Examining differential effects of psychosocial treatments for cocaine dependence: an application of latent trajectory analyses.
BACKGROUND
The NIDA Collaborative Cocaine Treatment Study yielded different efficacies for different psychosocial treatments for cocaine dependence. However, substantial heterogeneity of patient outcomes was evident. Longitudinal data analysis techniques can be helpful in examining differential effects of psychosocial interventions on specific subpopulations of patients.


METHODS
Overall drug and cocaine use of 346 patients diagnosed with DSM-IV cocaine dependence and treated with one of four psychosocial interventions were assessed monthly during 6-month treatment. Growth mixture models were used to identify patient subgroups based on typical patterns of change in substance use during treatment and to evaluate differential treatment effects within these subgroups.


RESULTS
Three patient subgroups following different change patterns in cocaine and overall drug use were identified irrespective of the treatment type: (a) those with moderate baseline severity of drug use and very rapid reduction of drug use during treatment, (b) those with moderate baseline severity of drug use and moderate reduction of drug use during treatment, and (c) those with severe levels of baseline drug use with moderate reduction of drug use during treatment. Patient baseline characteristics enabled discrimination between these subgroups. Individual drug counseling was most efficacious among those patients with moderate baseline severity and moderate treatment response. There were no differential treatment effects in the two other patient subgroups.


CONCLUSIONS
The population of treatment-seeking cocaine dependent individuals is heterogeneous. Research on patient subgroups with different change patterns revealed its potential to enable classifications of patients that indicate which treatment is most effective for which type of patient.
Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA. niklaus.stulz@psy.unibe.ch
Niklaus
N
Stulz
Robert
R
Gallop
Wolfgang
W
Lutz
Glenda L
GL
Wrenn
Paul
P
Crits-Christoph
D001294:Attitude to Health; D019970:Cocaine-Related Disorders / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005500:Follow-Up Studies; D006801:Humans; D054577:National Institute on Drug Abuse (U.S.); D010045:Outpatients; D012720:Severity of Illness Index; D012922:Social Change; D012944:Social Support; D013997:Time Factors; D014481:United States