Treatment outcome of alcoholics with and without cocaine disorders

The treatment outcome literature suggests that alcoholics with coexisting drug dependence have worse prognoses. We compared three groups of inpatients treated on the same hospital unit for disorders of alcohol only (n = 51), cocaine only (n = 27), or both disorders (dual group, n = 27). At follow-up, we contacted 105 (81%) of 129 patients at a mean of 13.4 +/- 4.1 months after discharge. The three groups significantly and equivalently decreased their consumption of substances at follow-up, and they also had equivalent improvements in employment and in medical and psychiatric well-being. A nonsignificant trend existed for greater abstinence in the alcohol group (53%) than in the dual group (35%), and with regression analysis diagnostic group and stable residence predicted abstinence in the past 30 days. Elapsed time before using alcohol was equivalent for the two alcohol groups, and relapse to alcohol preceded relapse to cocaine by 1 month on average. In sum, outcomes were more similar than different for the three groups. Although specific treatments to enhance abstinence for cocaine users are indicated, clinicians should approach cocaine-using alcoholics with equal optimism for improvement as with other alcoholics.