conducted using Comprehensive Meta-Analysis ver. 3 software (Biostat Inc., Englewood, NJ, USA). Hedges’
In total, 806 articles were identified via the PubMed search, and 10 relevant articles were selected for further full-text analysis after a review of titles and abstracts. An additional seven studies were selected for full-text inspection via a manual search of the reference list from the reviewed studies. Based on the inclusion criteria, two studies were excluded because they were not RCTs, and eight were excluded due to the lack of statistics required to calculate effect sizes (Figure
Search strategy used to select the studies in the meta-analysis.
We rereviewed 7 studies selected via a PubMed search and 10 selected through a manual search of reference lists for the follow-up data. Among these articles, three reported statistics appropriate for conversion to effect sizes for the follow-up data. Two studies reported data 6 months after treatment, and one study reported data 12 months after treatment. In these three studies, 297 patients with alcohol use disorder (144 and 153 in acupuncture and control groups, resp.) participated in a follow-up survey.
The studies were conducted in the United States (
Summary of studies included in the meta-analysis.
Study | Acupuncture/control | Treatment protocol | Assessment | F/U | |||
---|---|---|---|---|---|---|---|
| Age | Intervention | Acupoint | Treatment periods | |||
Chang et al. (2010) | 17/10 | 46/51 | Needle/relaxation | Ear | Twice weekly for 10 wks | Alcohol craving | |
Anxiety | |||||||
Trümpler et al. (2003) | 15/16 | 45/49 | Needle/sham laser | Ear | Daily until the end of withdrawal | Alcohol | |
withdrawal | |||||||
Karst et al. (2002) | 17/17 | 46/41 | Needle/placebo needle | Ear & body | Daily for 2 wks | Alcohol | |
withdrawal | |||||||
Anxiety | |||||||
Bullock et al. (2002) | 98/115 | NR | Needle, specific/nonspecific | Ear | Daily for 3 wks | Alcohol craving | 12 mon later |
Rampes et al. (1997) | 10/12 | 39/40 | Electroacupuncture, specific/nonspecific | Ear | Once weekly for 6 wks | Alcohol craving | 6 mon later |
Anxiety | |||||||
Alcohol use | |||||||
Worner et al. (1992) | 19/21 | 42/42 | Needle/sham transdermal | Body | Thrice weekly for 3 mon | AA attendance | 6 mon later |
Bullock et al. (1989) | 32/25 | NR | Needle, specific/nonspecific | Ear | Once weekly for the first 2 wks, thrice weekly for the next 4 weeks, and twice weekly for the last 2 wks | Drinking episode | |
Alcohol use | |||||||
Bullock et al. (1987) | 19/13 | NR | Needle, specific/nonspecific | Ear | Daily for 5 days, thrice weekly for the next 4 weeks, and twice weekly for 45 days | Alcohol craving | |
Alcohol use |
F/U, included in the follow-up data analysis; mon, month; NR, not reported; specific/nonspecific, specific point or nonspecific point to addiction; wks, weeks.
To estimate the overall effect of acupuncture on psychological variables, studies reporting alcohol-related symptoms or behaviors, such as alcohol craving, alcohol withdrawal, and the number of drinking episodes, were synthesized in the meta-analysis. As shown in Table
Effects of acupuncture on psychological variables in alcoholics.
Psychological variable | Studies, | Acupuncture, | Control, | ES | 95% CI | | |
---|---|---|---|---|---|---|---|
Overall effect | 7 | 129 | 114 | 0.656 | 0.389, 0.920 | 4.837 | <0.001 |
Alcohol craving | 3 | 46 | 35 | 0.781 | 0.080, 1.481 | 2.184 | 0.029 |
Anxiety | 3 | 42 | 45 | 0.320 | −0.110, 0.750, | 1.459 | 0.145 |
Alcohol use | 3 | 61 | 50 | 0.777 | −0.048, 1.602, | 1.847 | 0.065 |
Long-term effect | 3 | 144 | 153 | 0.286 | 0.059, 0.514 | 2.463 | 0.014 |
CI, confidence interval.
Overall effect size of the psychological variables in each study.
A significant difference was observed between the acupuncture and control conditions, with a small effect size for the follow-up data (
In meta-analysis, heterogeneity and publication bias may lead to erroneous conclusions. The former occurs when study outcomes vary between studies due to methodological and clinical differences, and the latter occurs when studies with statistically significant results are more likely to be published than those with nonsignificant results.
The
The present study is the first meta-analysis to examine the effect of acupuncture treatment on patients with alcohol use disorder and to provide data on the magnitude of this effect on alcohol-related clinical symptoms and behaviors. Our analysis shows that acupuncture treatment had a stronger effect on reducing specific clinical symptoms, including alcohol craving/withdrawal, and on modulating alcohol-related behaviors compared to a control intervention, with effect sizes of 0.6 to 0.8. Given that these results were drawn from data collected at the last posttreatment visit after completing 2 weeks to 3 months of treatment, the significant results may reflect the effect of multiple trials rather than that of a single trial. The magnitude of the long-term effect of acupuncture on alcohol-related symptoms and behaviors was statistically significant but weak, with a small effect size. Notably, this meta-analysis was limited by the small number of studies; thus, the findings should be interpreted cautiously. Well-controlled large cohort studies are needed to elucidate whether acupuncture is effective for treating alcohol use disorder over short-term and long-term periods.
Although the sample size of the present study was insufficient to allow a reliable interpretation of the meta-analytic findings, the magnitude of the effect of acupuncture treatment was relatively strong, with no publication bias and low heterogeneity across studies. The treatment protocols of the studies included in our meta-analysis varied, particularly regarding acupoint location, type of control condition, and treatment duration. Despite several methodological differences, the studies indicated a positive effect of acupuncture treatment on alcohol-related symptoms and behaviors. Our results are partly consistent with findings of a recent meta-analysis that observed a significant difference between acupuncture and control conditions in terms of reducing postintervention withdrawal/craving and anxiety in patients with a substance use disorder [
In conclusion, this meta-analysis suggests that acupuncture treatment has a more significant effect than control interventions on the alcohol-related symptoms and behaviors of patients with alcohol use disorder. However, as the number of studies included in the meta-analysis was small, further RCTs are required to yield a definitive conclusion about the effect. Furthermore, additional studies are needed to explore acupuncture treatment protocols for alcohol use disorder and to elucidate the long-term effects of such interventions on larger samples.
The authors declare that there are no competing interests regarding the publication of this paper.
This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korean Government (MSIP) (NRF-2015R1A5A7037508).