Interpersonal problems of cocaine dependent adults differ from those of a normative sample

Abstract

Our research examined patterns of interpersonal problems in patients with a primary diagnosis of cocaine dependence (CD), comparing them with those in a normative sample. We hypothesized that the patterns of individuals with CD would reveal constellations of interpersonal problems distinct from those of the sample, not only at baseline, but also at termination of treatment. Analysis was conducted on 402 CD patients from the training and the main trial phases of the National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Responses to the Inventory for Interpersonal Problems were analyzed—from baseline, from month one, and at treatment termination—according to the Interpersonal Circumplex Model and were compared to the normative sample. The CD sample was described using four distinct subtypes, named according to their relative angular displacement at baseline and highest two subscale means: Cold and Socially Avoidant, Vindictive and Domineering, Overly Nurturant and Intrusive, Nonassertive and Exploitable. Each subtype remained distinct across treatment and consistently reported different types of interpersonal difficulties than the normative population at termination, consistent with the interpersonal pathoplasticity model. In all subtypes, overall interpersonal distress decreased over the course of treatment, to the extent that by treatment termination they were no more or less distressed than the normative sample. These findings have important clinical implications. The interpersonal challenges of patients struggling with addiction to cocaine warrant clinical attention, beyond mediating levels of distress.

Keywords:

• Interpersonal problems
• interpersonal circumplex model
• interpersonal pathoplasticity
• cocaine dependence
• cocaine addiction
• clinical insight

Acknowledgements

The authors would also like to thank Nicole M. Cain and Leonard M. Horowitz for their early discussion of this paper, and subsequent contributions.

Ethical statement

The present study analyzed archival data, that was collected during the pilot and main trial phase of the National Institute on Drug Abuse (NIDA) Collaborative Cocaine Treatment, which was conducted at five sites in the Northeast United States. The study passed the Institutional Review Board of each site, and all patients were first screenED by telephone for eligibility. Once determined eligible, all participants attended an initial orientation/assessment visit which included written informed consent procedures.

Author contributions

All authors (A, B, C, D, and E) contributed to the writing and editing of this manuscript.

Author A was involved in every aspect of the design, implementation of this study and wrote the first several drafts of this manuscript.

Authors A, B, D, and E were involved in the design of the study.

Authors A, B, and D conducted the statistical analyses.

Author C conducted literature searches and wrote a revision of the introduction to the manuscript, as well as contributed to the editing of the entire manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

The current study was not funded, but used archival data of the National Institute of Drug Abuse Collaborative Cocaine Treatment Study.

The National Institute on Drug Abuse (NIDA) Collaborative Cocaine Treatment Study is a 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; PI), Lynne Siqueland (Project Coordinator), Karla Moras (Assessment Unit Director), Jesse Chittams, Robert Gallop (Director 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 the University of Pennsylvania, with Lester Luborsky (PI), Jacques P. Barber (co-principal investigator; CO-PI), and Delinda Mercer (Project Director); Brookside Hospital/Harvard Medical School, with Arlene Frank (PI), Stephen F. Butler (CO-PI/Innovative Training Systems), and Sarah Bishop (Project Director); McLean, Massa- chusetts General Hospital—Harvard University Medical School, with Roger D. Weiss (PI),David R. Gastfriend (CO-PI), Lisa M. Najavits, and Margaret L. Griffin (Project Directors); and the University of Pittsburgh/Western Psychiatric Institute and Clinic, with Michael E. Thase (PI), Dennis Daley (CO-PI), Ishan M. Salloum (CO-PI), and Judy Lis (Project Director). The training unit includes heads of the Cognitive Therapy Training Unit Aaron T. Beck (University of Pennsylvania) and Bruce Liese (University of Kansas Medical Center); heads of the Supportive-Expressive Therapy Training Unit Lester Luborsky and David Mark (University of Pennsylvania); head of the Individual Drug Counseling Unit George Woody (Veterans Administration/University of Pennsylvania Medical School) and heads of the Group Drug Counseling Unit Delinda Mercer (Head), Dennis Daley (Assistant Head; University of Pittsburgh/Western Psychiatric Institute and Clinic), and Gloria Carpenter (Assistant Head; 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, the project officers for this cooperative agreement, are also gratefully acknowledged.