Aims: To describe the characteristics of clients choosing auricular acupuncture or counselling to treat dependence at a UK self‐referral centre and the short‐term outcome for each group. Methods: Assessments made at entry, and at 2 months and 6 months included a range of psychometric variables (anxiety, depression, dependence severity, readiness to change), and alcohol and drug consumption. These variables were used to predict treatment choice in logistic regression analyses and to describe treatment outcome. Results: Of 162 clients, 36 chose acupuncture and 126 chose counselling. Alcohol was the main preferred drug in both groups but preference for heroin was the only independent variable determining choice for acupuncture vs. counselling. Six‐month follow‐up rate was 44% in the counselling group and 25% in the acupuncture group. There were significant improvements in psychological variables which correlated with a decrease in alcohol consumption at 2 and 6 months. Improvements were greatest in those who attended for 6 months. Conclusions: Acupuncture was preferred by clients whose main drug of choice was heroin. Across both treatments clients with alcohol problems who attended the 2 and 6 months follow‐up assessments showed a significant decrease in psychological distress and reduction of alcohol consumption.