Table 2 Summary of evidence-based cocaine use group treatment for adults

Coviello et al., 2001 [54]

94 veterans with CD (DIS) and without psychiatric or medical instability. Mean age 40 years, 0% female, 92% African American.

4-weeks:

1. 12-h per weekday hospital program (DH12; 12-h abbreviated version of a 27-h a weekday hospital program, with 7 h of group treatment, 3 h of educational therapy and 2 h of counseling and case management over five weekdays).

2. 6-h per week outpatient program (OP6; 6-h of

groups, 1 h of educational therapy and 1 h of counseling and case management over three weekdays).

1. Yes

2. Yes

RAAT; 4- and 7-month f/u. 93% f/u rate; 39% tx completion.

Across groups, patients reported a 52% reduction in days of cocaine use and experienced significant improvements in employment and psychiatric functioning at 7-month f/u. No difference between DH12 and OP6 programs in terms of abstinence during treatment, treatment completion, treatment or aftercare attendance or any Addiction Severity Index (ASI)-related variable at 4- and 7-month f/u.

Crits-Christoph et al., 1999 [41];

Crits-Christoph et al., 2001 [55];

Siqueland et al., 2002 [56]

487 solicited with CD (Anxiety Disorders Interview Schedule). Mean age 34 years, 23% female, 40% African American.

24 weekly group sessions for 90 min, 36 individual sessions for 50 min, plus 3 monthly booster sessions:

1. Manual guided group drug counseling (GDC; [57])

2. GDC plus individual supportive-expressive therapy (GDC + SE; [58]),

3. GDC plus individual cognitive therapy (GDC + CT)

4. GDC plus 12-step individual drug counseling (GDC + IDC)

1. Yes

2. Yes

3. Yes

4. Yes

RAAT; 3-, 6-, 9-, and 12-month f/u. 100% f/u rate. 31% tx completion.

IDC + GDC reduced drug composite score more than other treatments over 9- and 12-month f/u. No differences revealed between GDC or GDC + SE or GDC + CT. Superiority of IDC + GDC vs. others did not extend to other addiction associated problems. IDC + GDC stayed in treatment for fewer days than others but were more likely to be abstinent after dropout. Younger, African American, and unemployed patients were retained in treatment for fewer days than others. Higher psychiatric severity kept men in treatment longer but increased women’s risk for drop out. Higher psychiatric severity increased risk for continuing to use drugs after dropout.

Epstein et al., 2003 [59]

193 methadone-maintained outpatients using cocaine (DIS; diagnoses of heroin or CD not required) without psychosis, bipolar, or major depressive disorders, AD, or sedative dependence, medical conditions, pregnancy, cognitive impairment, or and urologic conditions that would preclude urine collection. Mean age of 29 years, 43% female, 70% African American.

Daily methadone and weekly individual counseling for 29 weeks, with baseline treatment (5 weeks), intervention (12 weeks), and maintenance therapy (12 weeks):

1. Voucher condition (CM; contingent on cocaine-negative urine or noncontingent).

2 CM plus CBT based group therapy (CM-CBT; 1x week, 90 min for 12 weeks)

3. Cognitive behavioral group (CBT; 1x week, 90 min for 12 weeks)

4. Control condition (Control; Social support group, 1x week, 90 min for 12 weeks)

1. Yes

2. Yes

2. No (Control; but Yes, for CM)

4. No

RAWC; 12- week f/u. 63% of control completed f/u, 62% of CM completed f/u, 58% of CBT completed f/u, and 57% of CM-CBT completed f/u. 76% of control completed tx, 81% of CM completed tx, 79% of CBT completed tx, and 69% of CM-CBT completed tx.

During treatment, initial effects of CM were dampened by CBT. Posttreatment CM-CBT evidenced positive results compared to others over 12-month f/u. CBT participants were also more likely to acknowledge cocaine use and its effects and to report employment.

Hoffman et al., 1996 [44]

184 referred individuals with cocaine abuse/CD (CIDI and DIS), without dependency on other drugs, or psychosis. Mean age 32 years, 40% female, 95% African American.

