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Combination therapy, acupuncture shown effective in curbing cocaine cravings

Yale Medicine Magazine, 2000 - Fall / 2001 - Winter


Many heroin addicts also abuse cocaine and continue taking the drug even after they stop using heroin. Currently available medications that help them stop using heroin do little to reduce their appetite for cocaine. Yale investigators have found that combining a drug used to treat alcoholism with an experimental drug to treat heroin addiction can help users abstain from using cocaine as well. Another study showed that acupuncture in combination with a heroin drug treatment regimen may also effectively diminish the desire for cocaine.

Past studies had shown that buprenorphine, an experimental alternative to methadone for treating opiate addiction, is effective in reducing heroin use, but no currently used medication treatment is effective in reducing an addict’s concurrent cocaine use. When buprenorphine was combined with disulfiram—a drug for treating alcoholism marketed as Antabuse—the combination worked better than buprenorphine alone in promoting three weeks of abstinence from cocaine use in persons with dual heroin and cocaine addictions. The early-stage study of 20 addicts appeared in the Spring 2000 issue of Biological Psychiatry. Tony P. George, M.D., assistant professor of psychiatry and an investigator for the study, said, “Addiction to heroin along with cocaine abuse is a horrible problem. Disulfiram can actually reduce cocaine use in these patients.”

Principal investigator Richard S. Schottenfeld, M.D. ’76, a professor of psychiatry, is now directing a trial of the drugs with a larger group of subjects and other studies of the combination treatment. He and colleagues are also working to correlate the medications’ mechanism of action with the genetics of drug addiction. “Even if disulfiram proves effective, it’s not an ideal treatment,” he said. “It has all sorts of associated problems. By finding its mechanism of action, we’ll be able to design a new drug that refines its effect.”

The acupuncture study tested 82 subjects in three groups. Among those who had needles inserted in acupuncture regions of the outer ear five times a week—a protocol already widely used in addiction treatment facilities—54.8 percent tested free of cocaine at the end of the eight-week study. The second group of subjects received treatment with acupuncture needles that were inserted into four points in the ear not thought to have a therapeutic effect. Among this group, 23.5 percent of the subjects managed to remain free of cocaine during the study. Only 9 percent of the third group, who watched relaxation videos, abstained for the eight-week period. Arthur Margolin, Ph.D., a research scientist in psychiatry and director of the study, said, “This was one of the most stringent tests of acupuncture to date, insofar as it compared the experimental treatment to two relatively ‘active’ control groups. However, further research is needed to replicate these findings, as well as to understand the mechanism of acupuncture in this application.” The study was published in the August issue of Archives of Internal Medicine.