Psychosocial Interventions for Individuals With Cocaine and Amphetamine Addiction

Peter M. Yellowlees, MBBS, MD


May 11, 2019

This transcript has been edited for clarity.

This is the Medscape Psychiatry Minute. I'm Dr Peter Yellowlees. Clinical guidelines recommend psychosocial interventions for cocaine and amphetamine addiction as first-line treatment, but which of the many different interventions should be offered first?

A team of investigators from the University of Oxford in England have performed a network meta-analysis to estimate the comparative effectiveness of all available psychosocial interventions (alone or in combination) for the short- and long-term treatment of people with cocaine and/or amphetamine addiction.[1]

The primary outcome measures were efficacy (proportion of patients in abstinence, assessed by urinalysis) and acceptability (proportion of patients who dropped out due to any cause) at the end of treatment. They also measured the acute and long-term effects of the interventions and the longest duration of abstinence.

They found that contingency management (CM) plus community reinforcement (CR) approaches had the highest number of statistically significant results in head-to-head comparisons, and that this combination was also superior to cognitive-behavioral therapy (CBT) alone, CM alone, CM plus CBT, and 12-step programs plus noncontingent rewards.

Why is this study important? Simply put, we need to focus on the principles of operant conditioning when treating patients with cocaine or methamphetamine abuse.

CR assumes that rewards for sobriety occur through social relationships and experiences, with patients receiving natural rewards through better social and interpersonal engagement. CM is more concrete, typically involving cash or voucher rewards that increase as length of sobriety increases, but which return to the starting point when sobriety ceases.

When you are helping your patients, think about the rewards in life that we all value most—relationships, time, and money—and try to link these to your patients' continued sobriety.

Thank you for listening to this Medscape Psychiatry Minute. Do continue to enjoy your practice.

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