Additional Treatment Services in a Cocaine Treatment Study: Level of Services Obtained and Impact on Outcome

Abstract

The objective of this study was to examine the level of additional treatment services obtained by patients enrolled in the NIDA Cocaine Collaborative Study, a multi-center efficacy trial of four treatments for cocaine dependence, and to determine whether these services impact treatment outcome. Cocaine-dependent patients (N = 487) were recruited at five sites and randomly assigned to six months of one of four psychosocial treatments. Assessments were made at baseline, monthly during treatment, and at follow-ups at 9, 12, 15, and 18 months post-randomization. On average, patients received little or no additional treatment services during active treatment (first six months), but the rate of obtaining most services increased during the follow-up phase (month 7 to 18). In general, the treatment groups did not differ in the rates of obtaining non-protocol services. For all treatment groups, patients with greater psychiatric severity received more medical and psychiatric services during active treatment and follow-up. Use of treatment services was unrelated to drug use outcomes during active treatment. However, during the follow-up period, increased use of psychiatric medication, twelve-step attendance, and twelve-step participation was related to less drug use. The results suggest that during uncontrolled follow-up phases, additional non-protocol services may potentially confound the interpretation of treatment group comparisons in drug use outcomes.

Spirituality as a Change Mechanism in 12-Step Programs: A Replication, Extension, and Refinement

“…This finding is consistent with the message of abstinence from all mood altering drugs that is endorsed by all 12-step programs. Contrary to many reports, however, this reduction in illicit drug use was not related to frequency of AA meetings (e.g., Gossop et al, 2007; Timko et al, 2006; Timko & Sempel, 2004; Weiss et al, 2005; Witbrodt & Kaskutas, 2005; Worley et al, 2008). Likewise, changes in spirituality were not predictive of later illicit drug use, although most of the spirituality measures did predict increased alcohol abstinence and reduced drinking intensity.…”

“…Several meta-analyses and numerous prospective studies have now shown that 12-step attendance alone, in combination with, and after treatment, is predictive of reductions in drinking (Emrick, Tonigan, Montgomery, & Little, 1993; Kaskutas, Bond, & Humphreys, 2002; Kelly, Stout, Magill, Tonigan, & Pagano, 2011; Tonigan & Rice, 2010; Tonigan, Toscova, & Miller, 1996) and illicit drug use (Gossop, Stewart, & Marsden, 2007; Timko, Billow, & DeBenedetti, 2006; Timko & Sempel, 2004; Weiss et al, 2005; Witbrodt & Kaskutas, 2005; Worley et al, 2008). It is important to note that long-term investigations into the benefits of 12-step programs are relatively rare, and a majority of studies are limited to 12-month follow-up.…”

The impact of treatment condition and the lagged effects of PTSD symptom severity and alcohol use on changes in alcohol craving

“…Therefore, a negative binomial model was used to model percentage of drinking days. Following the methods of Worely et al (2008), partial correlations were used to examine the relationship between non-study treatments received and the study outcomes (alcohol craving, percentage of drink days, PSS-I) during active treatment and follow-up while controlling for baseline measures of non-study treatment services received, baseline scores on the relevant outcome measure, and treatment condition.…”

Twelve-Step Program Attendance and Polysubstance Use: Interplay of Alcohol and Illicit Drug Use

“…For example, results from meta-analytic reviews and prospective studies indicate that AA attendance predicts reduced alcohol consumption and complete abstinence from alcohol (e.g., Emrick et al, 1993;Kaskutas et al, 2002;Tonigan and Rice, 2010;Tonigan et al, 1996). Likewise, participation in 12-step programs has been shown to predict reduced global drug use (e.g., Timko and Sempel, 2004;Timko et al, 2006;Witbrodt and Kaskutas, 2005) as well as the use of specifi c drugs such as marijuana, opiates, and psychostimulants (Carroll et al, 2000;Gossop et al, 2007;Toumbourou et al, 2002;Weiss et al, 2005;Worley et al, 2008).…”