Predictors of sustained abstinence during psychosocial treatments for cocaine dependence

Abstract

Using data from the National Institute of Drug Abuse Collaborative Cocaine Treatment Study, the authors examined 24 patient pretreatment variables as predictors of outcome. The most clinically meaningful outcome in the treatment of substance dependence—degree of sustained abstinence—was used. Predictor variables included demographic features, aspects of the disorder and the recovery environment, expectations about treatment, and beliefs about addiction, relapse, and the 12-step philosophy. Four of the 24 examined variables—craving, acuity of biomedical problems, belief in the 12-step philosophy, and expectations for improvement—were significantly predictive of degree of sustained abstinence using a Bonferroni-corrected alpha level. No significant interactions with treatment condition were noted. The joint effect of the 4 predictor variables had a clinically meaningful impact on outcome.

Zusammenfassung

Prädiktoren nachhaltiger Abstinenz während psychosozialer Behandlungen bei Kokainabhängigkeit

Unter Nutzung von Daten der kollaborativen Behandlungsstudie von Kokainabhängigkeit des Nationalen Drogenmissbrauchinstituts haben die Autoren 24 Vorbehandlungs-Patientenvariablen als Prädiktoren für das Behandlungsergebnis untersucht. Als Kriteriumsvariable wurde das klinisch bedeutsamste Ergebnis, nämlich der Grad der nachhaltigen Enthaltsamkeit benutzt. Die Prädiktorvariablen umfassten demografische Aspekte, Diagnosencharakteristika und die Behandlungsumgebung. Ebenso erfasst wurden Behandlungserwartungsannahmen zur Abhängigkeit, Rückfälle und die 12 Stufen-Philosophie. Von den 24 untersuchten Variablen sagten vier Variablen signifikant (mit einer Bonferroni-Korrektur des Alphaniveaus) den Grad der nachhaltigen Abstinenz voraus: Süchtigkeit, Akutheitsgrad biologisch-medizinischer Probleme, Glaube an die 12 Stufen-Philosophie und Besserungserwartung. Es gab keine signifikanten Interaktionen mit der Behandlungsbedingung. Auch ein klinisch bedeutsamer Effekt des Vorkommens der vier Variablen zusammen war festzustellen.

Résumé

Facteurs de prédiction d'une abstinence maintenue au cours de traitements psychosociaux de la dépendance à la cocaïne

Sur la base de données récoltées pour la National Institute of Drug Abuse Collaborative Cocaine Treatment Study, les auteurs ont utilisé 24 variables de prétraitement comme facteurs de prédiction du succès. C'est le résultat le plus important cliniquement dans la dépendance aux substances, le « degré d'abstinence maintenue » qui a été retenu. Parmi les variables de prédiction, il y avaient les caractéristiques démographiques, les aspects du trouble et de l'environnement du rétablissement, les attentes par rapport au traitement et les convictions par rapport à l'addiction, à la rechute et à la philosophie des 12 étapes. Avec un niveau alpha corrigé selon Bonferroni, quatre variables sur les 24 prédisaient, de façon significative, le degré d'abstinence maintenue, à savoir « le besoin marqué, l'acuité des problèmes biomédicaux, la conviction par la philosophie des 12 étapes, l'expectation d'amélioration ». Aucune interaction significative avec les conditions de traitement n’était observée. L'effet commun des 4 variables de prédiction faisait un impact significatif sur le résultat du traitement.

Resumen

Predictores de abstinencia sostenida durante los tratamientos psicosociales de la dependencia cocaínica

Los autores examinaron 24 variables de predictores de resultado en pacientes pretratamiento haciendo uso de datos del Estudio colaborativo para el tratamiento anticocaína del Instituto Nacional para el abuso de drogas (National Institute of Drug Abuse Collaborative Cocaine Treatment Study). Se utilizó el grado de abstinencia sostenida como mayor predictor significativo de resultado en el tratamiento de la dependencia de substancias. Las variables predictoras incluyeron: rasgos demográficos, aspectos del entorno de este desorden y de su recuperación, expectativas del tratamiento y creencias acerca de la adicción, la recaída y la filosofía de los 12 pasos. Cuatro de las variables examinadas – deseo intenso (craving), acuidad de los problemas biomédicos, creencia en la filosofía de los 12 pasos y expectativas de mejoría – fueron predictores significativos del grado de abstinencia sostenida usando un nivel alfa Bonferroni corregido (using a Bonferroni-corrected alpha level). No se notaron interacciones significativas con las condiciones del tratamiento. El efecto conjunto de las 4 variables predictoras tuvo un impacto clínicamente significativo sobre el resultado.

