For some cocaine abusers, urges to use cocaine come out of the blue.
But more often the urge is associated with an identifiable situation that
triggers drug use. A behavioral science research study supported by NIDA
has led to the development of a treatment technique that helps cocaine
users control their drug use by recognizing and coping with these high-risk
Dr. Damaris Rohsenow, Dr. Peter Monti, and their colleagues at Brown
University's Center for Alcohol and Addiction Studies in Providence, Rhode
Island, have developed a cocaine-specific coping skills training (CST)
technique that can be used as part of a treatment program to help cocaine
abuse patients identify situations that trigger their urges to use cocaine
and modify their behavior to avoid drug use.
In the study, patients who received CST as part of treatment "had significantly
shorter and less severe relapses during the 3-month followup period than
did patients who received standard treatment," Dr. Rohsenow says.
Patients who received CST were taught to identify high-risk situations,
called triggers, associated with drug use. These triggers were broadly
categorized into topic areas such as anger, money, frustration, or depression.
Patients then focused on specific personal examples of triggers and analyzed
the sequence of actions, called a "behavioral chain," that led to drug
use in those situations.
Patients learned how to avoid or modify the trigger situation when possible.
"For example, if a money trigger is associated with getting a paycheck,
they might arrange for their paycheck to be directly deposited in their
bank. Or if drug use is associated with their lunch break, patients could
eat with a group of coworkers rather than going out alone," Dr. Rohsenow
|Coping skills training
can help patients identify situations that trigger their urges to
use cocaine and modify their behavior to avoid drug use.
For situations in which the trigger could not be avoided, patients developed
a repertoire of cognitive and behavioral skills to modify the behavioral
chain and reduce their personal risk of drug use. "A phone call from an
ex-spouse might be an Ôanger' trigger that can't be avoided. But patients
can use coping skills training to change how they behave in response to
the call. They can Ôtalk out' their anger with friends or do something
physical like go out and play basketball," Dr. Rohsenow says.
The study involved 128 male and female patients selected from 2 drug
abuse treatment facilities. Standard treatment at these facilities is
an abstinence-based program that combines the principles of the Alcoholics
Anonymous 12-step program with educational information presented in group
formats, individual counseling sessions, and family or marital therapy.
Roughly half the patients received standard treatment plus eight 1-hour
sessions of CST. The other half received standard treatment plus eight
1-hour sessions of meditation-relaxation training (MRT), a procedure that
often is used as part of treatment programs but has no significant effect
on substance use. The MRT procedure assured that all patients in the study
spent the same amount of time in contact with therapists.
The patients were evaluated at 1 and 3 months following treatment. Roughly
45 percent of patients from each group suffered relapses following treatment,
but relapsing CST patients averaged only 6.2 days of drug use compared
with more than 13 days of cocaine use for patients who received MRT.
The improvement in outcome for most CST patients was far better than
these average figures suggest, Dr. Rohsenow points out, because one relapsed
CST patient used cocaine for 49 out of 90 days in the followup period.
The other CST patients averaged only 3.8 days of drug use.
Among CST patients, the longest binges averaged 2.8 days - less than
half as long as the binges for the other patients, which lasted an average
of 6 days.
"Patients with CST training were able to change the way they thought
and then change the way they behaved in situations that posed a risk of
relapse," Dr. Rohsenow says.
Monti, P.M.; Rohsenow, D.J.; Michalec, E.; Martin, R.A.; and Abrams,
D.B. Brief coping skills treatment for cocaine abuse: substance use outcomes
at three months. Addiction 92(12): 1717-1728, 1998.