Acupuncture for alcohol use disorder

Alcohol use disorder (AUD) affects approximately 240 million people worldwide, representing a major medical and social problem. Currently available treatments for AUD remain largely ineffective, making the search for new therapies necessary. This comprehensive review examines the potential of acupuncture as a complementary and alternative treatment for AUD, analyzing evidence from preclinical and clinical studies. Acupuncture, a traditional Chinese therapy that involves the insertion of fine needles at specific points on the body, has shown promising results in the treatment of alcohol use disorder.

Preclinical studies have shown that electroacupuncture at specific points such as ST-36 (Zusanli) and SP-6 (Sanyinjiao) can significantly reduce alcohol consumption in dependent rats. The inhibitory effect was mediated through activation of the endogenous opioid system, as it was blocked by naltrexone, a mu-opioid receptor antagonist. Notably, low-frequency (2 Hz) electroacupuncture proved more effective than high-frequency (100 Hz) in reducing voluntary alcohol intake. The HT-7 (Shenmen) point also demonstrated efficacy in reducing alcohol consumption and improving withdrawal symptoms.

Acupuncture showed significant benefits in alleviating alcohol withdrawal syndrome, a complex set of signs and symptoms that occur after abrupt cessation of chronic alcohol consumption. Studies have shown that acupuncture can suppress physical withdrawal signs such as tail rigidity, hypermobility, and tremors. Additionally, it reduced elevated c-Fos expression in dopaminergic terminal areas of the brain. Treatment also showed efficacy in reducing hyperalgesia during withdrawal, with ST-36 significantly prolonging paw withdrawal latency in response to radiant heat.

This analgesic effect was mediated through mu-opioid receptors in the habenula. One of the most important aspects of treatment is the reduction of anxiety associated with alcohol withdrawal. Acupuncture at HT-7 was shown to effectively attenuate anxiety-like behavior during withdrawal in rats, evidenced by elevated plus maze tests. The mechanism involved normalization of multiple neurotransmitter and hormonal systems, including corticotropin-releasing factor (CRF) in the central nucleus of the amygdala, catecholamines, and the hypothalamic-pituitary-adrenal axis.

Acupuncture also showed the ability to bidirectionally regulate the mesolimbic dopaminergic system, increasing dopamine levels when reduced and lowering them when elevated, always in the direction of restoring normal balance. Clinical studies in humans support the preclinical findings. Randomized controlled trials have demonstrated that real acupuncture was superior to placebo acupuncture in reducing alcohol craving, measured by visual analog scales. Auricular acupuncture (ear acupuncture) emerged as a particularly promising modality, with patients reporting improvements in lifestyle, consumption pattern, and physical and mental health.

Functional neuroimaging studies have shown that stimulation of the HT-7 point activated brain areas associated with alcohol-related disorders, including the bilateral postcentral gyrus, inferior parietal lobule, inferior frontal gyrus, claustrum, insula, and cerebellum. One of the unique features of acupuncture is its ability to normalize dysfunctions without disturbing normal states, demonstrating a bidirectional regulatory effect. This property contributes to its safety and broad applicability. The effect of acupuncture has also been shown to be specific to certain points, with appropriate point selection being crucial for therapeutic success.

However, not all clinical studies have supported the use of acupuncture for AUD. Some research has not found significant differences between specific and nonspecific acupuncture, or between acupuncture and standard care. These inconsistencies may be related to methodological problems, including inadequate choice of control groups, suboptimal point selection, and inappropriate outcome measures. Acupuncture represents an inexpensive and safe therapy when administered by trained personnel, offering a valuable complementary approach in the treatment of alcohol use disorder.