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Delayed Emergence of Psychotherapy Effects

Kathleen M. Carroll, PhD; Bruce J. Rounsaville, MD; Charla Nich, MS; Lynn T. Gordon, RN, MPA; Philip W. Wirtz, PhD; Frank Gawin, MD

Arch Gen Psychiatry. 1994;51(12):989-997.

Abstract
Background
Neither the durability of brief ambulatory treatments for cocaine dependence nor the relative ability of psychotherapy vs pharmacotherapy to effect lasting change has been evaluated in well-controlled randomized trials.

Methods
We conducted a 1-year naturalistic follow-up of 121 ambulatory cocaine abusers who underwent psychotherapy (cognitive-behavioral relapse prevention or clinical management) and pharmacotherapy (desipramine hydrochloride or placebo) in a 2X2 design. Subjects were interviewed 1, 3, 6, or 12 months after the termination of a 12-week course of outpatient treatment. Eighty percent (n=97) of the subjects who were randomized to treatment were followed up at least once.

Results
First, the effects of study treatments appeared durable over the follow-up; as for the full sample, measures of cocaine use indicated either improvement or no change over posttreatment levels. Second, abstinence during treatment was strongly associated with less cocaine use during follow-up. Third, random effects regression models indicated significant psychotherapy-by-time effects, suggesting a delayed improved response during follow-up for patients who received cognitive-behavioral relapse prevention compared with supportive clinical management.

Conclusions
Our findings suggest a delayed emergence of the effects of cognitive-behavioral relapse prevention, which may reflect the subjects' implementation of the generalizable coping skills conveyed through that treatment. Moreover, these data underline the importance of conducting follow-up studies of substance abusers and other groups because delayed effects may occur after the cessation of short-term treatments.

Author Affiliations
From the Division of Substance Abuse, the Department of Psychiatry, Yale University School of Medicine (Drs Carroll and Rounsaville and Ms Nich), and the APT Foundation (Ms Gordon), New Haven, Conn; the Departments of Psychology and Management Science, George Washington University, Washington, DC (Dr Wirtz); and the Laboratory for the Study of Addiction, the University of California—Los Angeles (Dr Gawin).

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