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Uncertainty remains about the long-term effects of acupuncture on smoking cessation, in the absence of sufficient evidence from rigorous trials.1 There is even less evidence involving ‘hard to reach’ smokers, and we know of no previous studies involving smokers with drug dependence. In her linked paper,2 Stuyt reports the provision of auricular acupuncture as an option in a residential drug rehabilitation unit for 231 patients, many with drug dependence and personality disorder (dual diagnosis). Those who chose acupuncture showed several apparent benefits in comparison with those who did not, including improved programme completion rates and increased long-term smoking cessation. It should be emphasised that the study was naturalistic with all the advantages that brings (eg, patients’ behaviour and choices are not distorted by rigid trial procedures), but also with several limitations from an evidence-based aspect, including non-randomisation of patients and no chemical validation of smoking cessation.
The 10% quit rate for smoking cessation at 1 year seems to be a highly respectable figure in this population with high dependence on chemical substances, and further research is justified to replicate the effects in a randomised controlled trial (RCT). Stuyt's paper also highlights other variables that modify the effect and must be …