Outcomes for cocaine abusers after once-a-week psychosocial therapy

OBJECTIVE: The authors studied the efficacy of once-weekly psychotherapy, family therapy, or group therapy led by paraprofessionals among patients with cocaine use disorders. METHOD: Of subjects who sought outpatient treatment, 168 consented to participate in the study and were each randomly assigned to one of the three forms of therapy; 122 patients were interviewed 6-12 months later. Their pre- and posttreatment scores on the Addiction Severity Index were compared. RESULTS: Significant improvements were observed for the cohort as a whole, but virtually all of the improvement was restricted to the 23 subjects (19%) who were not using cocaine at follow-up. There was a strong relationship between abstinence from cocaine use and absence of addiction-related problems, especially psychiatric symptoms and family problems. CONCLUSIONS: The results of the study indicate that outpatient therapy once a week is ineffective for cocaine use disorder. The 19% abstinence rate probably represents spontaneous remission among patients with enough motivation to seek treatment, as the number of therapy sessions attended was not related to improvement. Either an intense level of outpatient contact or residential treatment followed by aftercare is probably needed, at least initially, while the patient is attempting to initiate and sustain abstinence.