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Delayed Effects of Cognitive-Behavioral Therapy for Cocaine Dependence

Both psychotherapy and desipramine have been used to treat mixed opioid-cocaine dependence and abuse, but the long-term efficacy of these treatments has not been established. This one-year follow-up of patients with DSM-III-R cocaine dependence compared the short- and long-term effects of these two treatments.

Initially, researchers randomized 121 patients to one of four 12-week treatments: cognitive-behavioral therapy or nonspecific supportive psychotherapy, either with or without desipramine (average dose, 200 mg). Cognitive-behavioral therapy sought to identify and minimize factors and situations that increased the risk for relapse and to develop coping strategies. During one year of follow-up, 97 patients were evaluated with standardized instru-ments and urine screening to confirm abstinence.

Two important findings emerged from the complicated data analysis. First, while cocaine use did not increase after withdrawal of desipramine, the medication did not promote abstinence after it was discontinued. Second, cognitive-behavioral therapy did not enhance abstinence from cocaine immediately after treatment, but had a delayed effect after six months that was even more marked at the end of one year.

Comment: This study suggests that short-term cognitive-behavioral therapy has enduring treatment effects for cocaine dependence even though the benefits may not be apparent immediately: perhaps the skills learned take time to be integrated into patients' lives, or the effects of the specific psychotherapy were initially masked by short-lived effects of nonspecific psychosocial therapies administered to all patients in the study. Short-term studies that fail to find treatment differences may miss clinically important benefits that accrue months to years after treatment is discontinued. Conversely, if desipramine is effective in the short run, it should probably be continued.

— S Dubovsky

Published in Journal Watch Psychiatry February 1, 1995

Citation(s):

Carroll KM et al. One-year follow-up of psychotherapy and pharmacotherapy for cocaine dependence. Arch Gen Psychiatry 1994 Dec 51 989-997.

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