The association between cocaine use and short-term outcomes for the treatment of heroin dependence: findings from the Australian Treatment Outcome Study (ATOS)

Abstract

The aim of this study was to determine the prevalence of cocaine use among individuals presenting for treatment for heroin dependence, describe the clinical profile of heroin users who also use cocaine and to establish the effects of cocaine use on short term outcomes for the treatment for heroin dependence. A longitudinal follow-up of 549 heroin users recruited in Sydney for the Australian Treatment Outcome Study was conducted at 3-month post-baseline interview. At baseline, current cocaine use was common (39%) and was associated with increased drug use, needle risk taking and criminality. The 3-month prevalence of cocaine use declined significantly to 19%. Thirty-five per cent of those who had used cocaine at baseline continued to use at 3 months, while 9% of the sample had commenced cocaine use. Those who entered residential rehabilitation at baseline were less likely than other treatment entrants and the non-treatment group to have used cocaine at follow-up. Treatment retention was not affected by baseline cocaine use status; however, baseline cocaine users (CU) displayed higher levels of heroin use, polydrug use and drug-related problems. A poorer outcome was associated with the commencement or continuation of cocaine use, while cessation of cocaine use resulted in significant improvements on these measures. Cocaine use was common among individuals seeking treatment for heroin dependence and was an important moderator of treatment outcome. It appears that cocaine use has a strong negative effect on treatment outcome over and above that caused by polydrug use generally.

Predicting Outcome in Public Addiction Services Using Data Collected During Routinely Assessment Procedures

“…Overall, the above results support the clinical relevance of concurrent cocaine use in opioid dependent population (Maremmani et al 2007;Sullivan et al 2010;Williamson et al 2006aWilliamson et al , 2007. In particular they highlight the prognostic value of carefully assessing patterns of cocaine use and co-use, the route of administration of the drugs; and presence of psychiatric symptoms at the beginning of the treatment.…”

“…The proportion of primary cocaine addicts rose dramatically among patients and its use is widespread among heroin addicts in agonist treatment. Heroin addicts who also use cocaine face increased danger as they display higher current levels of social dysfunction, drug use, needle-risk taking behaviour and criminality (Williamson et al 2006a(Williamson et al , b, 2007. Several studies found the baseline cocaine-urine drug screen was associated with treatment outcome and retention in cocaine dependent subjects, and cocaine and heroin use in heroin addicts (Ahmadi et al 2006;Alterman et al 1997;Kampman et al 2002;McKay et al 2001;Sofuoglu et al 2003).…”

Psychosocial approaches to psychostimulant dependence: A systematic review

“…A longer term (5-year) follow-up of the DATOS cohort, however, found that patients in longer term residential rehabilitation reported significantly reduced cocaine consumption compared with those from outpatient methadone and outpatient drug-free groups (Hubbard et al, 2003), although this result was influenced by significant attrition favoring treatment completers. These results were supported by the Australian Treatment Outcome Study, which found that residential rehabilitation was significantly more effective than methadone or detoxification in reducing cocaine use in heroin-dependent individuals after 3 months of follow-up (Williamson, Darke, Ross, & Teesson, 2006). The authors attributed this success to the broader aims of residential rehabilitation to help patients cease all drug use, whereas the other interventions were more narrowly focused on heroin use.…”

“…Drug treatment programs solely focused on psychostimulant use cannot substitute for comprehensive health and welfare programs needed by people who lack basic social and economic support (Brecht et al, 2005). There is evidence that day care and long-term residential rehabilitation may be successful in more severely problematic cocaine users (Donovan et al, 2001;Lam et al, 1995;Marlowe et al, 2003;Milby et al, 2000;Williamson et al, 2006; see Table 2). …”

The effect of baseline cocaine use on treatment outcomes for heroin dependence over 24 months: Findings from the Australian Treatment Outcome Study

“…Baseline analyses showed that cocaine was being used by a large proportion of treatment entrants and that these individuals displayed particularly poor clinical profiles (Williamson, Darke, Ross, & Teesson, 2006). Indeed, despite not differing in drug use history or psychopathology, heroin users who also used cocaine exhibited a greater degree of drug-related harm, being more likely to report homelessness, criminality, needle sharing, and injection-related health problems.…”