Evaluation of treatment for cocaine dependence

1. At the Philadelphia VA Medical Center, veterans applying for treatment of cocaine dependence were significantly different from applicants dependent on opiates or alcohol without cocaine. The cocaine dependent patients were almost all black and they were mostly employed. Few were involved in crime and, for most, this was the first course of substance abuse treatment. Their use of cocaine began within the past three years and they had relatively few psychiatric, medical, employment or family problems when compared with other applicants for substance abuse treatment. 2. Completion rate for a course of outpatient treatment for cocaine dependence varies from a low of 37% in the general Day Treatment Program to 76% in a special Behavioral Treatment Program and 78% among methadone patients receiving an additional medication for cocaine dependence. Completion of a 28 day course of inpatient treatment was 86% whether the patient selected inpatient care or was assigned to it on a random basis. 3. Those outpatients who remained in treatment generally did well and refrained from cocaine use even during the course of outpatient, either day hospital treatment or behavioral treatment. When both inpatients and outpatients were re-examined four months after beginning treatment, there was significant improvement on almost all ASI categories. Both drop-outs and completers were re-examined. Despite the significantly greater completion rate for the patients assigned to inpatient treatment, both groups showed equal levels of improvements at the 4-month follow up point. 4. These preliminary results from five different treatment populations suggest that cocaine dependent patients can be engaged in treatment and that significant improvement is possible.