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National Institute on Drug Abuse -  NIDA Notes

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 situations.

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 explains.

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.

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