Cocaine treatment and recovery is a controversial issue for several reasons, all of which focus on the validity and effectiveness of various methods. The debate centers on questions such as whether addicts can really break their dependency on cocaine and whether any of the current therapies available to addicts has a high enough success rate to justify the $3.2 billion that the federal government annually spends on a variety of therapies.

Still, most American political and community leaders agree that cocaine and crack addicts who seek help should get it. The debate centers on determining the best strategy for curing the addict. This debate prompted the General Accounting Office (GAO) of the federal government to investigate the effectiveness of various therapies. In 1996 the GAO published the results of a lengthy study focused on cocaine that concluded that no one was sure exactly how much good therapy was doing:

Although studies conducted over nearly 3 decades consistently show that treatment reduces drug use and crime, current data collection techniques do not allow accurate measurement of the extent to which treatment reduces the use of illicit drugs. Furthermore, research literature has not yet yielded definitive evidence to identify which approaches work best for specific groups of drug abusers.

The conclusion of the General Accounting Office report that the best therapeutic approaches have not yet been identified prompted many specialists working in the field of drug rehabilitation to argue that no single therapy can be identified as being the best for all addicts and that the best strategy is for the addict and his or her therapist to explore several therapies. Experts have also concluded that whichever therapies are applied, the addict must understand that there are no short-term solutions to the complexities of addiction.

Recovery Is a Long-Term Commitment

The Strategy of Multiple Therapies

Individual Treatments

Group Therapy

Typically, the recovering addict participates in group therapy in addition to individual sessions with a therapist. Most cocaine therapists believe that at times in the recovery process addicts can learn valuable lessons from other recovering addicts. Groups generally consist of from three or four up to ten or fifteen addicts who are supervised by one therapist. Within the group setting, each addict has the opportunity not only to see how others deal with problems of addiction but to receive support and encouragement from other group members.

Group therapy sessions provide addicts with an opportunity to have their assumptions and excuses for their addictions challenged by their peers. This type of confrontational dialogue forces each member to maintain a high level of honesty with other group members. Whenever members believe that someone is lying or refusing to accept responsibility for his or her failures, they collectively challenge the person’s comments and defenses. When this is done in a responsible manner, the confrontation forces the person to rethink whatever he or she said. In theory, addicts in this way can reach clearer insight into their behavior.

Under certain circumstances, group therapy may involve family and friends of the addict. Called intervention therapy, this treatment is generally used to motivate a cocaine addict to seek help or to take his or her addiction more seriously by forcing a confrontation with people who have the closest emotional ties with the addict. The theory behind intervention therapy is that family and friends can often motivate an addict more effectively than strangers can. Intervention therapy also educates the addict’s family and friends about the problems of addiction and how to cope with the problems an addict may encounter while in therapy, such as loss of self-confidence, difficulty with communication, and feelings of guilt.

Medications

Although not commonly prescribed, for some patients medications are more effective than behavioral therapies. Two different types of medication are available. One causes intense discomfort if mixed with cocaine, and the other is used to help reduce the painful withdrawal symptoms and cravings during the first few weeks of abstinence.

Medications that create discomfort when mixed with cocaine are intended to deter addicts from using cocaine. The most common of these aversive drugs are Naltrexone and Clonindine. By themselves the medications are benign, but in combination with cocaine they elicit intense nausea and uncontrolled vomiting. Called aversion therapy because its goal is to create in the addict an aversion to the drug, the long-term goal is for the addict to abstain from using cocaine even though the benign medication that causes the nausea is no longer in his or her system.

The success of aversion therapy depends on the patient’s compliance in taking the medication as prescribed. The pitfall, not surprisingly, is that some patients who crave the rush and euphoria of cocaine will stop taking the aversion drug because they simply want to enjoy their drug. Consequently, success with aversion therapy often requires that therapists monitor patients to ensure they are regularly taking their medicine.

A second medicinal therapy uses antidepressants such as Desipramine to control the depression that accompanies withdrawal from cocaine. The object of the medication is simply to reduce the pain of withdrawal and the likelihood that the addict will relapse. When this therapy works, doctors will gradually reduce the use of the antidepressant as the withdrawal symptoms lessen until none is needed.

Hope for the Future

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