The Coordinating Center of the National Institute on Drug Abuse (NIDA) collaborative treatment of cocaine abuse project has three main functions: 1) administrative support for the study which includes coordination of steering committee meetings; 2) training and supervision of therapists; and, 3) data management and analysis. The Coordinating Center makes use of the expertise in training of therapists and data management and analysis present in the Clinical Research Center for the Study of Psychotherapy at the University of Pennsylvania. Dr. Aaron Beck is in charge of the training, monitoring, and supervision of psychotherapists for a cognitive therapy condition in the collaborative study. Dr. Lester Luborsky does the same for the psychodynamic therapy and Dr. George Woody for the drug counseling. A Data Management and Statistics Unit process the incoming data from clinical sites for entry on the computer and for analysis.
Thase, Michael; Western Psychiatric Institute
Psychosocial Treatments for Cocaine Abuse
This is a collaborative treatment site for the NIDA-sponsored clinical trial comparing the efficacy of Supportive-Expressive Psychotherapy, Cognitive Behavior Therapy, and/or Drug Counseling in cocaine abuse disorders. In addition to conducting the comparative trial (as finalized by the steering committee), this group will carry out a comprehensive investigation of the reliability, stability, and clinical significance of affective disorder diagnoses in cocaine abusers. This substudy has considerable public health significance: while affective disorders are apparently common in cocaine abusers (lifetime prevalence of up to 50%), the reliability of such diagnoses is questionable, their etiopathogenesis is poorly understood, and their implications for treatment planning remain controversial. Features of this substudy include: collection of life-time history and time-course of affective symptoms in relation to cocaine abuse; re-ratings of videotaped interviews and repeat interviews after 1 and 6 months to determine reliability and temporal stability; use of an alternate diagnostic format (SADS) to establish convergent validity; and construct validation of affective disorders diagnoses using the RDC Family History method. In addition, psychotherapy/counseling nonresponders will enter an 8-week placebo-controlled study of the efficacy of desipramine hydrochloride (DMI), with patients stratified by therapy assignment and presence/absence of affective disorder. This substudy will yield a wealth of information about the diagnosis and treatment of depression in cocaine abusers, which promises to result in refinements in classification and improved application of the differential therapeutics of these comorbid conditions. These findings thus are likely to lead to a better match between patients and available treatments of cocaine dependence (i.e., drug counseling, professional psychotherapy, and antidepressant pharmacotherapy).
Weiss, Roger; McLean Hospital
Psychosocial Treatment of Cocaine Use Disorder
The purpose of this project is to serve as a Collaborative Treatment Site for the NIDA Collaborative Study to compare three forms of psychosocial treatment in ambulatory cocaine abusers: 1) Supportive-expressive psychotherapy, 2) Cognitive-behavioral psychotherapy, and 3) Drug counseling. Patients are randomized to one of these three forms of therapy in addition to receiving standard drug counseling. The interaction between patient characteristics (e.g., sociodemographic characteristics, substance use history, psychiatric status), type of therapy, and treatment outcome will also be addressed.
In addition to this major study, a substudy is being performed to characterize more clearly the process of relapse and recovery in cocaine abusers. The substudy examines three specific dimensions of this process by addressing the following questions: 1. What abstinence symptoms do patients experience after stopping cocaine use? Are abstinence symptoms similar in inpatients and outpatients? 2. Does the degree of motivation for treatment correlate with treatment retention and/or outcome? What is the interaction between motivation, specific forms of therapy, and treatment outcome? 3. What is the nature of self-help group activities in which cocaine abusers participate? Does the frequency of attendance and/or degree of participation correlate with overall treatment outcome? Patients seeking treatment for cocaine use disorders at the outpatient program of the Alcohol and Drug Abuse Treatment Center of McLean Hospital and the Chemical Dependence Unit (West End Group Practice) of the Massachusetts General Hospital are being recruited for this study. Subjects receive (a) drug counseling, and (b) one of the three aforementioned forms of psychotherapy, to which they are randomly assigned. Study subjects are periodically interviewed and complete questionnaires to monitor their progress, cocaine abstinence symptoms, motivation and attitude toward treatment, and participation in self-help activities. Urine toxicological screens and breathalyzer tests also are performed to monitor drug and alcohol use. This study aims to study the efficacy of these three commonly used forms of therapy in the treatment of patients with cocaine use disorders.
Luborsky, Lester; University of Pennsylvania
Psychosocial Treatment of Cocaine Use Disorder
The purpose of this project is to serve as a Collaborative Treatment Site for a National Institute on Drug Abuse (NIDA) collaborative study for the comparison of the most promising psychosocial treatments for cocaine abuse disorders. The goals of this study are: 1) to study the efficacy of three psychosocial treatments (dynamic therapy + drug counseling, cognitive therapy + drug counseling, and drug counseling by two different counselors) for cocaine use disorder, and 2) to examine the interactions between patient characteristics (e.g., psychiatric severity and the presence of antisocial personality) and treatment in determining the outcome of treatment. The study is planned to include four sites; in each of these, 30 patients would be randomly assigned to each treatment group. The three treatments chosen have been shown to be effective in the methadone-assisted treatment of opiate disorders and in pilot studies at the Pennsylvania Veterans Administration (VA) Center for Studies of Drug Addiction. These treatments have been adapted specifically to the needs of cocaine abusers and new treatment manuals have been written detailing these adaptations.
Frank, Arlene; Northeast Psychiatric Associates
Effectiveness of Cocaine Abuse Treatment
Cocaine abuse is a major public health problem with enormous personal and societal costs. The need for treatments that are both effective and cost-effective is clear and compelling. The present project seeks to evaluate the relative effectiveness of three, promising psychosocial treatments for cocaine abuse: (1) Supportive-Expressive psychotherapy plus drug counseling (2) Cognitive-Behavioral psychotherapy plus drug counseling, and (3) Drug Counseling alone provided by two counselors. At each of four Collaborative Treatment Sites, 90 medication-free, cocaine-dependent outpatients, of varying levels of psychiatric severity, with and without antisocial personality disorder, are being randomly assigned to one of the three treatment conditions and followed prospectively for two years. Treatment outcome is being evaluated at regular intervals, using a comprehensive and multifaceted assessment battery. Concurrently, data on law enforcement, employment, family burden, and treatment costs will be obtained. These will be combined with the treatment efficacy data and with data on outcome utilities representing a variety of perspectives.