Psychosocial treatments for cocaine dependence - National Institute on Drug Abuse Collaborative Cocaine Treatment Study

Background: This was a multicenter investigation examining the efficacy of 4 psychosocial treatments for cocaine-dependent patients. Methods: Four hundred eighty-seven patients were randomly assigned to 1 of 4 manual-guided treatments: individual drug counseling plus group drug coun seling (GDC), cognitive therapy plus GDC, supportive-expressive therapy plu s GDC, or GDC alone. Treatment was intensive, including 36 possible individ ual sessions and 24 group sessions for 6 months. Patients were assessed mon thly during active treatment and at 9 and 12 months after baseline. Primary outcome measures were the Addiction Severity Index-Drug Use Composite scor e and the number of days of cocaine use in the past month. Results: Compared with the 2 psychotherapies and with GDC alone, individual drug counseling plus GDC showed the greatest improvement on the Addiction Severity Index-Drug Use Composite score. Individual group counseling plus G DC was also superior to the 2 psychotherapies on the number of days of coca ine use in the past month. Hypotheses regarding the superiority of psychoth erapy to GDC for patients with greater psychiatric severity and the superio rity of cognitive therapy plus GDC compared with supportive-expressive ther apy plus GDC for patients with antisocial personality traits or external co ping style were not confirmed. Conclusion: Compared with professional psychotherapy, a manual-guided combi nation of intensive individual drug counseling and GDC has promise for the treatment of cocaine dependence.