Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study.
BACKGROUND
Addiction to heroin and crack cocaine is debilitating and persistent, but such disorders are treatable. We present the first effectiveness study of the main community interventions for addiction to heroin and crack cocaine in England, using data from the National Drug Treatment Monitoring System (NDTMS).


METHODS
The study cohort consisted of all adults with a heroin or crack cocaine addiction, or both, who started pharmacological treatment (n=18 428 patients) or psychosocial treatment (n=2647) between Jan 1 and Nov 30, 2008, received at least 6 months' treatment or were discharged by the study endpoint (May 31, 2009), and had outcome data submitted to the NDTMS. Effectiveness was assessed from change in days of heroin or crack cocaine use, or both in the 28 days before the start of treatment and in the 28 days before review.


RESULTS
14 656 clients-74% of the cohort eligible for analysis at review with available data-were analysed at the study endpoint. During the 28 days before review, 37% (5016/13 542) of heroin users abstained from heroin and 52% (3941/7636) of crack cocaine users abstained from crack cocaine. A higher proportion of users of heroin only abstained than did users of both heroin and crack cocaine (42% [2465/5863] vs 33% [2551/7679]; OR 1.46, 95% CI 1.36-1.56), and more users of crack cocaine only abstained than did users of both drugs (57% [295/522] vs 51% [3646/7114]; 1.24, 1.03-1.48). Overall heroin use reduced by 14.5 days (95% CI 14.3-14.7) and crack cocaine use by 7.7 days (7.5-7.9). For clients given pharmacological treatment, reduction in days of heroin use was smaller for users of both heroin and crack cocaine than for users of heroin alone (p<0.0001), but this differential effectiveness was not recorded for psychosocial treatment in heroin or crack cocaine users compared with users of both drugs.


CONCLUSIONS
The first 6 months of pharmacological or psychosocial treatment is associated with reduced heroin and crack cocaine use, but the effectiveness of pharmacological treatment is less pronounced for users of both drugs. New strategies are needed to treat individuals with combined heroin and crack cocaine addiction.


BACKGROUND
National Treatment Agency for Substance Misuse.
National Addiction Centre, Institute of Psychiatry (King's College London), London, UK. john.marsden@kcl.ac.uk
John
J
Marsden
Brian
B
Eastwood
Colin
C
Bradbury
Annette
A
Dale-Perera
Michael
M
Farrell
Paul
P
Hammond
Jonathan
J
Knight
Kulvir
K
Randhawa
Craig
C
Wright
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use; D019970:Cocaine-Related Disorders / Q000453:epidemiology / Q000628:therapy*; D003156:Community Mental Health Services / Q000458:organization & administration*; D004739:England / Q000453:epidemiology; D005260:Female; D006556:Heroin Dependence / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D016014:Linear Models; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D015999:Multivariate Analysis; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D015397:Program Evaluation; D011446:Prospective Studies; D011613:Psychotherapy / Q000458:organization & administration*; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone