title: Additional treatment services in a cocaine treatment study: level of services obtained and impact on outcome.
abstract: The objective of this study was to examine the level of additional treatment services obtained by patients enrolled in the NIDA Cocaine Collaborative Study, a multi-center efficacy trial of four treatments for cocaine dependence, and to determine whether these services impact treatment outcome. Cocaine-dependent patients (N = 487) were recruited at five sites and randomly assigned to six months of one of four psychosocial treatments. Assessments were made at baseline, monthly during treatment, and at follow-ups at 9, 12, 15, and 18 months post-randomization. On average, patients received little or no additional treatment services during active treatment (first six months), but the rate of obtaining most services increased during the follow-up phase (month 7 to 18). In general, the treatment groups did not differ in the rates of obtaining non-protocol services. For all treatment groups, patients with greater psychiatric severity received more medical and psychiatric services during active treatment and follow-up. Use of treatment services was unrelated to drug use outcomes during active treatment. However, during the follow-up period, increased use of psychiatric medication, twelve-step attendance, and twelve-step participation was related to less drug use. The results suggest that during uncontrolled follow-up phases, additional non-protocol services may potentially confound the interpretation of treatment group comparisons in drug use outcomes.
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Worley
authors.forename: Robert
authors.initials: R
authors.lastname: Gallop
authors.forename: Mary Beth Connolly
authors.initials: MB
authors.lastname: Gibbons
authors.forename: Sarah
authors.initials: S
authors.lastname: Ring-Kurtz
authors.forename: Julie
authors.initials: J
authors.lastname: Present
authors.forename: Roger D
authors.initials: RD
authors.lastname: Weiss
authors.forename: Paul
authors.initials: P
authors.lastname: Crits-Christoph
mesh_terms: D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data*; D000437:Alcoholism / Q000453:epidemiology / Q000534:rehabilitation; D015982:Bias; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology / Q000534:rehabilitation; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000706:statistics & numerical data*; D011615:Psychotherapy, Group / Q000706:statistics & numerical data*; D012657:Self-Help Groups / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data