S10.04 - Behavioural therapies for the treatment of cocaine dependence

Abstract

Cocaine, already a significant drug problem in North and South America, has become a more prominent part of the European drug scene. No specific effective pharmacological treatment is available for cocaine addiction, although a number of medications have shown promising results. Behavioural therapies have demonstrated some effectiveness and are currently the standard type of treatment for cocaine addiction. At the present time, Cognitive-Behaviour Therapy (CBT) and Contingency Management (CM) techniques have the strongest empirical support for application with cocaine users. Cognitive behaviour approaches, such as relapse prevention, are grounded in social learning theories and principles of operant conditioning. Several randomised clinical trials have demonstrated the efficacy of cognitive-behaviour therapy (CBT) in the treatment of cocaine-dependent outpatients, particularly more severely dependent cocaine users and depressed. Contingency management approaches are based on principles of behavioural pharmacology and operant conditioning. It is a procedure that decreases the reinforcing efficacy of cocaine via the delivery of reinforcement contingent on abstinence and/or the delivery of punishment contingent on cocaine use. The two most commonly used CM strategies for treating cocaine and stimulant use disorders are voucher-based reinforcement therapy extensively investigated by Higgins and colleagues, and variable magnitude of reinforcement popularized by Petry and colleagues. CBT and/or CM possibly have additive effects when combined with pharmacotherapies.

A variety of other types of behavioural treatment like motivational therapy (MT), community reinforcement and the Matrix model have also been shown to be potent interventions for cocaine addiction. These behavioural interventions, excepted CBT and MT, are not used in France. It seems necessary to evaluate these approaches.