Adaptation of individual Cognitive-Behavioural Therapy (CBT) to group treatment delivery for patients with cocaine abuse or dependence

Individual Cognitive-Behavioural Therapy (CBT) is a short-term psycho-social approach that proved to be an effective treatment of cocaine addiction. We adapted Carroll’s individual CBT to a group treatment format for patients with cocaine abuse/dependence in order to provide a valid and effective psychotherapeutic group treatment for cocaine addiction. Participants (n=82) received 12 group CBT sessions in outpatient or residential settings. Outcomes included retention in treatment, self-reported use of cocaine, cocaine craving and cocaine consumption detected with urinary toxicological analytics (benzoylecgonine > 300 ng/ml). Retention in treatment was achieved in 32.9% of the sample and the proportion with negative urine analyses at the end of treatment was 41%. Daily craving declined significantly among outpatients and among patients with positive urine analyses at baseline. Compliance with CBT sessions and the proportion with negative urine analyses did not differ between settings, presence/absence of stabilized psychiatric disorders, alcohol use. Patients with opioid dependence had a significantly lower percentage of negative urine analyses (p=0.021) and were less compliant than those who did not use opioids. The temporal trend of craving differed significantly between settings, suggesting that CBT was more effective among outpatients than among residential patients (Mann-Whitney test Z=2.31, p=0.021). Comparison of craving slopes between patients with and without alcohol use and comorbid psychiatric disorders did not reveal any significant differences. Group CBT seems to be a promising treatment option for patients with cocaine addiction. We submit that group CBT can be provided in the outpatient setting as first-line treatment for subjects with cocaine abuse/dependence highly motivated to discontinue substance use, or as part of a combined treatment strategy (e.g. CBT plus pharmacotherapy) in patients with psychiatric and/or other toxicological comorbidity, in order to improve the outcome of pharmacological treatments.