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A National Evaluation of Treatment Outcomes for Cocaine Dependence
D. Dwayne Simpson, PhD;
George W. Joe, EdD;
Bennett W. Fletcher, PhD;
Robert L. Hubbard, PhD;
M. Douglas Anglin, PhD
Arch Gen Psychiatry. 1999;56:507-514.
Background This national study focused on posttreatment outcomes of community treatments of cocaine dependence. Relapse to weekly (or more frequent) cocaine use in the first year after discharge from 3 major treatment modalities was examined in relation to patient problem severity at admission to the treatment program and length of stay.
Methods We studied 1605 cocaine-dependent patients from 11 cities located throughout the United States using a naturalistic, nonexperimental evaluation design. They were sequentially admitted from November 1991 to December 1993 to 55 community-based treatment programs in the national Drug Abuse Treatment Outcome Studies. Included were 542 patients admitted to 19 long-term residential programs, 458 patients admitted to 24 outpatient drug-free programs, and 605 patients admitted to 12 short-term inpatient programs.
Results Of 1605 patients, 377 (23.5%) reported weekly cocaine use in the year following treatment (dropping from 73.1% in the year before admission). An additional 18.0% had returned to another drug treatment program. Higher severity of patient problems at program intake and shorter stays in treatment (<90 days) were related to higher cocaine relapse rates.
Conclusions Patients with the most severe problems were more likely to enter long-term residential programs, and better outcomes were reported by those treated 90 days or longer. Dimensions of psychosocial problem severity and length of stay are, therefore, important considerations in the treatment of cocaine dependence. Cocaine relapse rates for patients with few problems at program intake were most favorable across all treatment conditions, but better outcomes for patients with medium- to high-level problems were dependent on longer treatment stays.
From the Institute of Behavioral Research, Texas Christian University, Fort Worth (Drs Simpson and Joe); the Services Research Branch, National Institute on Drug Abuse, Rockville, Md (Dr Fletcher); the National Development and Research Institutes Inc, Raleigh, NC (Dr Hubbard); and the Drug Abuse Research Center, University of California–Los Angeles (Dr Anglin).
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