Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
intensive outpatient therapy or contingency management or CBT or motivational interviewing
Intensive outpatient therapy has been shown to be as effective as inpatient or residential programmes.[59][60][61] Individual and group counselling are often combined with couples/family therapy, with typically more than 9 hours of therapy per week over several weeks. However, there is some evidence that lower-intensity treatment (e.g., 6 hours a week) may be just as effective in patients with cocaine use disorder.[62] Other treatment options include adding contingency management, CBT, or motivational interviewing.[50] These may be used alone or in combination, depending on clinician and patient preference, and on service availability.
Contingency management uses operant behavioural techniques. Examples include voucher-based reinforcement therapy (VBRT), rewarding the achievement of agreed therapeutic goals. There is a large body of evidence stating that contingency management increases the period of abstinence and reduces the frequency of drug intake for people with stimulant use disorder and specifically cocaine use disorder.[50][63]
CBT for cocaine use disorder involves recognition of triggers and teaching of coping skills to avoid drug use. Clinical trials in patients with cocaine use disorder comparing CBT with control groups (meditation and relaxation training) or other psychosocial interventions have shown mixed results, although there is some evidence that the coping skills taught with CBT may be effective even once treatment has finished.[50][64][65]
People with more severe substance use disorder symptoms or with comorbid depression may be more likely to benefit from CBT.[56][66]
Computerised CBT delivered in a clinical setting has been shown to be as effective as traditional CBT in a diverse group of patients with substance use disorders. Computerised CBT was also associated with lower dropout rates.[67]
Motivational interviewing is a directive, patient-centred counselling approach that aims to increase people’s motivation to change their behaviour and reach their own goals. Clinical trials have only found motivational interviewing to be effective compared with no treatment, but not compared with control interventions such as relaxation training.[50][68]
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Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
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