Short and long-term improvements in psychiatric symptomatology to validate clinically meaningful treatment outcomes for cocaine use disorders

Abstract

Background: Substantial efforts have been made to identify clinically meaningful nonabstinence cocaine use outcomes by establishing associations between targeted drug use outcomes and long-term functional improvements. Psychiatric symptomatology is prevalent among those seeking treatment for cocaine use disorder (CUD). Establishing an association between cocaine use outcomes and improvements in psychiatric symptomatology would support clinical validity to these outcome measures. Method: With data pooled from 5 clinical trials evaluating treatment for CUD (n= 474) multiple linear mixed models were conducted to determine how five specific cocaine use outcome measures performed in terms of improvements in psychiatric symptomatology assessed with the Brief Symptom Inventory (BSI) at baseline, end-of-treatment and 6-month follow-up. Results: Three outcome measures performed comparably well (maximum days of consecutive abstinence, 3 or more weeks of abstinence and end-of-treatment abstinence), in that they consistently predicted improvements in several BSI composite scores at the end-of-treatment and follow-up. The poorer-performing outcome measures were complete abstinence during treatment, percentage of negative urinalysis results and percentage of days abstinent. Improvements in the BSI's global index of distress, positive symptom total, as well as depression, interpersonal sensitivity, obsessive-compulsion, phobic-anxiety and psychoticism dimensions were consistently

Validating the clinical relevance of alternative stimulant use treatment outcome measures by examining their association with 3-month follow-up outcomes.

“…Four within-treatment stimulant use outcome measures evaluated in this study were created based on outcome measures previously associated with long-term improvements in cocaine and methamphetamine use disorder treatment trials (Carroll et al, 2014;Miguel et al, 2019Miguel et al, , 2021. These outcomes included two continuous measures (LDA and percent of negative urinalysis submitted) and two dichotomous measures (abstinent in the last 2 weeks of treatment and three or more weeks of continuous abstinence).…”

“…Of these 15 outcome measures, two continuous measures (longest duration of abstinence [LDA] and percent of negative urinalysis submitted) and two dichotomous measures (abstinent in the last 2 weeks of treatment, and three or more weeks of continuous abstinence) performed comparatively well, being both sensitive to treatment effects and significantly associated with several followup outcomes. Later, these same outcome measures were shown to be associated with improvements in short-and long-term psychiatric symptomatology among treatment-seeking cocaine users (Miguel et al, 2019) and long-term life functioning among treatment-seeking methamphetamine users (Miguel et al, 2021). Despite their importance, these studies evaluated the long-term effects of cocaine and methamphetamine use outcomes separately.…”

“…To address this issue, the objective of this study was to explore the relationships between four within-treatment stimulant use outcome measures and eight clinically relevant outcomes, evaluated at a 3-month follow-up assessment. Based on previous studies (Carroll et al, 2014;Miguel et al, 2019Miguel et al, , 2021, we hypothesized that continuous outcome measures would show more consistent associations with follow-up outcomes when compared to dichotomous outcome measures, and that the LDA outcome measure would show the best performance.…”

“…This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.1 In order to compare our findings with the existing literature on this topic, we opted to adjust our analyses for the same covariates included in previous studies(Miguel et al, 2019(Miguel et al, , 2021. However, considering the known predictive effect of baseline UA results on treatment outcomes for SUD, particularly among CM trials, we have run these same analyses with the inclusion of baseline UA results as a covariate (data not shown).…”

Contingency management is effective in promoting abstinence and retention in treatment among crack cocaine users with a previous history of poor treatment response: a crossover trial

“…Treatment attendance was determined by the total number of sessions attended during the 12 weeks of treatment, and retention in treatment was determined considering the period elapsed between treatment intake and last appearance at the treatment facility. Cocaine abstinence was accessed using five different cocaine use outcome measures recently associated with short-and long-term functional improvements (Carroll et al, 2014;Donovan et al, 2012;Kiluk et al, 2016;Miguel et al, 2019). These were proportion of cocainenegative urine samples submitted (determined by dividing the total number of negative cocaine samples submitted by the total number of expected samples), longest duration of abstinence (LDA) (determined by the longest consecutive sequence of cocaine-negative samples submitted), achievement of three or more weeks of continuous abstinence (determined by the consecutive submission of nine or more cocaine-negative samples), retained and abstinent at the last week of treatment (determined by the presence in at least one treatment session and submission of all three cocaine-negative samples in the 12th week of treatment), and complete abstinent during treatment (determined by the submission of all 36 cocaine-negative urine samples).…”