ONE-YEAR FOLLOW-UP OF PSYCHOTHERAPY AND PHARMACOTHERAPY FOR COCAINE DEPENDENCE - DELAYED EMERGENCE OF PSYCHOTHERAPY EFFECTS

Background: Neither the durability of brief ambulatory treatments for cocaine dependence nor the relative ability of psychotherapy vs pharma cotherapy to effect lasting change has been evaluated in well-controll ed randomized trials. Methods: We conducted a 1-year naturalistic foll ow-up of 121 ambulatory cocaine abusers who underwent psychotherapy (c ognitive-behavioral relapse prevention or clinical management) and pha rmacotherapy (desipramine hydrochloride or placebo) in a 2X2 design. S ubjects were interviewed 1, 3, 6, or 12 months after the termination o f a 12-week course of outpatient treatment. Eighty percent (n=97) of t he subjects who were randomized to treatment were followed up at least once. Results: First, the effects of study treatments appeared durabl e over the follow-up; as for the full sample, measures of cocaine use indicated either improvement or no change over posttreatment levels. S econd, abstinence during treatment was strongly associated with less c ocaine use during follow-up. Third, random effects regression models i ndicated significant psychotherapy-by-time effects, suggesting a delay ed improved response during follow-up for patients who received cognit ive-behavioral relapse prevention compared with supportive clinical ma nagement. Conclusions: Our findings suggest a delayed emergence of the effects of cognitive-behavioral relapse prevention, which may reflect the subjects' implementation of the generalizable coping skills conve yed through that treatment. Moreover, these data underline the importa nce of conducting follow-up studies of substance abusers and other gro ups because delayed effects may occur after the cessation of short-ter m treatments.