Acupuncture has been used in the treatment of nicotine dependence in the West since an incidental observation in Hong Kong (Wen 1973). Opium smokers who had been given electrical stimulation to acupuncture needles (electroacupuncture) for pain relief claimed that their opiate withdrawal symptoms were less severe than they expected. Subsequently, various forms of needle or electrical stimulation have been used as a treatment for dependence on various addictive drugs, with the specific aim of reducing withdrawal symptoms and aiding cessation.
For smoking cessation, needles are usually inserted for the duration of a treatment session (often lasting 15 – 20 minutes) at the time of cessation. The treatment may be repeated on the following days. Alternatively, or in addition, to this intervention, specially designed indwelling needles may be inserted, usually in ear points, and held in position with surgical tape for several days. Patients are instructed to press these indwelling needles when they become aware of withdrawal symptoms. As an alternative to indwelling needles, small seeds may be attached to the ear with adhesive tape and pressed intermittently (acupressure). Descriptions also exist of the use of a surgical suture which is inserted in the ear and knotted with a bead attached (Man 1975).
Acupuncture needles are generally stimulated manually during the treatment of most conditions. For smoking cessation, some acupuncturists stimulate the needles electrically with the intention of stimulating more precisely the release of neurotransmitters that may be involved in suppression of withdrawal symptoms (Clement-Jones 1979). Other clinicians have argued that the needles are unnecessary and it is sufficient to apply the electrical stimulation through surface electrodes attached to the mastoid process or the ear. This form of treatment is variously known as neuroelectrical therapy or transcranial electrotherapy. Its use overlaps, and has to a certain extent merged with, the therapy known as Cranial Electrostimulation (CES) which developed separately, mainly in the former Soviet Union and Eastern Europe, as a treatment for insomnia, anxiety and depression. CES has also been used for treatment of alcohol and drug dependence (Klawansky 1995). The electric current is usually sufficient to cause mild tingling sensation, though sometimes subthreshold currents are used. It seems likely that the precise details of the placement of electrodes and the parameters of electrical stimulation are critical for success (Boutros 1998, Patterson 1993).