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Craving, Treatment And Cocaine Use

The key to successful treatment is control over the patient’s craving for a particular substance, either through medication or psychotherapy, or a combination of both. In cocaine-dependent patients, however, current pharmacotherapies have not proven effective in reducing craving. Researchers continue to study the mechanisms of craving and its effect on continued cocaine use. One such recent study examined the relationship between cocaine craving, psychosocial treatment and cocaine use during a 24-week treatment program. In addition to weekly toxicology screening and different types of counseling, participants in the study were assessed with a three-item Cocaine Craving Scale questionnaire:
1. Please rate how strong your desire was to use cocaine during the last 24 hours.
2. Please imagine yourself in the environment in which you previously used drugs and/or alcohol. If you were in this environment today, what is the likelihood that you would use cocaine?
3. Please rate how strong your urges are for cocaine when something in the environment reminds you of it.
Response options ranged from 0 for “no desire/likelihood of use” to 9 for “strong desire/likelihood of use.” A composite score (sum of scores on all three questions) of 1 – 5 indicated a mild craving; 6 – 11, a moderate craving; and 12 – 27, a severe craving. Self reports and toxicology screenings were used to determine cocaine use. It was found that higher scores were a significant predictor of cocaine use in the subsequent week.
Researchers also studied the relationship between the type of treatment the patient received and craving and subsequent cocaine use. Patients in the study were randomly assigned to one of the following types of treatment: 1) individual drug counseling plus group drug counseling; 2) supportive-expressive psychodynamic therapy plus group drug counseling; 3) cognitive therapy plus group counseling; or 4) group drug counseling alone. Results revealed that patients in the first group (individual drug counseling plus group drug counseling) had the fewest days of cocaine use and the greatest number of abstinent months, suggesting that patients in this group were better able to cope with a strong desire to use cocaine.
(Weiss, RD, Griffin, ML, Mazurick, C, Berkman, B, Gastfriend, DR, Frank, A, Barber, JP, Blaine, J, Salloum, I, Moras, K: The relationship between cocaine craving, psychosocial treatment, and subsequent cocaine use. American Journal of Psychiatry 160: 1320–1325, 2003.) Corresponding author: Dr. Roger D. Weiss, McLean Hospital, 115 Mill St., Belmont, MA 02478.

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