Behavioral Interventions for Cocaine Addiction
Many behavioral treatments for cocaine addiction have proven to be effective in both residential and outpatient settings. Indeed, behavioral therapies are often the only available and effective treatments for many drug problems, including stimulant addictions. However, the integration of behavioral and pharmacological treatments may ultimately prove to be the most effective approach.
Contingency Management (CM)
Contingency management (CM), also called motivational incentives, is showing positive results in people with cocaine use disorders. Programs use a voucher or prize-based system that rewards patients who abstain from cocaine and other drugs. On the basis of drugfree urine tests, the patients earn points, or chips, which can be exchanged for items that encourage healthy living, such as a gym membership, movie tickets, or dinner at a local restaurant. CM may be particularly useful for helping patients achieve initial abstinence from cocaine and stay in treatment. This approach has recently been shown to be practical and effective in community treatment programs.
Research indicates that CM benefits diverse populations of cocaine users. For example, studies show that cocaine-dependent pregnant women and women with young children who participated in a CM program as an adjunct to other substance use disorder treatment were able to stay abstinent longer than those who received an equivalent amount of vouchers with no behavioral requirements. Patients participating in CM treatment for cocaine use who also experienced psychiatric symptoms—such as depression, emotional distress, and hostility—showed a significant reduction in these problems, probably related to reductions in cocaine use.
Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy (CBT) is an effective approach for preventing relapse. This approach helps patients develop critical skills that support long-term abstinence—including the ability to recognize the situations in which they are most likely to use cocaine, avoid these situations, and cope more effectively with a range of problems associated with drug use. This therapy can also be used in conjunction with other treatments, thereby maximizing the benefits of both.
Recently, researchers developed a computerized form of CBT (CBT4CBT) that patients use in a private room of a clinic. This interactive multimedia program closely follows the key lessons and skill-development activities of in-person CBT in a series of modules. Movies present examples and information that support the development of coping skills; quizzes, games, and homework assignments reinforce the lessons and provide opportunities to practice skills. Studies have shown that adding CBT4CBT to weekly counseling boosted abstinence and increased treatment success rates up to 6 months after treatment.
Therapeutic Communities (TCs)
Therapeutic communities (TCs)—drug-free residences in which people in recovery from substance use disorders help each other to understand and change their behaviors—can be an effective treatment for people who use drugs, including cocaine. TCs may require a 6- to 12-month stay and can include onsite vocational rehabilitation and other supportive services that focus on successful reintegration of the individual into society.
Scientists have found promising results from telephone-based counseling as a low-cost method to deliver aftercare. For example, people who misused stimulants who participated in seven sessions of telephone counseling showed decreasing drug use during the first 3 months, whereas those who did not receive calls increased their use. Voucher incentives can boost patients’ willingness to participate in telephone aftercare, doubling the number of sessions received according to one study
Community-Based Recovery Groups
Community-based recovery groups—such as Cocaine Anonymous—that use a 12-step program can also be helpful in maintaining abstinence. Participants may benefit from the supportive fellowship and from sharing with those experiencing common problems and issues.
Support & Aftercare
Regardless of the specific type of substance use disorder treatment, it is important that patients receive services that match all of their treatment needs. For example, an unemployed patient would benefit from vocational rehabilitation or career counseling along with addiction treatment. Patients with marital problems may need couples counseling.
Once inpatient treatment ends, ongoing support—also called aftercare—can help people avoid relapse. Research indicates that people who are committed to abstinence, engage in self-help behaviors, and believe that they have the ability to refrain from using cocaine (self-efficacy) are more likely to abstain. Aftercare serves to reinforce these traits and address problems that may increase vulnerability to relapse, including depression and declining self-efficacy areas—improving legal, employment, and mental health outcomes.
If you are a Connecticut resident seeking access to substance abuse treatment, including assessment centers, medication-assisted treatment (MAT), detox, and residential treatment, call the Access Line. The Access Line is able to prioritize transportation services for detox and may also be able to arrange transportation to DMHAS substance abuse residential treatment.