One-Year Follow-up of Psychotherapy and Pharmacotherapy for Cocaine Dependence: Delayed Emergence of Psychotherapy Effects

doi:10.1001/archpsyc.1994.03950120061010

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Vol. 51 No. 12, December 1994

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One-Year Follow-up of Psychotherapy and Pharmacotherapy for Cocaine Dependence

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 cocainedependence nor the relative ability of psychotherapy vs pharmacotherapyto effect lasting change has been evaluated in well-controlledrandomized trials.

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

Results
First, the effects of study treatments appeared durable overthe follow-up; as for the full sample, measures of cocaine useindicated either improvement or no change over posttreatmentlevels. Second, abstinence during treatment was strongly associatedwith less cocaine use during follow-up. Third, random effectsregression models indicated significant psychotherapy-by-timeeffects, suggesting a delayed improved response during follow-upfor patients who received cognitive-behavioral relapse preventioncompared with supportive clinical management.

Conclusions
Our findings suggest a delayed emergence of the effects of cognitive-behavioralrelapse prevention, which may reflect the subjects' implementationof the generalizable coping skills conveyed through that treatment.Moreover, these data underline the importance of conductingfollow-up studies of substance abusers and other groups becausedelayed effects may occur after the cessation of short-termtreatments.

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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