Quality of Life, Needs, and Interest Among Cocaine Users: Differences by Cocaine Use Intensity and Lifetime Severity of Addiction to Cocaine

Abstract

We examined the quality of life (QoL) of 149 patients who were recruited in 2005 at outpatient treatment centers for cocaine dependence in Spain. Important life areas and life areas with potential need and interest to change in order to improve the QoL were analyzed in terms of patients’ cocaine use intensity within the previous six months and lifetime severity addiction to cocaine. The Spanish versions of the Drug User Quality of Life Scale and the Lifetime Severity Index for Cocaine were used to measure QoL, needs and interest, and severity addiction to cocaine. The data analysis employed t-tests, linear regression, Mann–Whitney U tests, multivariate regression, and chi-square tests. Tailoring treatment programs to address the life areas that are considered relevant to cocaine users considering their intensity of consumption and lifetime severity addiction to cocaine may improve retention and treatment outcomes. Further research needs to consider patients of different ethnic backgrounds and cultural contexts. The study's limitations are noted.

RÉSUMÉ

Nous examinons la qualité de vie (QV) de 149 patients en traitement ambulatoire pour une dépendance à la cocaïne en Espagne. Pour cela, nous avons analysé certains domaines de vie considérés comme importants et aussi des domaines de vie avec une nécessité ou un intérêt de changer pour améliorer la QV. Toujours en termes d’intensité d’usage de la cocaïne pendant les 6 mois préalables et la sévérité de l’addiction à la cocaïne au long de la vie. Le DUQOL-Spanish fût utilisé pour mesurer la QV, domaines de vie importants, nécessités et intérêts ; et le LSI-C-Spanish pour mesurer la sévérité de l’addiction à la cocaïne. Pour l’analyse de données on utilisât l’épreuve T-Student, la régression linéale, l’épreuve de U Mann-Whitney, la régression multi variable et le Test du χ². Lorsque l’on conçoit des programmes de traitement qui assistent les domaines de vie qui sont perçus par les patients comme relevants pour sa qualité de vie, l’on considère l’intensité de la consommation et la sévérité de l’addiction à la cocaïne, améliore la rétention et la réponse au traitement. Des futures études devraient considérer des patients d’autres groupes ethniques et d’autres contextes culturels. Les limitations de l’étude sont indiquées.

RESUMEN

Examinamos la Calidad de Vida (CV) de 149 pacientes en tratamiento ambulatorio por dependencia a la cocaína en España. Áreas de vida consideradas importantes, y áreas de vida con necesidad e interés de cambiar para mejorar la CV se analizaron en términos de la frecuencia de uso de la cocaína durante los seis meses previos y severidad de la adicción a la cocaína a lo largo de la vida. El DUQOL-Spanish se usó para medir la CV, áreas de vida importantes, y necesidades e intereses; y el LSI-C-Spanish para medir la severidad de la adicción a la cocaína. En el análisis de datos se empleó la prueba T-Student, regresión lineal, prueba de U Mann-Whitney, regresión multivariable y prueba Chi cuadrado. Al diseñar programas de tratamiento que asisten las áreas de vida que son percibidas por el paciente como relevantes para su calidad de vida, considerando su frecuencia de consumo y severidad de la adicción a la cocaína, mejora la adherencia y respuesta al tratamiento. Futuros estudios necesitan considerar pacientes de otros grupos étnicos y contextos culturales. Se señalan las limitaciones del estudio.

Keywords :

• quality of life
• cocaine-related disorders
• needs assessment
• therapy
• treatment outcome
• satisfaction

THE AUTHORS

Claudia Cristina Morales Manrique. PhD Psychologist researcher. Completed her studies of psychology at the Universidad Rafael Urdaneta (Venezuela); obtained postgraduate diplomas in Clinical Psychology at the Universitat de Barcelona (Spain), and in Design and Statistics in Health Sciences, at the Universitat Autònoma de Barcelona (Spain). Her PhD degree in psychology was obtained at the Universitat de València. Since 2003 she has collaborated with her mentor Dr. Juan Carlos Valderrama Zurián, at the Universitat de València, doing research in the area of drug dependence. She worked in many projects related to risk and protective factors for alcohol and other drugs consumption in immigrant population (ej. latinoamerican), and in the validation of some questionnaires. Currently she has special interest in doing research on Subjective Quality of Life in drug users, immigrants, and ethnic minorities.

Anita Palepu, MD, MPH, FRCPC, is an Associate Professor, Division of Internal Medicine, UBC, and a Michael Smith Foundation for Health Research Senior Scholar. She has been actively involved with the launch of an independent, open access general medical journal Open Medicine and is currently the Co-Editor. Her research program falls under the broad umbrella of urban health research with particular interest in vulnerable populations such as drug users, HIV-infected persons, and homeless persons. She is the Organizing Conference Chair of the 7th International Conference on Urban Health held in Vancouver in October 2008.

Juan Carlos Valderrama Zurián MD, PhD in Medicine from the University of Valencia and Professor in the University of Valencia, Spain. He has published over 60 journal articles and chapters in the areas of drug abuse research. His research has been supported by grants from the Delegación del Gobierno para el Plan Nacional sobre Drogas, Dirección General de Drogodependencias and Dirección General de Salud Pública of the Generalitat Valenciana, and from the Plan Municipal de Drogodependencias y otros Trastornos Adictivos of the Ayuntamiento de Valencia. Dr. Valderrama Zurián has been recognized for his contributions and has received the first Research Award from the Generalitat Valenciana/Bancaja for his research in risk behaviors, psychopathology, and HIV.

Rafael Aleixandre Benavent, MD, PhD, is a tenured scientist at the Spanish Research Council-CSIC. His PhD is in Information Science from the University of Valencia. Associated professor at the Instituto de Historia de la medićina de la Ciencia López Piñero at the University of Valencia. His research has been funded by competitive sources such as the Spanish National R&D Plans and the Autonomous Region of Valencia R&D Plans. He is member of the Unidad de Información e Investigación Social y Sanitaria UISYS (Universitat de Valèncía-CISIC) and serves on the Advisory Board of several journals. His areas of experience include research evaluation, bibliometric indicators, comparative studies on R&D outputs at the European and Spanish level, journals evaluation, information sources in S&T, and research in drug dependence.

Miguel Castellano Gómez, MD, is Chief of Studies and Research Service of Plan of Drug Dependence of the region of Valencia. He has coordinated several clinical and epidemiological studies and he has participated in European Twinning Programmes which consist in offering a practical advise to the institutions and administrations of the Eastern European countries. He is working on several aspects related to psychoactive substances, mainly in the areas of epidemiological studies related to the patterns of alcohol and drug use in several settings, developing policies, preventive programs, and treatment services.

Notes

1 Treatment can be briefly and usefully defined as a planned, goal directed change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.) and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types—which are not also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer QoL treatment-driven model, there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note

2 The reader is reminded of the need to distinguish between work and employment. Whereas many drug users, who represent a heterogeneous population, are not employed (salary, hours, delineated roles, opportunities for advancement or being fired, tasks, sites, etc.) being an active drug users is work with its own range of “demands,” very often being more than a full time “job.” Editor's note.