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5-Year Outcomes Following Cocaine Treatment

Cocaine use is a serious challenge faced by drug treatment programs in the U.S., and there are questions about long-term outcomes of cocaine-dependent patients following discharge. In this study we found that only 1 of every 4 patients interviewed 5 years after discharge from a national sample of treatment programs still used cocaine on a weekly basis -- similar to rates reported in the first year after treatment.  Greater severity of drug use and related problems at intake as well as more limited treatment contact were related to poorer outcomes on drug use and criminal activity.

Interviews were conducted at 1 and 5 years after treatment for 708 subjects (from 45 programs in 8 cities) who met DSM-III-R criteria for cocaine dependence when admitted in 1991-1993. Primary outcome measures included drug use and criminality. Self-reported cocaine use showed high overall agreement with urine (79% agreement) and hair (80% agreement) toxicology analyses.

  • Weekly cocaine use was reported by 25% of the sample in the fifth year of follow-up, slightly higher than the 21% for the first year after treatment.  (Similarly, 26% had cocaine detected in urine specimens at follow-up.)
     
  • Daily alcohol use decreased from 22% before intake to 8% in Year 5.
     
  • Illegal activity declined from 40% before intake to 25% in Year 5 (up slightly from 16% in Year 1).
     
  • Arrests in the past year dropped from 34% before intake to 18% in Year 5 (down slightly from 22% in Year 1).

    Chart: 5-Year Outcomes for Cocaine Sample (Changes from before to after treatment)

    [Figure 1]


These outcomes were examined in relation to Problem Severity at Intake (PSI, defined on 7 domains of drug history and psychosocial functioning) and record of treatment exposure in DATOS and during the 5-year follow-up period.  "Low treatment" usually meant less than 3-months of treatment -- considered the minimum "threshold" for an effective length of stay.

  • Poorer long-term outcomes were related to higher problem severity at treatment admission and less treatment.
     
  • Middle-to-high PSI patients (i.e., those reporting problems in 4 or more of the 7 areas represented) with "low treatment" had significantly poorer outcomes in Year 5, compared to those who had treatment exposure above threshold.

    Chart: Cocaine Use in Year 5 (by PSI and Treatment Exposure)

    [Figure 2]

The large decreases in cocaine use in the first year after discharge from treatment were sustained over a 5-year follow-up period, along with significant post-treatment improvements in heavy alcohol use and criminal involvement as well.  Severity of drug and psychosocial problems at intake was predictive of long-term outcomes, but outcomes improved in direct relation to level of treatment exposure (particularly for those with more serious problems at intake).

Reference

Simpson, D. D., Joe, G. W., & Broome, K. M. (2002). A national 5-year follow-up of treatment outcomes for cocaine dependence.  Archives of General Psychiatry, 59, 538-544. [Abstract]

 

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