Encouraging efforts to kick cocaine.

Encouraging efforts to kick cocaine

A national "epidemic' of cocaine abuse has received considerable attention over the past decade. Of the over 4 million Americans who use the drug one or more times per month, it is estimated that 10 percent will go on to heavy, uncontrollable cocaine use. But until recently, cocaine abuse treatment has attracted little scientific attention.

Last week, two researchers reported encouraging data from some of the first studies to chart the effectiveness of nonhospital cocaine treatment programs. One investigator says that for those who want counseling, group-based peer counseling similar to that used by Alcoholics Anonymous helps many long-term cocaine abusers to stay off the drug for up to two years. There is also evidence, says the other, that some people hooked on cocaine require antidepressant medication in addition to individual and group psychotherapy.

An intensive program that stresses practical ways to achieve abstinence appears to help a large majority of cocaine abusers under study, said Arnold W. Washton at a press seminar in Washington, D.C., held by the Alcohol, Drug Abuse and Mental Health Administration. Washton, of The Regent Hospital in New York City, and co-worker Mark S. Gold of Fair Oaks Hospital in Summit, N.J., followed 205 chronic cocaine abusers, most of whom were white, middle-class males with intact families and good jobs. Treatment included signing a contract to stay away from all drugs, undergoing urine tests several times weekly and attending cocaine recovery groups and supportive counseling sessions. After 6 to 12 months, treatment continued according to each patient's needs.

A big problem appears to be getting people to stick with treatment. During the first month of treatment, 78 of the subjects dropped out of the program, says Washton. But 83 percent of the remaining patients have not used cocaine or other drugs for almost two years, he adds. The more time patients spent in treatment, the more likely they were to remain abstinent. Washton is now following about 150 cocaine abusers with low-paying jobs and less stable families to see if they respond to the same treatment.

There is also evidence that the antihypertensive drug clonidine eases the craving for cigarettes, alcohol, opiates and possibly cocaine (SN: 1/17/84, p. 310). But it is too early to tell if any medication will dampen cocaine withdrawal or reduce the number of people who drop out of treatment, says Gold. He is now studying the effects of several drugs on cocaine craving.

"Our data on a group-based peer recovery program provide a baseline to help decide whether additional treatments offer any more help,' notes Gold.

Washton and Gold have conducted a "nice clinical study,' says Herbert D. Kleber of Yale University, "but their data provide a baseline only for the selected population they looked at.' In a presentation at the National Institute of Mental Health, Kleber said that he and his colleagues have observed a comparable recovery rate among cocaine abusers treated with an antidepressant drug and psychotherapy. The Yale researchers are now studying cocaine abusers who receive psychotherapy and additional, random assignment to antidepressant, lithium or placebo treatment. Cocaine investigators, holds Kleber, have not yet clearly defined subjects according to their severity of abuse, personal background and reasons for entering treatment.