A national evaluation of treatment outcomes for cocaine dependence

Background: This national study focused on post-treatment outcomes of commu nity treatments of cocaine dependence. Relapse to weekly (or more frequent) cocaine use in the first year after discharge from 3 major treatment modal ities was examined in relation to patient problem severity at admission to the treatment program and length of stay. Methods: We studied 1605 cocaine-dependent patients from 11 cities located throughout the United Stares using a naturalistic, nonexperimental evaluati on design. They were sequentially admitted from November 1991 to December 1 993 to 55 community-based treatment programs in the national Drug Abuse Tre atment Outcome Studies. Included were 542 patients admitted to 19 long-term residential programs, 458 patients admitted to 24 outpatient drug-free pro grams, and 605 patients admitted to 12 short-term inpatient programs. Results: Of 1605 patients, 377 (23.5%) reported weekly cocaine use in the y ear following treatment (dropping from 73.1% in the year before admission). An additional 18.0% had returned to another drug treatment program. Higher severity of patient problems at program intake and shorter stays in treatm ent (<90 days) were related to higher cocaine relapse rates. Conclusions: Patients with the most severe problems were more likely to ent er long-term residential programs, and better outcomes were reported by tho se treated 90 days or longer. Dimensions of psychosocial problem severity a nd length of stay are, therefore, important considerations in the treatment of cocaine dependence. Cocaine relapse rates for patients with few problem s at program intake were most favorable across all treatment conditions, bu t better outcomes for patients with medium- to high-level problems were dep endent on longer treatment stays.