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Use of the NADA protocol in the treatment of cocaine/crack abuse

by Dr (TCM) Attilio D'Alberto



Background: The United Kingdom has had a significant increase in addiction to and use of cocaine amongst 16-29 from 6% in 1998 to 10% in 2000. In 2000, the UK had the highest recorded consumption of 'recent use' cocaine in Europe, with 3.3% of young adults. Acupuncture is quick, inexpensive and relatively safe, and may establish itself as an important addiction service in the future.
Aim of study: To select investigations that meet the inclusion criteria and critically appraise them in order to answer the question 'Is acupuncture effective in the treatment of cocaine addiction?' The focus shall then be directed towards the use of the NADA protocol as the intervention and the selection of sham points for the control group.
Data Sources: The ARRC database was accessed via Trina Ward at Thames Valley University. AMED, Medline and Embase were also accessed along with 'hand' searching methods at Middlesex University and the British library.
Inclusion and Exclusion Criteria: People addicted to either cocaine or crack cocaine as their main addiction, needle-acupuncture, single/double blind process, randomised subjects, a reference group incorporating a form of sham points. Exclusion criteria: use of moxibustion, laser acupuncture, T.E.N.S. electroacupuncture or conditions that did not meet the inclusion criteria.
Quality Assessment: The criteria set by ter Riet, Kleijnen and Knipschild (1990); Hammerschlag and Morris (1990); Koes, Bouter and van der Heijden (1995), were modified into one set of criteria consisting of 28 different values. Results: Six randomised controlled trials (RCTs) meet the inclusion criteria and were included in this review. All studies scored over 60 points indicating a relatively adequate methodology quality. The mean was 75 and the standard deviation was 6.80. A linear regression analysis did not yield a statistically significant association (n=6, P=0.11).
Reviewer's Conclusions: This review could not confirm that acupuncture was an effective treatment for cocaine abuse. The NADA protocol of five treatment points still offers the acupuncturist the best-possible combination of acupuncture points based upon traditional Chinese medicine. Throughout all the clinical trials reviewed, no side effects of acupuncture were noted. This paper calls for the full five set of treatment points as laid out by the NADA to be included as the treatment intervention. Points on the helix, other than the Liver Yang points, should be selected as sham points for the control group.

Key words: Key words used to search for literature were 'cocaine' and 'acupuncture'.