Factors accounting for cocaine use two years following initiation of continuing care

Aims. To examine the relationship between various interpersonal, intraperso nal and situational factors assessed at 6, 12 and 18 months after entrance to continuing care, and cocaine use in subsequent periods. Design. A random ized clinical trial with a 2-year follow-up. Setting. An outpatient US Vete rans Administration substance abuse treatment program. Participants. Cocain e-dependent male veterans (N = 132) entering continuing care. Interventions . 12-Step focused group treatment vs. individualized relapse prevention con tinuing care. Measurements. Motivation, coping and mood, social support, co -morbid problem severity, treatment attendance, self-help participation and cocaine use variables were assessed at each follow-up. Findings. During th e 2-year follow-up, patients used cocaine on fewer than 8% of the days in e ach of the four 6-month periods, which represented a highly significant dec rease in relation to cocaine use prior to treatment. In univariate analyses , abstinence commitment, self-efficacy, positive mood, support from family, employment, attendance in continuing care and self-help participation at t wo or more of the follow-ups predicted less cocaine use in subsequent 6-mon th periods. Readiness to change and medical, psychiatric, legal and family/ social problem severities either did not predict, or were inconsistently re lated to, subsequent cocaine use. In multivariate analyses, degree of self- help participation emerged as the strongest and most consistent predictor o f cocaine use. However, when current cocaine use at each follow-up was cont rolled, none of the predictors was significant at more than one follow-up p oint. There was little evidence of interactions between treatment condition and the predictor variables. Conclusions. Continued self-help participatio n and the early achievement of cocaine abstinence appear to be important fa ctors in the maintenance of good cocaine use outcomes over extended periods . The results also highlight the importance of controlling for various post -treatment factors when evaluating the relationship between any one factor and subsequent outcome, as many of the factors that were significant predic tors in the univariate analyses were no longer significant when other facto rs were controlled.