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
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: firstname.lastname@example.org
Karen K. Howell: email@example.com