Cocaine abuse by HIV-positive individuals is a major factor in the transmission of HIV to the HIV-negative population; consequently, developing and testing effective treatments for this disorder among HIV- positive patients is an urgent public health concern. Preliminary data from our site suggest that an alternative therapy, auricular acupuncture, may reduce cocaine abuse among HIV-positive patients, but that a number of issues must be addressed before conducting a full-scale clinical trial. The proposed series of studies will investigate three critical dimensions of the auricular protocol -- dose, interpersonal context, and acute physiological and subjective effects of treatment -- that may influence outcome in HIV-positive patients. All studies will enroll HIV-positive cocaine-abusing, methadone-maintained patients. Study number 1 Aim: In an 8-week trial enrolling 40 patients, to compare a non-interactive and an interactive acupuncturist style on retention in, and clinical outcome of, auricular acupuncture; Study number 2 Aims: In a series of single session studies, each enrolling 12 patients, to determine whether the number of needles inserted into the auricle (1,3,or 5), compared to each other and to relaxation and needle insertion controls, influences beta-endorphin levels and acute subjective effects; Study number 3 Aims: In an 8-week randomized trial enrolling 40 patients, to compare the standard 5-needle auricular acupuncture protocol to a """"""""titrating dose"""""""" protocol (one needle in month one; three needles in month two), on clinical efficacy and cue-elicited cocaine craving, when delivered using the level of patient-acupuncturist interaction found to be most beneficial in Study number 1. Additional aims: To explore: (a) auricular acupuncture's effects on measures of cognitive functioning, and the influence of this interaction upon treatment retention; (b) auricular acupuncture's effects on HIV-related symptoms, and (c) the association between antiretroviral medications and response to auricular acupuncture treatments. Findings from these studies will guide the design of a full-scale clinical trial of auricular acupuncture for cocaine abuse in HIV-positive patients, and will provide information for generating hypotheses concerning auricular acupuncture's mechanism of action.
| Margolin, Arthur; Avants, S Kelly; Arnold, Ruth (2005) Acupuncture and spirituality-focused group therapy for the treatment of HIV-positive drug users: a preliminary study. J Psychoactive Drugs 37:385-90 |
