RESEARCHERS SAY 'YEA' TO YALE COCAINE STUDY

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Pioneer researchers in the acupuncture treatment of addictions field are applauding the latest published findings from Yale University on treatment of cocaine addiction.

According to Milton Bullock, MD, "It was a well done study. The methods are laid out exactly. I think definitely these findings are sufficient to enable more research to be done."

Bullock was lead author of the two late 1980s publications that put this acupuncture for addiction on the map as a serious topic for study by Western science. Together with Patricia Culliton, MA, DiplAc, and others, he conducted real vs. sham randomized trials for chronic alcoholics that showed marked improvements in retention and recidivism for the patients receiving real acupuncture.

In the opinion of Ron Jackson, MSW, the Yale findings "are just as good as any other forms of treatment that have been tried for these folks, and even though the retention wasn't all that they might have hoped for in the active acupuncture cohort, that [rate] pretty well parallels the drop out rate in other interventions for cocaine. You can look at this as a glass that is half empty or half full and I think it is more than half full."

Jackson is another experienced researcher working on US-government and foundation-funded projects. Some of his published work has been in the area of acupuncture treatment of patients on methadone maintenance - the same type of patients as took part in the new Yale study.

For the last 20 years, Jackson has run a large methadone provider agency in downtown Seattle. His advice to methadone colleagues, re: acupuncture? "Full speed ahead. When you consider the range of other options that you have to offer people who have cocaine dependency and who come into your clinic for care, I don't see any reason not to go head on with [utilizing acupuncture].

"I hope folks do it. That is what I tell my colleagues. [Before starting acupuncture] I was frustrated, we weren't doing worth a damn with our patients who had cocaine dependence and I thought well 'let's try something, and at the very least this is a do-no-harm kind of thing.'" And, Jackson adds, "acupuncture still meets that test."

Jackson explains that the Yale findings are clinically relevant to most methadone programs, because of the high incidence of cocaine use usually found. The cocaine-dependent population among his own patient group runs from 25-30% and may be even higher in some other communities.

While acknowledging that acu detox methods are already in use in many programs, "maybe in the thousands," Bullock stopped short of agreeing that this utilization is justified by the scientific evidence actually in hand. He is previously on record with his doubts about the evidence-basis for acu detox, (see Guidepoints, June, 1998) and observed that the Yale authors expressed caution regarding the still-remaining methodological difficulties of the subject.

However, Bullock strongly endorses the potential value of acupuncture, and of a need for further research, while calling for standardization of study methods, including points used and types of patients studied. He also calls for much larger patient samples.

In 1999, Bullock and his colleagues published a study of 438 cocaine addicts, some of whom received acu detox treatment, sham treatment or different doses of real acupuncture as part of a regular addiction treatment program. Sophisticated analysis revealed no measurable improvement in the outcomes of those who received the real treatment.

But, says Bullock, "making a comparison between our paper and [the new Yale study] is very difficult because there were two different populations and we used different points, and so forth. So to try to discuss why we found no significant effects, whereas they found a decrease in positive urines with the true acupuncture group, that's a difficult discussion because of the differences."

As to details of a possible standard model of research, Bullock recommends that the acu point locations described in the new Yale work ought to be the ones used. This is because Yale's control [or "sham"] points, located on the helix of the ear, have been shown by previous Yale publications to be an improvement over previous control points. (See Guidepoints, June, 1997.)

A standard model should also include significant follow up to see if the positive effects noted during acute treatment persist over time, Bullock says. Acknowledging that it would add significantly to the cost of studies, Bullock proposes designing future research projects to include follow up at three months, six months and one year, post-discharge.

Contact: Milton L. Bullock, MD, director of division of addiction and alternative medicine, Hennepin County Medical Center, 701 · Park A venue South, Minneapolis, MN 55415. Fax:(612) 904-4299.

Ron Jackson, MSW, director, Evergreen Treatment Services, 1700 Airport Way S, Seattle, WA 98134-1618 Fax: (206) 223-1482. Email: ronjack@u.washington.edu

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