SUBSTANCE ABUSE AND TREATMENT

Therapeutic Intervention of Cocaine Abusers

By Lauren Gilmore

A recent study conducted by Dr. Sharon Hall and her colleagues at the University of California, San Francisco, investigated the efficacy of both cognitive- behavioral therapy and 12 step programs. Results indicated that particular personal characteristics have an effect on which type of therapy is more effective in abstaining from crack/cocaine abuse.
Many people with various types of disorders, including addictive diseases, have benefited from both cognitive-behavioral therapy (CBT) and the traditional 12 step philosophies. CBT is based on teaching people how to think and act differently in response to their surroundings. CBT theory includes the belief that we are strongly influenced by our environment. When focusing on addiction issues, people are taught to avoid situations and people that may trigger them to use, as well as to develop necessary coping skills. The 12 step philosophy used in Alcoholics Anonymous (AA), involves spirituality as well as companionship and support from others who suffer from addictive diseases. The belief in a "higher power" and admitting to being powerless over addiction has helped many to refrain from abusing drugs.

Dr. Hall and her fellow researchers recruited 128 crack/cocaine smokers from various inpatient and outpatient programs at the Veterans Affairs Medical Center. Patients were put into two groups: one group which received cognitive-behavioral therapy, and another group which received 12 step facilitation. Each group received three group therapy sessions and one individual session each week for 12 consecutive weeks. The subjects in the 12 step group attended Cocaine Anonymous meetings and worked each step of the program. In addition to the meetings, these patients attended the group therapy sessions and received individual counseling. The CBT focused more on restructuring thinking patterns, increasing awareness, and maintaining a positive attitude. These patients also attended cognitive-based self-help groups.
At the end of the study, less than half of the participants had attended the group therapy and individual sessions that were offered. However, the majority did attend the follow-up session and 89 percent were drug tested on the 26th week of the study. Overall, the CBT subjects were more likely to maintain abstinence than the 12 step subjects. When looking closely at the results, researchers found that other patterns emerged.

In the CBT group, subjects who scored higher on tests of abstract reasoning maintained abstinence for longer periods of time. In contrast, the subjects from the 12 step group who scored lower on tests of abstract reasoning maintained longer periods of abstinence. Another finding among the 12 step group was that those who tested higher on a scale of "religious motivation" were more likely to maintain abstinence than those who scored low in this category.
Unfortunately, the population used for this study does not represent most cocaine users, making it difficult to generalize to a typical sample of society. All of the participants were veterans, and most were indigent males. However, this study does have significant implications. In addition to demonstrating the effectiveness of different treatment protocols, it is suggested that a person's personal characteristics should be taken into consideration when deciding what kind of treatment would be most beneficial to the individual.

The Maternal Substance Abuse and Child Development Project is funded in part by the Georgia Department of Human Resources Division of Public Health.

The Maternal Substance Abuse and Child Development Study is under the direction of Claire D. Coles Ph.D., with the Department of Psychiatry and Behavioral Science, Emory University School of Medicine. For more information, please contact: Claire D. Coles: ccoles@emory.edu Karen K. Howell: khowell@emory.edu