摘要：Objectives . This study examined the effect of acupuncture alone and in combination with education on smoking cessation and cigarette consumption. Methods . We prospectively studied 141 adults in a quasi-factorial design using acupuncture, sham acupuncture, and education. Results . All groups showed significant reductions in smoking and posttreatment cigarette consumption, with the combined acupuncture–education group showing the greatest effect from treatment. The trend continued in follow-up; however, significant differences were not maintained. Greater pack-year history (i.e. the number of years smoking multiplied by baseline number of cigarettes smoked per year, divided by 20 cigarettes per pack) negatively correlated with treatment effect. Trend analysis suggested 20 pack-years as the cutoff point for this correlation. Conclusions . Acupuncture and education, alone and in combination, significantly reduce smoking; however, combined they show a significantly greater effect, as seen in subjects with a greater pack-year history. Acupuncture is increasingly being used to treat problems of chemical dependency. 1 Wen and Cheung first described the effects of acupuncture in alleviating the severity of opiate withdrawal symptoms. 2– 3 They reported that individuals addicted to opiates who underwent acupuncture anesthesia experienced a substantial reduction in the severity of their withdrawal symptoms. Acupuncture procedures based on Wen’s initial protocol, which used electroacupuncture on 2 ear points, have become varied and diverse. Reports have generally noted that ear points seem the most effective body site for treating chemical withdrawal symptoms. 4 Acupuncture has been used to treat addiction to a variety of substances, including alcohol, cocaine, heroin, and tobacco. Several controlled studies have evaluated acupuncture as an aid to smoking cessation. In a recent meta-analysis reported in the Cochrane database 5 and in print format, 6 White et al. examined all of the published studies listed in MEDLINE and hand-searched the non-MEDLINE literature. They found 18 trials; however, only those that used a blinded, sham-control design were included in the analysis. The meta-analysis showed no difference between acupuncture and placebo treatment of smoking. White and colleagues’ study also rated the trials and judged their overall quality to be poor. They noted several concerns regarding design flaws in the trials and offered suggestions for improving the quality of future trials. The authors stated that further research on the role of acupuncture in smoking cessation treatment requires higher-quality studies with the following components: a clear hypothesis; calculation and recruitment of adequate sample sizes; an appropriate method of randomizing subjects; concealment of randomization; minimization of therapist bias (e.g., intention or expectation bias); long-term follow-up for at least 6, and preferably 12 months; highly trained and experienced acupuncturists; and biochemical validation of smoking cessation. Our study improves on previous work in the field by using a more rigorous research design that addresses all but the final concern.