4-months with up to 4 vocational assessment/therapy sessions on an individual basis, and up to 4 family group therapy sessions once a month):

1. Standard Group Therapy (SGT; 90-min, 2 sessions per week) with Individual Therapy (IT; 60 min, 2 sessions per week starting month 1 and 1 session thereafter) (SGT + IT)

2. SGT + IT plus Family Therapy (FT; 90-min sessions, 1 session per week starting in month 2) (SGT + IT+FT)

3. SGT only

4. Intensive Group Therapy (IGT; 120-min, 5 sessions per week) with IT (IGT + IT)

5. IGT + IT+FT

6. IGT only

1. Yes

2. Yes

3. Yes

4. Yes

5. Yes

6. Yes

7. Yes

RAAT; 12-month f/u, 66% 12-month f/u rate. Tx completion rates were: 19.1% SGT only, 38.5% SGT + IT, 46.8% SGT + IT+FT, 45.2% IGT only, 34.3% IGT + IT, and 38.5% IGT + IT+FT.

Across groups, patients evidenced significant pre-post treatment gains: reduced regular cocaine use, reduced other drug use, reduced regular alcohol use, and reduced involvement in illegal activities. Regular cocaine users over 12-month f/u were more likely to be female, less educated, have been using cocaine prior to treatment, spent fewer days incarcerated during 12-months post treatment, and have attended fewer treatment sessions.

McKay et al., 1997 [21];

McKay et al., 1999 [20]

132 veterans referred from intensive outpatient treatment with CD (SCID). Mean age 40 years, 0% female, 85% African American.

2 sessions per week for 5 months:

1. Standard aftercare group (ST; addiction counseling and 12-step based)

2. Individual relapse prevention (RP; 1 weekly ST group plus 1 session individual therapy, self-efficacy focused)

1. No

2. Yes

RAAT. 2-yr. f/u, 92% follow-up rate, 43% tx completion.

Complete abstinence rates favored ST but RP was more effective in limiting extent of cocaine use. Self-efficacy predicted cocaine use. Patients reporting commitment to absolute abstinence had better cocaine use outcomes in RP compared to ST. Patients reporting less stringent abstinence goals had better cocaine use outcomes in ST compared to RT. Patients with CD or AD upon entering tx who received RP had better cocaine use outcomes in Months 1–6 and better alcohol use outcomes in Months 13–24 than those in ST. At 2 years, medical outcomes were significantly better for RT compared to ST.

Magura et al., 1994 [60]; Magura, et al., 200,256)

141 patients in methadone maintenance treatment with CD (SCID). Mean age 39 years, 33% female, 26.2% African American, 39.7% Hispanic.

8 months of treatment:

1. Cognitive behavioral therapy plus treatment reinforcement plan (CBT; Matrix model; In Phase I, subjects participated in a 4-month CBT program with two individual and three group sessions per week. Phase II consisted of two group sessions per week.

2. Treatment as usual (TAU; standard methadone maintenance therapy)

1. Yes

2. No

RAWC across tx site (2 sites offered CBT, 2 sites TAU); 4- and 12-month f/u. 76% 12-month f/u rate. For CBT 56% tx completion for Phase I and 51% tx completion for Phase II.

Cocaine use declined significantly from baseline to 4- and 12-month f/u across groups. CBT participants rated the quality of their counseling relationship higher and obtained more supportive services than TAU. Group was not associated with outcome. Measures associated with poorer outcomes across both groups were: currently enrolled in methadone treatment, higher cocaine use frequency, greater cocaine use associated problem recognition, and an ambivalence toward methadone treatment.

Petry et al., 2007 [61]

387 patients in intensive outpatient with cocaine abuse or CD (SCID) and without psychosis, suicidal, or pathological gambling. Mean age 36 years, 50% female, 51% African American.

12-weeks:

1. Treatment as usual (TAU)

2. TAU plus contingency management (CM; chance to earn prizes or vouchers for submitting negative samples and/or completing goal-related activities)

1.No

2. Yes

RAWC; Months 1, 3, 6, and 9 f/u, 84.2, 81.2, 73.5, and 69.0% f/u rates at months 1, 3, 6, and 9. Tx completion rate not reported.

Quality of life (QOLI) scores over time differed by group, with QOLI scores rising over time in CM participants and remaining stable in TAU. CM achieved greater durations of abstinence, and duration of abstinence was correlated with post treatment QOLI. Abstinence mediated the relationship between treatment condition and QOLI over time.

Rawson et al., 2002 [62]

120 patients in methadone maintenance program with CD (SCID). Mean age 43 years of age, 32% African American, 26% Hispanic.

