This competing renewal requests funds to continue our research investigating auricular acupuncture as a treatment for cocaine addiction. In the previous grant period we conducted three clinical studies enrolling 211 patients. Each study compared auricular acupuncture to two control conditions - a needle insertion control using sites in the auricle helix, and a relaxation group - under a variety of conditions, with and without a widely used psychosocial treatment (Coping Skills Training - CST) as well as financial incentives for attendance. Findings supported the efficacy of acupuncture when provided in conjunction with CST and without financial incentives. However, these studies were not designed to definitively examine the interaction between acupuncture and CST, or to determine whether acupuncture is more effective than CST delivered alone. The proposed study builds upon our previous research and will investigate two widely used treatments and their interactions - acupuncture and CST - in a clinical context in which each treatment is provided by substance abuse counselors, employing a research design consistent with the need to bring research findings to clinical practice, and in which relative cost of each treatment is also considered. We propose to conduct a """"""""Phase III"""""""" clinical trial in which 200 cocaine-abusing methadone maintained patients, all receiving standard methadone maintenance treatment, will be randomly assigned to 4 treatment conditions, each of 12 weeks duration, in a 2 (acupuncture/no acupuncture) by 2 (weekly coping skills training group/no coping skills training) factorial design. The four groups are: (a) acupuncture only (ACU); (b) coping skills training only (CST); (c) acupuncture plus coping skills training (ACU+CST); (d) standard methadone maintenance only (MM). In a second phase of the study, in order to explore the effectiveness of these treatments in preventing relapse, patients who initiate abstinence in the 12-week trial will be invited to continue their assigned treatment for 6 months. Both clinical efficacy, cost, as well as treatment/patient matching variables, will be examined.
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