ABSTRACT
We evaluated the influence of psychotherapy attendance on treatment outcome in 90 dually (cocaine and heroin) dependent outpatients who completed 70 days of a controlled clinical trial of sublingual buprenorphine (16 mg, 8 mg, or 2 mg daily, or 16 mg every other day) plus weekly individual standardized interpersonal cognitive psychotherapy. Treatment outcome was evaluated by quantitative urine benzoylecgonine (BZE) and morphine levels (log-transformed), performed three times per week. Repeated-measures linear regression was used to assess the effects of psychotherapy attendance (percent of visits kept), medication group, and study week on urine drug metabolite levels. Mean psychotherapy attendance was 71% of scheduled visits. Higher psychotherapy attendance was associated with lower urine BZE levels, and this association grew more pronounced as the study progressed (p=0.04). The inverse relationship between psychotherapy attendance and urine morphine levels varied by medication group, being most pronounced for subjects receiving 16 mg every other day (p=0.02). These results suggest that psychotherapy can improve the outcome of buprenorphine maintenance treatment for patients with dual (cocaine and opioid) dependence.
Subject(s)
Buprenorphine/therapeutic use , Cocaine-Related Disorders/therapy , Narcotic Antagonists/therapeutic use , Opioid-Related Disorders/therapy , Patient Compliance/psychology , Psychotherapy , Administration, Sublingual , Adult , Buprenorphine/administration & dosage , Cocaine-Related Disorders/psychology , Cocaine-Related Disorders/urine , Combined Modality Therapy , Female , Humans , Male , Narcotic Antagonists/administration & dosage , Opioid-Related Disorders/psychology , Opioid-Related Disorders/urine , Treatment OutcomeABSTRACT
Contingency management (CM) rapidly reduces cocaine use, but its effects subside after treatment. Cognitive-behavioral therapy (CBT) produces reductions months after treatment. Combined, the 2 might be complementary. One hundred ninety-three cocaine-using methadone-maintained outpatients were randomly assigned to 12 weeks of group therapy (CBT or a control condition) and voucher availability (CM contingent on cocaine-negative urine or noncontingent). Follow-ups occurred 3, 6, and 12 months posttreatment. Primary outcome was cocaine-negative urine (urinalysis 3 times/week during treatment and once at each follow-up). During treatment, initial effects of CM were dampened by CBT. Posttreatment, there were signs of additive benefits, significant in 3- versus 12-month contrasts. Former CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment.
Subject(s)
Behavior Therapy/methods , Cocaine-Related Disorders/rehabilitation , Cognitive Behavioral Therapy/methods , Token Economy , Adult , Analgesics, Opioid/therapeutic use , Analysis of Variance , Baltimore , Cocaine-Related Disorders/complications , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Male , Methadone/therapeutic use , Opioid-Related Disorders/complications , Opioid-Related Disorders/drug therapy , Psychotherapy, Group/methods , Regression AnalysisABSTRACT
In order to evaluate the effect of frequency of counseling sessions, we studied retention, cocaine use and craving, and psychiatric symptoms of 68 cocaine-dependent outpatients randomly assigned to twice weekly, once weekly, or biweekly sessions in a 12-week treatment program that utilized manual-based, individual cognitive behavioral psychotherapy. All participants were tested and monitored twice a week. Retention was comparable among treatment groups, and improvement was found regardless of counseling frequency. Cocaine use (urine toxicology and self-report), cocaine craving (VAS), and total psychiatric symptoms (SCL-90) decreased by modest but statistically significant (p < 0.05) amounts in all treatment groups. Findings suggest that cognitive behavioral therapy is effective in reducing cocaine use even if a less intensive schedule is used.