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Home > Effectiveness Bank Bulletin [Continuing care enhancements for cocaine-dependent patients].

[Drug and Alcohol Findings] (2013) Effectiveness Bank Bulletin [Continuing care enhancements for cocaine-dependent patients]. London: Drug and Alcohol Findings. Effectiveness Bank Bulletin, 8 May

PDF (Randomized trial of continuing care enhancements for cocaine-dependent patients following initial engagement.)


Randomized trial of continuing care enhancements for cocaine-dependent patients following initial engagement.
McKay J.R., Lynch K.G., Coviello D. et al. Journal of Consulting and Clinical Psychology: 2010, 78(1), p. 111–120.

Unusually this US study took a set of patients who had generally already initiated abstinence from cocaine use and then used abstinence incentives and/or cognitive-behavioural therapy to extend and consolidate these gains. There was some evidence that offering the therapy and improving attendance via incentives prolonged the impact of those incentives.

This US study of treatment for cocaine dependence aimed to test whether the remission of patients who had initially done well in intensive outpatient treatment could be preserved and extended by financially rewarding cocaine non-use ('contingency management') and/or by extra individual counselling sessions based on cognitive-behavioural principles intended to help the patients avoid relapse. Unusually it tested contingency management not as way to initiate abstinence, but to sustain it. Essentially the study found that the combination of both approaches helped the greatest proportions of patients to remain free of cocaine use, most notably in the middle of the 18-month follow-up.

The study recruited 100 adult patients who had attended regularly during their initial fortnight at one of two 12-step group-based programmes. For up to four months, these programmes scheduled sessions three days a week totalling nine to 10 hours per week, before stepping down to a session a week. Of the 573 patients approached to see if they were suitable for and wanted to join the study, 200 did not join because they did not complete the initial fortnight or the following baseline research assessments. Among other criteria, the patients had to have not injected heroin for at least a year. Typically participants were unmarried black women (nearly 6 in 10 were female) and were in the their late 30s and early 40s. By the time they entered the study, 70% had not used cocaine for at least a month.

They were randomly allocated to carry on with treatment as usual or to one of three additional therapies. For 12 weeks one set (the contingency management set) were rewarded with shopping vouchers if urine tests taken three days a week were clear of indications of cocaine use, a regimen implemented by non-clinical study staff. Another set (relapse-prevention patients) were instead offered 20 weekly individual relapse-prevention counselling sessions aimed at identifying situations which for them had precipitated substance use and learning to anticipate and cope with these in future. The final set (combination patients) were offered both types of additional intervention, with the rider that the voucher incentives required not just cocaine-free urine tests, but also attendance at the relapse-prevention sessions. This seems to have had the desired impact, as on average they attended 13 sessions compared to just three for the relapse-prevention patients who had been offered the same sessions but with no inducements to attend. By the final follow-up 18 months after the study started, three quarters of the patients could be reassessed by being interviewed and the same proportion by urine tests.

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