TREATMENT OF PROBLEM COCAINE USE COCAINE PROBLEM OF TREATMENT A REVIEW OF THE LITERATURE LITERATURE REVIEW ISBN 92-9168-274-8 ISBN EMCDDA literature reviews Treatment of problem cocaine use: a review of the literature EMCDDA literature reviews — Treatment of problem cocaine use Acknowledgements This literature review is based on a consultant report by Christian Haasen and Katja Thane, Institut für Interdisziplinäre Sucht- und Drogenforschung (ISD), Hamburg, at the Zentrum für Interdisziplinäre Suchtforschung (ZIS) of the University of Hamburg (Service Contract CT.06.RES.144.1.0). EMCDDA project managers: Dagmar Hedrich and Alessandro Pirona. Other contributors to this project included Prepress Projects, Rosemary de Sousa and Peter Thomas. Cataloguing data European Monitoring Centre for Drugs and Drug Addiction, 2007 EMCDDA Literature reviews — Treatment of problem cocaine use: a review of the literature Lisbon: European Monitoring Centre for Drugs and Drug Addiction 2007 — 50 pp. — 21 x 29.7 cm Language: EN Catalogue Number: TD-XB-06-001-EN-N ISBN: 92-9168-274-8 ISSN: 1725-0579 © European Monitoring Centre for Drugs and Drug Addiction, 2007. Reproduction is authorised provided the source is acknowledged. Rua da Cruz de Santa Apolónia 23-25, PT-1149-045 Lisbon, Portugal Tel: (+351) 21 811 3000 Fax: (+351) 21 813 1711 [email protected] http://www.emcdda.europa.eu 3 EMCDDA literature reviews — Treatment of problem cocaine use List of abbreviations ADHD attention deficit hyperactivity disorder BBD blood-borne disease CA Cocaine Anonymous CBT cognitive–behavioural therapy CEDRO Centrum voor Drugsonderzoek (Netherlands) CM contingency management CNS central nervous system CRA community reinforcement approach CRH corticotrophin-releasing hormone DA dopamine DSM-IV Diagnostic and Statistical Manual of Mental Disorder (4th edition) EMCDDA European Monitoring Centre for Drugs and Drug Addiction FOS Forschungsverbund stationäre Suchttherapie (Switzerland) GABA gamma-aminobutyric acid GP general practitioner GVG gamma-vinyl-GABA HIV human immunodeficiency virus IDU injecting drug user IFT Institut für Therapieforschung (Munich, Germany) ISD Instituut voor Sociaal Drugonderzoek (Belgium) MAO monoamine oxidase MI motivational interviewing MMT methadone maintenance treatment NADA National Acupuncture Detoxification Association NcA nucleus accumbens NHS National Health Service (UK) NIDA National Institute on Drugs and Drug Abuse (USA) NSAID non-steroidal anti-inflammatory drug NTA National Treatment Agency (UK) NTORS National Treatment Outcome Research Study (UK) RCT randomised controlled trial Reitox European Information Network on Drugs and Drug Addiction SROM slow-release oral morphine SSRI selective serotonin reuptake inhibitor TC therapeutic community TCA 2,4,6-trichloranisol Trimbos Netherlands Institute Of Mental Health And Addiction WHO World Health Organization 4 EMCDDA literature reviews — Treatment of problem cocaine use Table Of Contents List of abbreviations ............................................................................................................................. 4 Table Of Contents.................................................................................................................................. 5 Foreword ................................................................................................................................................ 6 1 History and epidemiological characteristics of cocaine use .................................7 2 Current issues in the treatment of problem cocaine use .......................................9 2.1 Research and evaluation ................................................................................................... 9 2.2 Polydrug use and heterogeneity of client profiles.............................................................. 9 2.3 Treatment entry................................................................................................................ 10 2.4 Quality assurance ............................................................................................................ 10 3 Pharmacological treatment .....................................................................................13 3.1 Substances for relapse prevention .................................................................................. 13 3.2 Other pharmacological measures.................................................................................... 19 3.3 Immunisation and vaccination ......................................................................................... 19 3.4 Optimising opioid treatment in the presence of additional cocaine use .......................... 20 3.5 Treatment of cocaine use in subjects with other psychiatric disorders ........................... 21 4 Psychosocial treatment ...........................................................................................24 4.1 Cognitive–behavioural therapy (CBT) and other behavioural approaches ..................... 24 4.2 Rewards/punishment-based therapies ............................................................................ 26 4.3 Motivational interviewing.................................................................................................. 27 4.4 Relapse prevention.......................................................................................................... 28 4.5 Family therapy ................................................................................................................. 29 4.6 Counselling ...................................................................................................................... 29 4.7 Other approaches ............................................................................................................ 29 5 Harm reduction .........................................................................................................31 6 Inpatient treatment ...................................................................................................33 7 Aftercare....................................................................................................................34 8 Conclusion ................................................................................................................35 Bibliography......................................................................................................................................... 36 5 EMCDDA literature reviews — Treatment of problem cocaine use Foreword Treatment systems in Europe are increasingly confronted with cocaine use-related problems. After opioids and cannabis, cocaine has become the third most commonly reported reason for entering drug treatment and accounted for about 8 % of all treatment demands across the EU in 2004. This overall figure reflects a wide variation between countries; however, the proportion of new clients demanding treatment for cocaine use is estimated to have grown from 10 % to 20 % during the period 1999–2004 (EMCDDA, 2006). Cocaine use has also become more common among drug users in contact with outreach workers or low-threshold agencies, and new findings with respect to treatment need to be evaluated in order to adapt addiction services to the new demands. The aim of this report is to provide an up-to-date summary of research regarding treatment approaches to cocaine dependency, and their effectiveness1. New treatment concepts need to be evidence based, calling for a research perspective in the evaluation of treatments for cocaine dependence. Nonetheless, innovations in treatment also result from individual experiments by clinicians, so that a clinical perspective needs to be added in order to obtain a complete overview of developments in the treatment of cocaine dependence. In this direction, conferences were organized across Europe to gather further knowledge on cocaine treatment by bringing together European researchers and clinicians. For example, a conference on clinical research on cocaine took place in April 2006 in Paris organised by the Mission Interministérielle de Lutte contre la Drogue et la Toxicomanie. In June 2006, the Federazione Italiana Comunità Terapeutiche (FICT) organised in Rome the Congress ‘Cocaina: la FICT tra prassi e innovazione: Esperienze a confronto nel contesto italiano’ with the aim of sharing experiences and disseminating best practices in relation to cocaine treatment. A similar conference was held in Madrid on the 17th of May 2007. In conclusion, the present report aims to portray the state-of-the-art in health responses to cocaine use, with a special emphasis on mental health problems related to cocaine use. However, there is no doubt that current research efforts will in the near future bring about innovations of great importance in this field. We hope that this report will support the dynamic research process that is under way and at the same time support adjustments in policy regarding addiction services to improve their response to cocaine users. (1) This report reviews the current literature on cocaine treatment, based on a search of the databases Medline, PubMed and PsychInfo for the years 2002–07, using the following keywords: cocaine, treatment, dependence. In addition, the reference lists of all publications identified through the search were evaluated and reports from European research centres, including Trimbos and Cedro in the Netherlands, ISD in Belgium, IFT in Germany and the NTA in the UK, were also considered. Please note