PATTERNS AND PREDICTORS OF COCAINE AND CRACK USE BY CLIENTS IN STANDARD AND ENHANCED METHADONE-MAINTENANCE TREATMENT

This paper reports on the patterns of cocaine use among subjects (N = 427) admitted to a methadone maintenance treatment demonstration proje ct designed to reduce risk for HIV. Assessments were conducted at inta ke and at approximately 18-24 months after treatment admission. Self-r eported data on cocaine use was compared with results of urinalysis te sts at both intake and follow-up; 29 subjects who falsely reported no use were recoded as users. Over one-third used some form of cocaine at both intake and follow-up, while approximately 30% abstained at both points. Approximately 20% ceased as well as initiated cocaine use betw een intake and follow-up. Use of powder cocaine, either alone or combi ned with heroin in ''speedballs,'' decreased at follow-up, whereas cra ck use increased. Discriminant function analyses were performed to det ermine the predictors of the different patterns of cocaine use by type . Receipt of enhanced methadone treatment compared with standard metha done treatment, treatment duration, or average duration of counselor c ontact appeared unrelated to cocaine use. Cocaine use at follow-up was associated with polydrug and alcohol use, illegal activity, a negativ e emotional state, and sex work. Crack users were more likely to be Af rican American than nonusers; continuous users of powder cocaine were more likely to also be using heroin than were nonusers; and continuous speedball users were more likely to be women sex workers with high le vels of depression. This analysis demonstrated that cessation or conti nuation of cocaine use after entry into methadone maintenance treatmen t is not uniform across different types of cocaine.