Predictors of Cocaine Use Disorder Treatment Outcomes: a Systematic Review

Abstract

Background: Cocaine use disorder (CUD) is a complex condition in which multiple variables can alter the course of the addiction. Treatment retention rates with current treatment approaches are low. Thus, the aim of this study is to explore predictors of treatment retention and abstinence in CUD. Methods: This systematic review was performed according the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched three databases—PubMed, PsychINFO and Web of Science—for randomized clinical trials published in English and Spanish from database inception through April 1, 2023. We selected all studies that met the inclusion criteria (adults aged ≥18, outpatient treatment, CUD as main addiction, and no severe mental illness) to obtain data for a narrative synthesis. After data extraction was completed, risk of bias was assessed using the Cochrane risk-of-bias tool for randomized trials (RoB-2). Results: A total of 566 studies were screened, and, of those, 32 were included in the synthesis. Younger age, more years of cocaine use, and craving levels were significant predictors of relapse and treatment dropout. Fewer withdrawal symptoms, greater baseline abstinence, greater treatment engagement, and more self-efficacy were all predictors of longer duration of abstinence. The role of impulsivity as a predictor of CUD is unclear due to conflicting data, although the evidence generally suggests that higher impulsivity scores can predict more severe addiction and withdrawal symptoms, and earlier discontinuation of treatment. Conclusion: The treatment of CUD is complex due to the numerous interconnected variables that can influence treatment outcomes. Consequently, it is important to identify and evaluate the factors that predict abstinence and treatment retention in order to select the most appropriate treatment approach. Finally, this study was funded by the Spanish Ministry of Science, Innovation and Universities, Instituto Carlos III (ISCIII) (FIS PI20/00929) and FEDER funds and Fundació Privada Hospital de la Santa Creu i Sant Pau (Pla d’acció social 2020). Systematic Review registration: This systematic review is registered at PROSPERO (ID: CRD42021271847).