The lack of effective pharmacotherapies for psychostimulant dependence has created substantial interest in alternative or complementary therapy approaches. Auricular acupuncture for cocaine dependence has been widely practised in the USA and Europe. Although the specific mechanism of action is unclear, it may have potential through calming patients, reducing or assisting with the management of cravings and in the retention of patients in psychosocial treatment. However, evidence for the effectiveness of auricular acupuncture is weak and early promise has not been sustained in larger, more rigorous trials.

Auricular acupuncture

Recently a large single blind controlled trial involving 620 cocaine users recruited in six US cities compared auricular acupuncture, a needle insertion control condition and relaxation (Margolin, Kleber, Avants, Konefal et al., 2002). The investigators had previously found, in an RCT involving 82 cocaine-dependent methadone patients, that those who had received auricular acupuncture were significantly more likely to provide cocaine-negative urine samples (Avants, Margolin, Holford & Kosten, 2000). However, these early positive findings were not replicated in the subsequent trial with no differences between the treatment conditions in the principal outcomes of cocaine positive urine samples and retention in treatment and no differences in any secondary outcome measures. These negative findings were consistent with those reported in an earlier trial of true and sham acupuncture in 236 residential treatment clients (Bullock, Kiresuk, Pheley, Culliton & Lenz, 1999).

Hypericum

Hypericum (St John's Wort) has been used as a treatment for mild to moderate depression in Europe. In a 55-subject placebo controlled trial, the dosage of hypericum had little effect on cocaine use and further investigation was not considered warranted (Watson, Shoptaw, Rawson, Reiber & Ling, 2002).