TREATING COCAINE-USING METHADONE PATIENTS: PREDICTORS OF OUTCOMES IN A PSYCHOSOCIAL CLINICAL TRIAL

Abstract

Cocaine-using methadone patients in two clinics were assigned to 8 months of enhanced methadone treatment—primarily cognitive-behavioral therapy (CBT) for cocaine use—while similar patients in two “sibling” clinics were assigned to standard methadone treatment during 1995–1998. Cocaine use declined significantly from baseline to 4- and 12-month follow-ups. Patients receiving CBT rated the quality of their counseling relationship higher and obtained more supportive services than those receiving standard treatment. However, study treatment condition itself was not associated with outcome. Baseline measures associated with poorer outcomes across both treatment conditions were: currently enrolled in methadone treatment (in contrast to being newly enrolled), higher cocaine use frequency, greater cocaine use associated problem recognition, and an ambivalent attitude toward methadone. The results are consistent with some previous clinical trials showing that psychosocial treatments of different intensities result in similar declines in cocaine use. The findings indicate that methadone maintenance treatment can help dually-addicted patients reduce their cocaine use.

• Cocaine treatment
• Methadone maintenance
• Efficacy trial
• Outcome study
• Substance dependency
• Relapse prevention therapy

RESUMEN

Asignaron los pacientes usadores de cocaína en dos clínicas de la metadona a 8 meses del tratamiento realzado de la metadona—sobre todo terapia cognoscitivo-del comportamiento (CBT) para el uso de la cocaina—mientras que asignaron los pacientes similares en dos “clínicas hermanas” al tratamiento estándar de la metadona. El uso de la cocaína declinó perceptiblemente de línea de fondo a las cartas recordativas de 4 y 12 meses. Los pacientes que recibían el CBT classificaron la calidad de su lazo del asesoramiento más favorable y obtuvieron servicios más suportativos que ésos que recibían el tratamiento estándar. Sin embargo, la condición sí mismo del tratamiento del estudio no fue asiociada a resultado. Las medidas de la línea de fondo asociadas a resultados más pobres a través de ambas condiciones del tratamiento eran: alistado actualmente en el tratamiento de la metadona (en contraste con nuevamente ser alistado), una frecuencia mâs alta del uso de la cocaína, el mayor reconocimiento del problema de la cocaína, y una actitud ambivalente hacia la metadona. Los resultados son constantes con algunos ensayos clínicos anteriores que muestran que los tratamientos sicosociales de diversas intensidades dan lugar a declinaciones similares en uso de la cocaína. Los resultados indican que el tratamiento del mantenimiento de la metadona puede ayudar za pacientres dual-adictos a reducir su uso de la cocaína.

RÉSUMÉ

Des patients utilisateurs de cocaine dans deux cliniques de methadone ont été affectés à 8 mois du traitement rehausse—principalement la thérapie cognitif-comportementale (CBT) pour l’usage de cocaïne—tandis que des patients semblables dans deux “cliniques soeurs” étaient affectés au traitement standard de méthadone. L’utilisation de cocaïne a diminué de manière significative de la ligne de base aux suivis de 4 et 12 mois. Les patients recevant le CBT ont évalué la qualité de leur rapport de consultation plus favorablement et ont obtenu des plus de support de la part des services que ceux recevant le traitement standard. Cependant, l’état de traitement d’étude lui-même n’a pas été associé aux résultats. Les mesures de ligne de base associées à des résultats plus faibles à travers les deux conditions de traitement étaient: l’inscription actuelle en le traitement de méthadone (cmparee a une nouvelle l’inscription), la fréquence plus élevée d’utilisation de cocaïne, la plus grande identification de problème de cocaïne, et une attitude ambivalente envers la méthadone. Les résultats sont conformes à ceux de quelques épreuves cliniques précédentes prouvant que les traitements psychosociaux de différentes intesités ont comme conséquence les déclins semblables dans l’utilisation de cocaïne. Les résultats indiquent que le traitement d’entretien de méthadone peut aider les patients duel-inoxiqués à réduire leur utilisation de cocaïne.

Additional information

Notes on contributors

Stephen Magura

Stephen Magura, Ph.D., C.S.W., is Deputy Executive Director of National Development and Research Institutes, Inc. He has designed and directed drug dependency clinical trials, treatment outcome studies, health services research, social epidemiology studies, HIV prevention research, and policy analysis. He has been the principal investigator of numerous studies sponsored by the National Institutes of Health and private foundations. He has published over 100 articles and authored/edited several books and special journal issues. Member of the editorial board of Substance Use and Misuse.

Andrew Rosenblum

Andrew Rosenblum, Ph.D., is the Director of the Institute for Treatment and Services Research at the National Development and Research Institutes, Inc. He has served as principal investigator, co-investigator, and project director on several research projects on substance use, including innovative interventions for the treatment of cocaine dependence, outreach to homeless populations, and an evaluation of a treatment linkage model for street-based sex workers.

Chunki Fong

Chunki Fong, M.S., is an Assistant Project Director within the Institute for Treatment and Services Research at the National Development and Research Institutes, Inc. He has a background in statistics/computer science, and conducts statistical analysis and provides data support for various substance use research projects.

Cherie Villano

Cherie L. Villano, Psy.D., is a post-doctoral fellow in the Behavioral Sciences Training Program, which is funded by the National Institute on Drug Abuse and administered through National Development and Research Institutes, Inc. and Medical and Health Research Associates of New York, Inc. She was a Research Associate within the Institute for Treatment and Services Research at NDRI.

Beverly Richman

Beverly L. Richman, M.D., is Chief, Medical Services, Methadone Maintenance Treatment Program of Beth Israel Medical Center, and is an internist. She has been working in chemical dependency for 31 years, providing general medical care and substance dependency treatment in inpatient settings and in methadone maintenance. She has participated in many clinical research studies and has published numerous articles.