Non-attendance at Counselling Therapy in Cocaine-using Methadone-maintained Patients: Lessons Learnt from an Abandoned Randomised Controlled Trial

Overview

Journal Ir J Med Sci

Specialty General Medicine

Date 2012 Jan 13

PMID 22237795

Citations 4

Authors

C Darker

B Sweeney

H El Hassan

A Kelly

S O Connor

B Smyth

J Barry

Affiliations

Soon will be listed here.

Abstract

Background: Recently, the authors commenced a randomised controlled trial to study the effectiveness of cognitive behavioural coping skills (CBCS) to reduce cocaine usage in methadone-maintained patients' in a clinical setting by assessing attendance at treatment sessions and outcomes in terms of cocaine use. However, recruitment into the study stopped when it became apparent that attendance at counselling sessions was poor.

Aims: The aim of the current study was to determine the reasons for both non-attendance and attendance from a patient's perspective at counselling sessions.

Methods: A cross-sectional design was employed whereby participants who were recruited for the original study were interviewed utilising a semi-structured interview format.

Results: Motivational inconsistencies were most frequently cited as the reason for dropping out of counselling, whereas a good relationship with staff was cited by attenders as the most important factors which aided their attendance at counselling sessions.

Conclusions: Selecting opiate-dependent methadone-maintained cocaine abusers on the basis of their urine toxicology and offering them counselling as a way of reducing their harmful drug use did not prove efficacious. Attempting to address cocaine misuse within this cohort may need a more stepped approach including brief interventions, such as motivational interviewing, or other enhancers of motivation before we can test the effectiveness of CBCS in this population.

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References

Monti P, Rohsenow D, Michalec E, Martin R, Abrams D . Brief coping skills treatment for cocaine abuse: substance use outcomes at three months. Addiction. 1998; 92(12):1717-28. View

Carroll K, Nich C, Ball S, MCCANCE E, Frankforter T, Rounsaville B . One-year follow-up of disulfiram and psychotherapy for cocaine-alcohol users: sustained effects of treatment. Addiction. 2000; 95(9):1335-49. DOI: 10.1046/j.1360-0443.2000.95913355.x. View

Kartalova-ODoherty Y, Tedstone Doherty D . Recovering from recurrent mental health problems: giving up and fighting to get better. Int J Ment Health Nurs. 2010; 19(1):3-15. PMC: 2839479. DOI: 10.1111/j.1447-0349.2009.00636.x. View

Sayre S, Schmitz J, Stotts A, Averill P, Rhoades H, Grabowski J . Determining predictors of attrition in an outpatient substance abuse program. Am J Drug Alcohol Abuse. 2002; 28(1):55-72. DOI: 10.1081/ada-120001281. View

Rohsenow D, Monti P, Martin R, Michalec E, Abrams D . Brief coping skills treatment for cocaine abuse: 12-month substance use outcomes. J Consult Clin Psychol. 2000; 68(3):515-20. DOI: 10.1037//0022-006x.68.3.515. View

Marsden J, Eastwood B, Bradbury C, Dale-Perera A, Farrell M, Hammond P . Effectiveness of community treatments for heroin and crack cocaine addiction in England: a prospective, in-treatment cohort study. Lancet. 2009; 374(9697):1262-70. DOI: 10.1016/S0140-6736(09)61420-3. View

Petry N . Contingency management treatments. Br J Psychiatry. 2006; 189:97-8. DOI: 10.1192/bjp.bp.106.022293. View

Alterman A, McKay J, Mulvaney F, McLellan A . Prediction of attrition from day hospital treatment in lower socioeconomic cocaine-dependent men. Drug Alcohol Depend. 1996; 40(3):227-33. DOI: 10.1016/0376-8716(95)01212-5. View

Knapp W, Soares B, Farrel M, Lima M . Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. Cochrane Database Syst Rev. 2007; (3):CD003023. DOI: 10.1002/14651858.CD003023.pub2. View

10.

Brewer D, Catalano R, Haggerty K, Gainey R, Fleming C . A meta-analysis of predictors of continued drug use during and after treatment for opiate addiction. Addiction. 1998; 93(1):73-92. View

11.

King A, Canada S . Client-related predictors of early treatment drop-out in a substance abuse clinic exclusively employing individual therapy. J Subst Abuse Treat. 2004; 26(3):189-95. DOI: 10.1016/S0740-5472(03)00210-1. View

12.

Carroll K, Fenton L, Ball S, Nich C, Frankforter T, Shi J . Efficacy of disulfiram and cognitive behavior therapy in cocaine-dependent outpatients: a randomized placebo-controlled trial. Arch Gen Psychiatry. 2004; 61(3):264-72. PMC: 3675448. DOI: 10.1001/archpsyc.61.3.264. View

13.

Aharonovich E, Hasin D, Brooks A, Liu X, Bisaga A, Nunes E . Cognitive deficits predict low treatment retention in cocaine dependent patients. Drug Alcohol Depend. 2005; 81(3):313-22. DOI: 10.1016/j.drugalcdep.2005.08.003. View

14.

Gossop M, Stewart D, Browne N, Marsden J . Factors associated with abstinence, lapse or relapse to heroin use after residential treatment: protective effect of coping responses. Addiction. 2002; 97(10):1259-67. DOI: 10.1046/j.1360-0443.2002.00227.x. View

15.

Rawson R, Huber A, McCann M, Shoptaw S, Farabee D, Reiber C . A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Arch Gen Psychiatry. 2002; 59(9):817-24. DOI: 10.1001/archpsyc.59.9.817. View

16.

Agosti V, Nunes E . Patient factors related to early attrition from an outpatient cocaine research clinic. Am J Drug Alcohol Abuse. 1996; 22(1):29-39. DOI: 10.3109/00952999609001643. View

17.

Petry N, Peirce J, Stitzer M, Blaine J, Roll J, Cohen A . Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs: a national drug abuse treatment clinical trials network study. Arch Gen Psychiatry. 2005; 62(10):1148-56. DOI: 10.1001/archpsyc.62.10.1148. View

18.

Carroll K, Rounsaville B, Nich C, Gordon L, Wirtz P, Gawin F . One-year follow-up of psychotherapy and pharmacotherapy for cocaine dependence. Delayed emergence of psychotherapy effects. Arch Gen Psychiatry. 1994; 51(12):989-97. DOI: 10.1001/archpsyc.1994.03950120061010. View

19.

Carroll K, Nich C, McLellan A, McKay J, Rounsaville B . 'Research' versus 'real-world' patients: representativeness of participants in clinical trials of treatments for cocaine dependence. Drug Alcohol Depend. 1999; 54(2):171-7. DOI: 10.1016/s0376-8716(98)00161-6. View

20.

Carroll K, Nich C, Rounsaville B . Contribution of the therapeutic alliance to outcome in active versus control psychotherapies. J Consult Clin Psychol. 1997; 65(3):510-4. DOI: 10.1037//0022-006x.65.3.510. View