Listed by Topics
of Cocaine Dependence
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
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.
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.
- Although all patients
in the study met clinical criteria for cocaine dependency, not all were
daily or heavy users in the year before treatment. In LTR, 49% used
cocaine daily before treatment, dropping to 12% in the year afterwards.
In addition, heavy drinking (3 or more days per week) dropped from 42%
to 16%, and incarcerations in jail dropped from 79% to 35% in the year
before versus after treatment.
- In ODF, 28% used
cocaine daily before treatment, dropping to 9% in the year afterwards.
Heavy drinking (3 or more days per week) dropped from 34% to 16%, and
incarcerations in jail dropped from 73% to 28%.
- In STI, 45% used
cocaine daily before treatment, dropping to 8% in the year afterwards.
Heavy drinking (3 or more days per week) dropped from 45% to 15%, and
incarcerations in jail dropped from 53% to 20%. (Only 33% of the STI
group were unemployed on a full-time job in the year prior to admission,
compared to 59% in LTR and 51% in ODF.)
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.
- Problem indicators
included multiple drug use (27% of the total sample), alcohol dependence
(51), criminal activities (60%), unemployment at a full-time job (47%),
low social support from family and friends (56%), depression or anxiety
(66%), and no insurance (76%).
- Low-level severity
(0 to 3 problems) described 26% of admissions to LTR, 43% of ODF, and
64% of STI; on the other hand, 24% of LTR, 11% of ODF, and 6% of STI
were high-severity patients (with 6-7 problems).
- Overall, 20% of
reported relapse to weekly cocaine use, regardless of whether they had
short-term or long-term stays in treatment. ("Long-term" was
defined as at least 90 days for LTR or ODF, and at least 21 days for
- Among patients
with medium-to-high problem severity at intake (i.e., 4 or more problems),
40% of those with short-term treatment stays relapsed to weekly cocaine
use, compared to 28% of those with long-term stays.
For the most severe cases (with 6-7 problems), however, treatment setting
became highly significant. In particular, we found that these patients
needed at least a "minimum dose" of more intensive services
in LTR (usually therapeutic community) programs. After staying in one
of these programs for at least 3 months, 15% relapsed in the 1-year follow-up.
By comparison, relapse rates were 29% for similar patients
treated in ODF settings for 3 months or longer and 38% of those treated
for prescribed stays of at least 21 days in STI programs.
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.)
Simpson, D., Joe,
G., Fletcher, B., Hubbard, R., & Anglin, D. (1999). A national evaluation
of treatment outcomes for cocaine dependence. Archives of General
Psychiatry, 56, 507-514. [Abstract]
Simpson, D. &
Brown, B. (Eds). (1999). Special issue on treatment process and outcome
studies from DATOS. Drug and Alcohol Dependence. [Summary]
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