By Patrick Zickler, NIDA NOTES Staff Writer
NIDA-supported researchers have found that clinicians without access to the resources of a comprehensive substance abuse program can treat cocaine abuse with "network therapy," a treatment approach that combines individual therapy and the involvement of patients' friends or family members. The patient completion rate--a key measure of the likelihood that patients will remain drug free--is comparable to that of other outpatient treatment approaches, the researchers say.
Dr. Marc Galanter, of New York University School of Medicine, reviews a training tape to be shown to clinicians learning network therapy. Developed through NIDA's Behavioral Therapies Development Program, network therapy combines individual cognitive-behavioral therapy with sessions that include the patient and members of his or her network--family members or peers.
Network therapy was developed through NIDA's Behavioral Therapies Development Program by Dr. Marc Galanter and his colleagues at the New York University School of Medicine in New York City. The treatment combines cognitive-behavioral therapy, which enables patients to identify and develop strategies to avoid or cope with circumstances that lead to their drug use, with network sessions that include the patient and one or more "network members"--family members or peers who are not substance abusers.
"Network therapy expands the practitioner's capability to treat cocaine abuse by enlisting family and peer support to provide the reinforcement necessary for the patient's success," says Dr. Galanter. "Physicians in small practices do not have the benefits offered by a large clinical environment, such as social workers, multidisciplinary psychiatric staff, or the opportunity to schedule nightly group meetings. This approach helps overcome those limitations."
The researchers trained 28 psychiatry residents to provide network therapy. Training involved classroom seminars and video presentations based on a 122-page manual. The residents then treated 47 patients who had applied for cocaine abuse treatment and had no other substance abuse or psychiatric disorder.
The patients (mean age 35 years, 85 percent male, 62 percent white) paid $20 per session over a 24-week sequence of twice-weekly individual therapy sessions. Network sessions were held weekly for the first month and monthly thereafter. Twelve patients dropped out of the program after the first week. Of the 35 who remained beyond the first week, nearly half (17) completed the full
24-week course of treatment, a completion rate comparable to those in other outpatient treatment programs.
Treatment success for each participant was based on two measures: the proportion of drug-free weekly urine tests and the participant's drug-free status for the last three tests. Overall, 73 percent of tests throughout treatment were drug free; 20 participants (43 percent of the entire group) were drug free the last 3 weeks of treatment. Success was most likely among patients who involved network members and remained in treatment longest.
"The network sessions involved training network members to provide a supportive environment for abstinence to help patients adhere to behavioral strategies, such as avoiding situations that might trigger drug use," Dr. Galanter explains. "Interestingly, it was the number of network sessions--not the number of individual sessions--that most closely correlated with a good outcome. This suggests the central role of involvement with network members in shaping outcome."
Dr. Dorynne Czechowicz of NIDA's Division of Treatment Research and Development says that the involvement of young doctors in the delivery of network therapy represents a significant additional accomplishment of this research. "The recent approval of buprenorphine for office-based treatment of opiate addiction represents a first step in the movement of drug abuse treatment out of specialized facilities and into the more routine world of health care," she says. "Training young doctors to deliver therapy is a crucial step in getting general practitioners involved in drug abuse treatment, and treatments such as network therapy can help accelerate that movement."
Dr. Galanter is now conducting a study of the effectiveness of network therapy in combination with the administration of buprenorphine in treating heroin addiction. "There is a need for training in psychosocial approaches to drug abuse treatment that are applicable to a practitioner's office, both as a stand-alone option and in combination with pharmacotherapy." Dr. Galanter says. "Our findings in the use of network therapy in treating cocaine addiction are promising. Results so far suggest that network therapy may also be a valuable, easily delivered approach to support buprenorphine treatment in an office setting."
Galanter, M.D.; Dermatis, H.; Keller, D.; and Trujillo, M. Network therapy for cocaine abuse: Use of family and peer supports. American Journal on Addictions 11(2):161-166, 2002.
Volume 18, Number 2 (August 2003)