***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Although intensive outpatient therapy is recommended for treatment of cocaine , psychosocial characteristics associated with crack cocaine abuse are also implicated in attrition from outpatient programs . Acupuncture , medications , and brainwave therapy ( biofeedback ) , have all been used to encourage treatment retention and drug use outcomes . The effectiveness of three adjunct therapies in improving retention and drug use outcomes in intensive outpatient cocaine treatment was tested in a primarily young , indigent African-American sample of crack cocaine users at a community hospital in a low-income , high drug use neighborhood in Houston . Subjects were assigned to receive either neurobehavioral treatment alone or neurobehavioral with one of three adjunct therapies . These included acupuncture , anticraving medication , or brainwave therapy . Comparative results indicated that dosage of any adjunct therapy was associated with days in treatment and st and ard treatment sessions attended , and that st and ard treatment sessions attended was associated with negative urinalysis results at follow-up . None of the adjunct therapies were directly associated with drug use outcomes This study used a r and omized pretest/posttest control group design to test the effectiveness of auricular acupuncture interventions in diminishing psychological and physiological changes associated with cocaine craving in 30 treatment-seeking cocaine-dependent patients . The experimental group received the real auricular acupuncture intervention , insertion of needles into ear point locations specifically targeted for drug withdrawal . The control group received sham or placebo auricular acupuncture , insertion of needles into ear point locations not targeted for any specific therapeutic benefit . Psychological ( Cocaine Craving Question naire - Now ) and physiological ( skin conductance activity ) changes associated with cocaine craving were measured . Results showed no differences between the control and the experimental group in diminishing psychological and physiological measures associated with craving . There were differences from pre- to posttest on measures of psychological but not physiological craving for the combined experimental and control groups BACKGROUND Partly because of a lack of a conventional , effective treatment for cocaine addiction , auricular acupuncture is used to treat this disorder in numerous drug treatment facilities across the country for both primary cocaine-dependent and opiate-dependent population s. OBJECTIVE To evaluate the effectiveness of auricular acupuncture for the treatment of cocaine addiction . METHODS Eighty-two cocaine-dependent , methadone-maintained patients were r and omly assigned to 1 of 3 conditions : auricular acupuncture , a needle-insertion control condition , or a no-needle relaxation control . Treatment sessions were provided 5 times weekly for 8 weeks . The primary outcome was cocaine use assessed by 3-times-weekly urine toxicology screens . RESULTS Longitudinal analysis of the urine data for the intent-to-treat sample showed that patients assigned to acupuncture were significantly more likely to provide cocaine-negative urine sample s relative to both the relaxation control ( odds ratio , 3.41 ; 95 % confidence interval , 1.33 - 8.72 ; P = . 01 ) and the needle-insertion control ( odds ratio , 2.40 ; 95 % confidence interval , 1.00 - 5.75 ; P = .05 ) . CONCLUSIONS Findings from the current study suggest that acupuncture shows promise for the treatment of cocaine dependence . Further investigation of this treatment modality appears to be warranted The authors conducted a single-blind study of auricular acupuncture in 36 cocaine-dependent inpatient veterans on a substance abuse treatment unit to determine whether the treatment could help reduce craving , increase treatment retention , and prevent relapse .  Acupuncture was given on a predetermined schedule to both treatment and control groups , with status assessed regularly by independent , blinded raters . The study failed to show a significant difference between treatment and control groups . However , the study patients , as a whole , did remain in treatment longer than a retrospectively analyzed group who received no acupuncture We evaluated objective criteria for defining points for needle insertion prior to conducting a multisite clinical trial of auricular acupuncture for cocaine addiction . Thirty-four cocaine-abusing subjects participated in a study in which the trial 's active zones ( Shenmen , Liver , Lung , and Sympathetic ) and control zones ( located on the ear helix ) were divided into quadrants and assessed along four dimensions : electrical resistance , skin discoloration , skin topography , and tenderness . Acute effects of needles inserted into points of low electrical resistance in one ear and high electrical resistance in the other were also assessed . Results showed that the active zones had lower overall electrical resistance and more subcutaneous ridges than control zones . Zones did not possess significant variability along any single dimension . Acute effects of needling high and low resistance points were similar , differing only for " fullness . " Based on these findings , and in view of the difficulty of accurately measuring electrical resistance at ear points , we do not recommend the use of electrical devices for point determination in the multisite study . At present , there seems to be little scientific basis for the pre selection of specific points for needle insertion within auricular zones . Needle placement should be based upon clinical judgement There are several varieties of treatment facilities and modalities for dealing with substance abuse . In this study , the addition of acupuncture treatments to the usual care program at an existing county-based substance abuse treatment clinic was tested . Men and women who voluntarily attended the clinic or who were rem and ed by the court to attend were r and omized to receive  usual care , usual care plus frequent urine testing , or usual care plus frequent urine testing and acupuncture treatments . Clients who received acupuncture treatments in addition to the usual care and frequent urine testing became clean ( as measured by negative urine tests ) in 57 % of the time required for the frequent urine testing group . Difficulties experienced included low counselor compliance with the protocol and a high drop-out rate , indicating that further research is necessary ; however , this study demonstrates that acupuncture can be a feasible and effective addition to existing drug treatment programs OBJECTIVE To compare findings from two consecutive clinical trials of auricular acupuncture for cocaine addiction conducted at the same site in order to explore consistency of treatment effects . SUBJECTS One hundred and sixty-five ( 165 ) cocaine-dependent , methadone-maintained patients ( study 1 , n = 82 ; study 2 , n = 83 ) . INTERVENTIONS Subjects in both studies were r and omly assigned to auricular acupuncture , a needle insertion control condition , or a no-needle relaxation control . Treatment sessions were offered five times weekly for 8 weeks . The two studies were equivalent in design , except that unlike study 1 , study 2 offered subject payments for attendance and did not include weekly group counseling . OUTCOME MEASURES Cocaine use assessed by three times weekly urine screens constituted the primary outcome . Secondary measures included retention in treatment , treatment attendance , treatment credibility , therapeutic alliance , and acute effects of treatments . RESULTS Intent-to-treat analysis showed that patients assigned to acupuncture in study 1 , but not in study 2 , were significantly more likely to provide cocaine-negative urine sample s relative to the two control conditions . CONCLUSIONS The positive effect for acupuncture found in study 1 was not found in study 2 . Even though the two studies were similar , reasons for this inconsistency can not be determined definitively , but may be because of differences in psychosocial context and payment contingencies between the two studies , or the lack of effectiveness of acupuncture in this application . The need to critically consider the influence of treatment context and other potential moderating variables on outcome in order to draw conclusions regarding treatment effectiveness is discussed We conducted a single-blind study ( n = 48 ) comparing subjective evaluations of needles inserted into sham and real auricular acupuncture points . Both ears were needled concurrently , one in sham sites and the other in active points used in the treatment of cocaine addiction . Subjects then completed a question naire rating the intensity of five sensations in each ear , and also attempted to identify which ear received sham and which ear received real acupuncture . Results showed that real points were more painful than sham ; there were no other overall differences . Subjects ' ability to identify which ear received sham and which ear received real acupuncture did not rise above the level of chance Anecdotal studies have reported acupuncture alleviating the severity of withdrawal symptoms associated with cocaine abuse . The efficacy of auricular ( ear ) acupuncture in reducing cocaine/crack craving and consumption was examined via a single-blind , placebo experiment . One hundred and fifty individuals seeking treatment for cocaine/crack abuse were r and omly assigned to receive either experimental or placebo acupuncture treatments . Treatments were provided in an outpatient setting for a one-month period . Placebo treatments involved acupuncture at ear locations not used for drug treatment . Subjects provided urine specimens for drug content analysis after each acupuncture session . Urinalysis results over the one-month study period favored the experimental group . Experimental subjects in treatment over 2 weeks had significantly lower cocaine metabolite levels relative to placebo subjects in treatment for a comparable period . Treatment retention with both groups was similar . Relative to pretreatment usage , a significant decrease in cocaine consumption was reported by both groups . Self-report outcomes did not indicate significant between-groups