Abstinence and relapse in outpatient cocaine addicts.

A discussion is provided of clinical techniques for establishing abstinence and preventing relapse in cocaine addicts within the context of an intensive outpatient treatment program. A basic tenet of this article is that to produce higher success rates in these and other drug-dependent patients more attention must be paid to some very fundamental treatment issues, such as program structure, counselor attitude, and patient motivation.

Structured outpatient treatment of alcohol vs. drug dependencies.

This chapter describes the rationale, indications, design, and use of a structured outpatient treatment approach as an effective alternative to residential treatment for alcohol and drug dependencies. An increasing demand for outpatient treatment services is being created by a combination of clinical and economic factors, including the influx of employed drug abusers who do not need or desire residential care and mounting financial pressures to contain health care costs. To be effective as a primary treatment modality, outpatient programs must be highly structured and intensive and able to deal with the full spectrum of alcohol and drug addictions. Perpetuating the historical separation between alcoholism and drug abuse treatment programs is unnecessary and counterproductive, although certain modifications in treatment approaches are needed to accommodate the distinctive characteristics of particular classes of drugs and the people who use them. The "outpatient rehab," a treatment model that approximates the intensity of inpatient treatment on an outpatient basis, may help to maximize the clinical efficacy and cost-effectiveness of outpatient treatment as a viable alternative to residential care. Initial treatment results with this model are encouraging.

Outpatient treatment of cocaine addiction: suggestions to increase its effectiveness.

Faced with the difficult challenge of making effective treatment more available to larger numbers of addicts/users at lower cost, providers and payers of addiction/drug user treatment in the U.S. are looking for cost-effective models of outpatient care as alternatives to expensive residential treatment. This article discusses the clinical appropriateness of outpatient treatment and how to make it more efficacious for cocaine and crack addicts/users.

Preventing relapse to cocaine.

An effective treatment program for cocaine addiction must incorporate education and counseling. Education is a key element in preventing relapse; patients must be taught to understand the subtle cues by which they are affected, the multiple factors that drive their cocaine use, and the need for complete abstinence from all mood-altering substances, including alcohol and marijuana. Although abstinence is essential to relapse prevention, it is not the only issue. Recovery can be achieved only when patients change their attitudes and behaviors that led to and/or were associated with drug use. Patients must learn: (1) that relapse begins long before drug use occurs, (2) to anticipate high-risk situations, and (3) to develop alternative coping skills to manage the stress and frustration of daily life. Moreover, if relapse does occur, it must be viewed as a learning event rather than as a negative, guilt-provoking disaster in order to avoid recurrences. Analytically oriented psychotherapy is contraindicated early in therapy; counseling and self-help groups must provide support that is reality-based.

Nonpharmacologic treatment of cocaine abuse.

This article describes nonpharmacologic techniques for treating the cocaine abuser on an outpatient basis. Key issues in assessment and treatment planning are discussed as well as specific relapse prevention strategies and success rates.

Structured outpatient treatment of cocaine abuse.

This article describes specific clinical techniques for treating the cocaine abuser in a structured outpatient program. The advantages, limitations, and indications for such a program are discussed in addition to issues of treatment planning, relapse prevention, recovery groups, urine testing, family involvement, medication, and success rates.

Recent trends in cocaine abuse: a view from the National Hotline, "800-COCAINE".

A series of research surveys of callers to the "800-COCAINE" National Hotline over the past three years has revealed shifting patterns of cocaine use in the U.S. In addition to showing the geographic spread of cocaine use to virtually all parts of the country, the surveys provide evidence of increased cocaine use among women, adolescents, minorities, and lower socioeconomic groups. Increases have also been seen in individual levels of cocaine consumption, the popularity of freebase smoking, concomitant use of other drugs, cocaine-related automobile accidents, and the use of cocaine in the workplace. Despite inherent limitations, data from the Hotline are highly consistent with large-scale government surveys and predictive of clinical trends.

Opiate and cocaine dependencies. Techniques to help counter the rising tide.

Clonidine (Catapres) is a safe and effective agent for detoxification of selected opiate addicts. It seems best suited for transitional treatment between opiate dependency and aftercare with naltrexone (Trexan). The current epidemic of cocaine abuse in the United States is associated with intensified usage patterns and an increased prevalence of adverse medical consequences. Successful treatment of the cocaine abuser may require either hospitalization or structured outpatient treatment in a specialized program.