Resumo

Preditores de manutenção da abstinência durante tratamentos psicológicos para a dependência da cocaína

Utilizando dados do Estudo Colaborativo de tratamento da Cocaína (National Institute of Drug Abuse Collaborative Cocaine Treatment Study), os autores examinaram variáveis pré-tratamento de 24 pacientes como preditores de resultados. Foi utilizado o resultado clinicamente mais significativo no tratamento da dependência de substâncias – grau de manutenção da abstinência. As variáveis preditoras incluíam aspectos demográficos, aspectos da perturbação e do ambiente de recuperação, expectativas em relação ao tratamento e crenças sobre o adicção, recaída e a filosofia dos 12 passos. Quatro das 24 variáveis examinadas – necessidade (craving), problemas biomédicos agudos, crença na filosofia dos 12 passos e as expectativas de melhorias – foram significativamente preditivas do grau de manutenção da abstinência utilizando um valor de alfa corrigido de Bonferroni. Não se verificaram interacções com o tratamento significativas. O efeito conjunto das 4 variáveis preditoras teve um impacto clinicamente significativo nos resultados.

The NIDA Collaborative Cocaine Treatment Study is a NIDA-funded cooperative agreement involving four clinical sites, a coordinating center, and NIDA staff. The coordinating center at the University of Pennsylvania includes Paul Crits-Christoph (principal investigator), Lynne Siqueland (project coordinator), Karla Moras (assessment unit director), Jesse Chittams and Robert Gallop (directors of data management), and Larry Muenz (statistician). The collaborating scientists at the Treatment Research Branch, Division of Clinical and Research Services at NIDA, include Jack Blaine and Lisa Simon Onken. The four participating clinical sites are University of Pennsylvania (Lester Luborsky, principal investigator; Jacques P. Barber, co-principal investigator; Delinda Mercer, project director); Brookside Hospital/Harvard Medical School (Arlene Frank, principal investigator; Stephen F. Butler, co-principal investigator, Innovative Training Systems; Sarah Bishop, project director); McLean/Massachusetts General Hospital/Harvard University Medical School (Roger D. Weiss, principal investigator; David R. Gastfriend, co-principal investigator; Lisa M. Najavits and Margaret L. Griffin, project directors); and University of Pittsburgh/Western Psychiatric Institute and Clinic (Michael E. Thase, principal investigator; Dennis Daley, co-principal investigator; Ishan M. Salloum, co-principal investigator; Judy Lis, project director). The Training Unit includes Cognitive Therapy Training Unit heads Aaron T. Beck (University of Pennsylvania) and Bruce Liese (University of Kansas Medical Center); Supportive–Expressive Therapy Training Unit heads Lester Luborsky and David Mark (University of Pennsylvania); Individual Drug Counseling Unit head George Woody (Veterans Administration/ University of Pennsylvania Medical School); Group Drug Counseling Unit head Delinda Mercer, assistant head Dennis Daley (University of Pittsburgh/Western Psychiatric Institute and Clinic), and assistant head Gloria Carpenter (Treatment Research Unit, University of Pennsylvania). The Monitoring Board includes Larry Beutler, Jim Klett, Bruce Rounsaville, and Tracie Shea. The contributions of John Boren and Deborah Grossman (NIDA project officers for this cooperative agreement) are also gratefully acknowledged.

Preparation of this article was supported in part by NIDA grants U01-DA07090, U01-DA07663, U01-DA07673, U01-DA07693, U01-DA07085, R01-DA018935, and R21-DA016002.