Home > Effectiveness bank bulletin. [Psychosocial treatments for cocaine dependence]

Drug and Alcohol Findings. (2012) Effectiveness bank bulletin. [Psychosocial treatments for cocaine dependence]. Drug and Alcohol Findings, 21 Apr,

PDF (Drug and Alcohol Findings Review of Stulz psychosocial treatments for cocaine dependence) - Published Version

External website: http://findings.org.uk/docs/bulletins/Bull_21_04_1...

Examining differential effects of psychosocial treatments for cocaine dependence: an application of latent trajectory analyses.
Stulz N., Gallop R., Lutz W. et al. Drug and Alcohol Dependence: 2010, 106(2–3), p. 164–172.
Advanced statistical techniques applied to data from a landmark US cocaine therapy study revealed three typical recovery trajectories; at the extremes patients who fared best and worst did so whatever the therapy, but in the middle a consistent approach (in this case, 12-step) which matched cultural expectations worked best.

Summary The featured report sought to differentiate cocaine-dependent patients based on how well they responded to psychosocial therapies, and then to assess whether different therapies were more or less effective for these groups of patients. The aim was to go beyond, 'Is treatment A better than treatment B?', to 'Which treatment works best for which types of patients?'

Data for the featured report derived from a landmark US study described in an earlier Findings analysis, which confounded expectations by showing that well structured drug counselling can better professionally delivered psychotherapies.

In the original trial, 487 patients were randomly assigned to different manual-guided treatments. For six months all received group drug counselling weekly based on 12-step principles. For some this was the sole treatment, for others it was supplemented by one of three individual treatments: drug counselling also based on 12-step principles; cognitive psychotherapy; or supportive-expressive psychotherapy. Each individual treatment was provided over the same weekly or twice weekly schedule in the first six months then monthly for the next three months.

Whether the measure was overall drug use, the frequency of cocaine use, or the proportion of clients altogether avoiding cocaine, over the year following the intensive six-month treatment phase, patients receiving combined individual and group drug counselling tended to fare better than those receiving either of the psychotherapies, which were no better than basic group counselling. For example, 38% of the combined counselling clients managed three months without using cocaine compared to around 20% of the psychotherapy clients and 27% of those receiving just group counselling.

The featured report re-analysed this data using an advanced statistical technique which divided up the patients in to groups with characteristic trends during the first six months of treatment both in the number of days they had used cocaine and the severity As measured by the Addiction Severity Index drug use composite score. of their overall drug and alcohol use. This meant narrowing the analysis to the 346 (of 487) patients who completed at least five monthly assessments during this phase. Typically they were employed white men in their 30s who lived alone; over 8 in 10 smoked crack cocaine.

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