Cocaine addicts with problems such as unemployment, poor support from family and friends, current alcohol or multidrug use, depression or anxiety require more intensive and lengthier treatment to overcome their drug abuse than those without such problems, according to a new study funded by the National Institute on Drug Abuse (NIDA), National Institutes of Health. Patients with moderate or severe problems are significantly more likely to achieve long-term abstinence if they receive at least 90 days of treatment.
The study investigated 1,605 cocaine patients admitted during 1991-1993 to 55 community based-treatment programs in NIDA's nationwide Drug Abuse Treatment Outcome Study (DATOS). Included were patients admitted to short-term inpatient (STI), long-term residential (LTR), and outpatient drug-free (ODF) treatment programs. Based upon their admissions interviews, each patient was designated as having low, medium, or high problem severity. Approximately 1 year following discharge, the patients were contacted again and asked about their cocaine use since completing treatment. Some underwent drug testing to corroborate their answers.
Among patients with low problem severity, weekly cocaine use was reduced about 80% during the year following discharge. This treatment outcome was similar notwithstanding the kind of treatment they received - STI, LTR, or ODF - or how long they remained in the program.
Patients with moderate and severe problems were able to reduce their weekly cocaine use by 85%, but only if they received the optimal type of therapy and stayed in it for at least 90 days. For patients with moderate problems, the optimal therapy was ODF; for patients with severe problems, it was LTR. Among patients with moderate or severe problems who did not remain in the optimal type of therapy for the minimum amount of time, weekly cocaine use was reduced only 60%-70%.
"These findings show the value of assessing patient needs carefully at intake and then assigning patients to different treatments based on their needs," says Dr. Dwayne Simpson of Texas Christian University in Fort Worth and lead author of the study. "LTR programs are better equipped to provide the more intensive care needed by high problem patients. Medium problem patients are better suited for ODF programs, which are also less expensive than LTR programs."
"This study indicates that patients addicted to cocaine who have moderate to severe problems need at least 3 months of treatment to get a maximum effect," says NIDA Director Dr. Alan I. Leshner. "Clearly, these findings argue against the efforts that have been made recently to cut back on the length of drug abuse treatment in order to save money."
Besides Dr. Simpson, researchers associated with NIDA; the National Development and Research Institutes, Inc., in Raleigh, N.C.; and the University of California, Los Angeles participated in the study. The study appears in the June 1999 issue of Archives of General Psychiatry.