Cocaine Use: Recommendations in Treatment and Rehabilitation

7. General Conclusions and Summary of Best Practices

National survey and local school survey data suggest that relatively few Canadians use cocaine and that the rates have been relatively stable in the 1990s. However, surveys do not capture the serious health and social problems that are associated with cocaine use, such as the epidemic of HIV and Hepatitis C infections among people who inject drugs in some of Canada's larger cities. Although it is sometimes difficult to disentangle the harmful effects due to cocaine use from effects that may be due to other substances and lifestyle choices, research indicates that even casual users often report quitting because of perceived health risks.

Research into effective treatment methods have focussed on pharmacotherapy and behavioural interventions. The results of pharmacotherapy research have not yet produced a substitute drug that can play the same role with cocaine as methadone has with heroin. However, there is some evidence that pharmacotherapy may increase treatment retention in the initial stages of treatment. There is evidence that behavioural treatment, either contingency management or cognitive behavioural treatment is effective in retaining clients in treatment and reducing cocaine use.

Best Practice Guideline #1: The literature does not yet provide sufficient evidence for the efficacy of specific drugs in the treatment of cocaine dependence. However, several antidepressant drugs have shown promise in retaining users in the initial stages of treatment, particularly depressed patients and those who "snort" cocaine. There appears to be some evidence that drugs used in the treatment of opiate or alcohol dependence may be useful in reducing cocaine use in patients addicted to cocaine and heroin or cocaine and alcohol.

Best Practice Guideline #2: The literature shows good evidence that behavioural treatment procedures (particularly contingency management and cognitive behavioural therapy) are effective in reducing cocaine use and retaining clients in treatment. Further, other active, directive therapeutic approaches using different theoretical approaches may be as effective as CBT.

Best Practice Guideline #3: Enhanced treatment (greater frequency of contact, a comprehensive recruitment plan with more treatment components) is associated with reduced cocaine use at follow-up.

Best Practice Guideline #4: Consistent with other literature in the substance-abuse field, research continues to support the cost-effectiveness of outpatient/day-treatment versus inpatient treatment. However, some cocaine-dependent clients may require the additional support provided by residential care or inpatient treatment, e.g. clients who are homeless.