16-weeks:

1. Contingency Management (CM; vouchers for stimulant-free urine samples; three samples per week and meet briefly with the CM technician)

2. CBT group (CBT; three 90-min group sessions each week, for 16 weeks).

3. CM plus CBT groups (CM-CBT; separate sessions)

4. Treatment as usual (TAU; methadone maintenance clinic)

1. Yes

2. Yes

3. Yes

4. No

RAAT; 17, 26 and 52 weeks, 80% follow-up rate, tx completion not reported.

Two CM groups had superior urine analysis results compared to CBT and TAU at 16 weeks. At week 17 all groups but TAU evidenced reduced rates of cocaine use. At 26 and 52 week f/u CBT showed improvement, gaining equivalence to CM groups in urine analysis and cocaine use.

Rohsenow et al., 2000 [34];

Rohsenow et al., 2001 [63]

128 recruited patients in private substance abuse treatment facilities with CD (SCID). Mean age 28 years, 31% female, 8% African American.

Up to eight 45-min individual sessions held three to five times per week:

1. Meditation-relaxation training (MRT; Control).

2. Cocaine specific coping skills treatment (CST).

1. Yes

2. Yes

RAWC; 3-, 6- and 9-month f/u., 79% f/u rate, 84% tx completion (N = 108).

CST participants who relapsed had significantly fewer cocaine use days than did the control group during the first 6 months f/u, no differences over 9-month f/u. CST drank alcohol more frequently during 6 months f/u than MRT. No differences in heavy drinking days. No interaction of treatment was found with gender, education, route of administration, drug use severity, sociopathy, or depression.

Rosenblum et al., 1995 [64];

Rosenblum et al., 1999 [65]

198 methadone patients with CD (SCID), stabilized methadone dose without psychosis or medical condition. Mean age 38 years, 43% female, over 50% Hispanic.

26 weeks:

1. Cognitive behavioral therapy (CBT; Matrix model; 5 days per week, 30 min individual and 45 min. Group sessions. During week 1–4, 3 individual and 2 group sessions, at week 5, 2 individual sessions and 3 group sessions)

2. Low intensity therapy (LIT; weekly group)

1. Yes

2. Yes

RAAT; 48-week f/u. 97.5% 6- month f/u rate, 90.4% 15-month f/u rate. 60% tx completion.

Both groups showed significant and equivalent reductions in cocaine use. Completing tx and lower cocaine severity at baseline were associated with lower proportion of cocaine-positive urines over f/u. High-severity patients improved more in CBT compared to LIT. Positive outcomes for therapy completers relative to non-completers increased over time.

Volpicelli et al., 2000 [66]

87 mothers with CD (ASI) without

psychosis, homicidal or suicidal,

medical condition, or

opioid dependence. Mean age 32 years, 100% female, 97% African American.

Group therapy sessions (GDC) available 5 days per week, expected to attend 2 sessions per week, plus:

1. Case management (CM; 1 15-min session weekly)

2. Psychologically enhanced program (PET access to parenting classes, GED classes, access to a staff psychiatrist, and unlimited access to an individual therapist)

1. No

2. Yes

RAAT; 12-month f/u, 50% completed PET, and 40% completed CM. f/u rates not reported.

Program retention was better for patients in PET. Mean number of days of cocaine use decreased from baseline in both groups, and PET had fewer days of cocaine use at 12-month f/u than CM.

Weinstein, et al. (1997) [67]; Gottheil et al. (1998) [68].

447 referred patients with CD (screened via Risky AIDS Behavior Inventory), and not psychotic, suicidal or cognitively impaired. Mean age of 32 years, 44% female, 93% African American.

Weekly sessions for 12 weeks.

1. Individual counseling (IC, 1 h; supportive, expressive, problem focused)

2. Individual counseling (1 h) plus 1 weekly group session (1 h) (IC-G)

3. Intensive Treatment group (IT; 3 –hours of group, 3 times per week).

1. No

2. No

3. No

RAAT; 6-month and 9-month f/u, 70% of IC completed f/u, 72% of IC-G completed f/u and 70% of IT completed f/u. 20% of IC and IC-G completed tx, and 32% of IT completed tx.

IT evidenced improvement on addiction severity, depression and psychiatric symptoms at end of tx. Regardless of group, at 9-month f/u participants who remained in treatment longer evidenced fewer drug problems, positive drug screens, better employment and fewer psychiatric problems. No significant differences between groups at 6-month or 9-month follow-up.