differences Acupuncture has been incorporated as a treatment component in numerous addiction treatment programs in the United States ; however , its efficacy has not been demonstrated in large-scale , controlled clinical trials . In this article we discuss the background and design of the Cocaine Alternative Treatments Study ( CATS ) , a r and omized , controlled , multisite study of acupuncture that will enroll 500 cocaine-dependent individuals at 6 sites across the country , and that constitutes the largest controlled trial for the treatment of cocaine addiction undertaken to date . After presenting the background of the study , we discuss the approach taken to address several critical issues , including the choice of appropriate control conditions , point location for needle insertion , degree of blinding , and bias checks . Complementary therapies are used by a significant number of individuals , and the need to evaluate them in controlled clinical trials is an ongoing and urgent issue We conducted a 6-week , single-blind study of acupuncture for cocaine dependence in methadone-maintained patients ( N = 40 ) for the purpose of identifying an appropriate needle puncture control for use in future large-scale clinical trials . Patients were r and omly assigned to receive daily acupuncture in three auricular sites plus one body site ( LI-4 ) , or in control sites within 2 - 3 mm of the four active sites . Overall , there was a positive response to treatment on a variety of drug-related and psychosocial measures . Cocaine use decreased significantly for patients in both needle puncture groups . The only statistically significant difference between the two types of needle puncture was on ratings of craving . Subjects rated each type of needle puncture as equally credible and perceived no significant differences on the acute effects of the two types of needle insertions . Power calculations based on these findings suggest that very large sample sizes would be required to detect treatment differences between this control condition and active acupuncture . Alternative controls are suggested , and the challenges inherent in implementing controlled clinical trials of acupuncture are discussed In order to identify an appropriate needle puncture control for clinical trials of acupuncture we conducted a study in which ten cocaine dependent subjects rated local and systemic effects of four auricular needle puncture configurations ( a ) sites commonly used for addiction ; ( b ) sites proximate to addiction specific sites ; ( c ) sites not specific for cocaine addiction ; and ( d ) sites in the helix . Subjects received one treatment per day on four successive days . The addiction specific sites were rated highest on local effects ; proximal sites a common control were rated highest on systemic effects . A majority of patients ranked the addiction specific sites as the most preferred treatment and the helix points as the least preferred . Results suggest that needle insertion into proximate and non-specific sites may be too active for use as controls ; helix regions may be more suitable A single-blind , r and omized , placebo-controlled study was performed to evaluate  auricular acupuncture ( AAc )  in the treatment of cocaine addiction . Two linked but concurrent studies were done . In Study 1 , residential clients ( N = 236 ) were r and omized to true acupuncture ( Ac ) , sham Ac , and conventional treatment without Ac . Treatment group subjects received Ac at three ear points considered to be specific for the treatment of substance abuse ( SA ) . Control subjects received three nonspecific ( sham ) points . In Study 2 , day treatment clients ( N = 202 ) were r and omized to one of three dose levels of true Ac ( 28 , 16 , or 8 treatments ) . Subjects received Ac at five , rather than three , specific ear points . Nonspecific ( sham ) points were not used in Study 2 . With rare exception , the data failed to identify significant treatment differences among the true and sham Ac , and psychosocial groups . Furthermore , no differences were observed among the three dose levels of true Ac CONTEXT Auricular acupuncture is widely used to treat cocaine addiction in the United States and Europe . However , evidence from controlled studies regarding this treatment 's effectiveness has been inconsistent . OBJECTIVE To investigate the effectiveness of auricular acupuncture as a treatment for cocaine addiction . DESIGN R and omized , controlled , single-blind clinical trial conducted from November 1996 to April 1999 . SETTING Six community-based clinics in the United States : 3 hospital-affiliated clinics and 3 methadone maintenance programs . PATIENTS Six hundred twenty cocaine-dependent adult patients ( mean age , 38.8 years ; 69.2 % men ) ; 412 used cocaine only and 208 used both opiates and cocaine and were receiving methadone maintenance . INTERVENTION Patients were r and omly assigned to receive auricular acupuncture ( n = 222 ) , a needle-insertion control condition ( n = 203 
    Output:
    
Conclusion This systematic review and meta- analysis does not support the use of acupuncture for the treatment of cocaine dependence .