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Treatment of Cocaine Dependence Cocaine use is the most common drug problem of patients entering treatment for illicit drug use. In a national sample from 55 treatment programs, problem severity of patients at admission was found to be directly related to cocaine relapse in the year following discharge, and treatment retention also was a significant predictor among moderate-to-high problem groups. Among the highest severity patients, 90 days or longer in residential programs was needed to improve outcomes. Findings suggest patient assessments should play a central role in the selection of appropriate settings and duration of treatment to maximize outcomes. One-year follow-up interviews with a national sample of 1605 patients treated for cocaine dependence in 55 programs showed (again) that longer treatment stays are related to better outcomes. Overall, 1 of 4 (24%) reported relapses to weekly cocaine use and another 18% obtained further treatment in the year after discharge in DATOS due to continuing problems. The sample included 542 from 19 long-term residential (LTR) programs, 548 from 24 outpatient drug-free (ODF) programs, and 605 from 12 short-term inpatient (STI) treatment programs.
However, comparisons of relapse to weekly cocaine use rates between different types of client and treatment programs were the main focus of the study. Problem severity at intake (PSI, defined by 7 scores on drug history and psychosocial indicators) was assessed and found to differ across types of treatment programs; on average, LTR treated the most severe cases and STI the least problematic cases. PSI scores were predictive of relapse to weekly cocaine use after treatment, but different programs were not all equally effective. While low-severity patients did about equally well regardless of the type of treatment they received or how long they stayed, outcomes for medium-to-high problem patients improved significantly if they were treated for at least 3 months.
The results of this study, of course, lead to many other questions about the particular treatment services involved, the therapeutic engagement process, influences of treatment history and social context, and cost benefits. These are some of the topics addressed in the next wave of DATOS articles contained in special issue of Drug and Alcohol Dependence (Simpson & Brown, eds., 1999). A report on the first national study of treatment outcomes in England is also included, which replicates many of the DATOS findings (see the NTORS Web site at www.ntors.org.uk for more details.)
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