OBJECTIVE: The authors studied the efficacy of once-weekly
psychotherapy, family therapy, or group therapy led by paraprofessionals
among patients with cocaine use disorders. METHOD: Of subjects who sought
outpatient treatment, 168 consented to participate in the study and were
each randomly assigned to one of the three forms of therapy; 122 patients
were interviewed 6-12 months later. Their pre- and posttreatment scores on
the Addiction Severity Index were compared. RESULTS: Significant
improvements were observed for the cohort as a whole, but virtually all of
the improvement was restricted to the 23 subjects (19%) who were not using
cocaine at follow-up. There was a strong relationship between abstinence
from cocaine use and absence of addiction-related problems, especially
psychiatric symptoms and family problems. CONCLUSIONS: The results of the
study indicate that outpatient therapy once a week is ineffective for
cocaine use disorder. The 19% abstinence rate probably represents
spontaneous remission among patients with enough motivation to seek
treatment, as the number of therapy sessions attended was not related to
improvement. Either an intense level of outpatient contact or residential
treatment followed by aftercare is probably needed, at least initially,
while the patient is attempting to initiate and sustain abstinence.Abstract Teaser