Cocaine-dependent Patients Research Articles

The Effect of Trauma Cue Exposure on Cocaine Cravings among Cocaine Dependent Inpatients with and without Posttraumatic Stress Disorder: Exploring the Mediating Role of Negative Affect and Discrete Negative Emotional States

This study examined the effect of personalized trauma cue exposure (relative to neutral cue exposure) on cocaine cravings within a sample of trauma-exposed cocaine dependent patients with and without current PTSD. We also examined the extent to which negative affect (as well as the discrete negative emotional states of anxiety, anger, and shame/guilt) in response to the trauma cue accounted for these cocaine cravings. Sixty cocaine dependent patients in residential substance use treatment (50% with PTSD) were exposed to a personalized trauma and neutral script on separate days. Self-reported cocaine cravings and emotional response prior to and following each script were assessed. PTSD was associated with increased cocaine cravings following a personalized trauma (but not a neutral) script, and, for men specifically, the experience of self-conscious emotions (shame and guilt) to the trauma script mediated the relationship between PTSD and cocaine cravings following trauma script exposure. Treatment implications are discussed.

Psychiatric Profile of Three-Month Retention in Cocaine-Dependent Patients Treated in a Therapeutic Community

The purpose of this study was to examine the psychopathological profile that may be associated with the retention of patients for 90 days in a therapeutic community. In this study, we used a prospective longitudinal descriptive design. Participants were 218 cocaine-dependent individuals. Psychopathological assessment was performed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) and Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID). The outcome measure was retention and was defined as the time in therapeutic community treatment (number of days), the type of discharge, and the clinical impression of the therapeutic outcome. Of all patients, 68.3% (149) were stayers, and 31.7% (69) were dropouts after 3 months of treatment. In comparison with stayers, the dropout patients were in therapeutic community treatment fewer days, and they had a larger percentage of nonrelevant or minimal clinical changes at the end of the treatment (p < .001). Regarding the presence of other mental disorders, among the dropout patient group, the percentage of diagnostics is larger than in the stayer group. This difference is statistically significant for borderline personality disorder and attention-deficit/hyperactivity disorder. The results of this study demonstrate the importance of the impact of psychopathological comorbidity, particularly for the disorders associated with impulsivity and the control of impulses, in the therapeutic success of treatment in a therapeutic community.

Frontal systems related symptoms in cocaine dependent patients with comorbid personality disorders

The co-occurrence of cocaine dependence and personality disorders may contribute to frontal systems-related behavioral symptoms in cocaine users. This study aims to characterize apathy, disinhibition, and dysexecutive symptoms in cocaine users with comorbid personality disorders. Thirty-nine participants meeting criteria for cocaine dependence and personality disorders, 35 participants meeting criteria for cocaine dependence without comorbidities, and 29 controls matched for age, education, and IQ completed the Frontal Systems Behavior Scale (FrSBe), which provides present and retrospective assessments (of the period preceding cocaine use) about apathy, disinhibition, and dysexecutive symptoms. Additionally, relatives of cocaine patients (34 relatives from comorbid patients and 31 relatives from noncomorbid patients) completed the informant version of the FrSBe. We used one-way ANOVAs to investigate present-moment differences between the groups and related samples t tests to quantify changes between pre-disorder and present-moment symptoms. Cocaine users with personality disorders self-reported higher present-moment apathy and disinhibition symptoms than noncomorbid users and controls. Informant ratings showed that comorbid users exhibited pre-disorder elevations in apathy, disinhibition and dysexecutive symptoms, and that these symptoms did not significantly change between the pre-disorder and the present-moment assessments. In contrast, noncomorbid users exhibited increased apathy, disinhibition, and dysexecutive symptoms at present-moment compared with pre-disorder measures. The co-occurrence of cocaine dependence and personality disorders is associated with elevated frontal systems-related behavioral symptoms. Comorbid and noncomorbid users differ in frontal symptoms' trajectories, with the former showing pre-disorder stable elevations and the latter showing lower baseline symptoms but greater addiction-related elevations.

Negative urgency, disinhibition and reduced temporal pole gray matter characterize the comorbidity of cocaine dependence and personality disorders

BackgroundIndividuals with cocaine dependence and co-occurring personality disorders are more likely to have increased impulsivity, dysfunctional beliefs, executive dysfunction and brain structural abnormalities by virtue of the conjoint impact of both pathologies. MethodsWe recruited 32 cocaine dependent patients with comorbid Cluster B personality disorders, 44 cocaine dependent patients without comorbidities and 34 non-drug-using controls. They completed the UPPS-P impulsivity scale, the Personality Belief Questionnaire, and executive function tests of working memory, attention/response inhibition and shifting. A subsample (n=61) was also scanned using Magnetic Resonance Imaging. We used univariate ANOVAs for group comparisons, and tested the association between impulsivity, executive control and personality dysfunction and diagnoses using correlation and multivariate logistic regression analyses. ResultsCocaine dependent patients with personality disorders had elevated negative urgency and borderline beliefs, decreased inhibition and attention regulation, and reduced temporal pole gray matter with respect to the rest of the sample. Trait and cognitive measures correctly classified 73% of comorbid patients (60% sensitivity and 82% specificity). ConclusionThe co-occurrence of cocaine dependence and personality disorders is associated with negative-mood impulsivity and beliefs, executive dysfunction and temporal pole attrition.

Abstinence duration modulates striatal functioning during monetary reward processing in cocaine patients

Pre-clinical and clinical studies in cocaine addiction highlight alterations in the striatal dopaminergic reward system that subserve maintenance of cocaine use. Using an instrumental conditioning paradigm with monetary reinforcement, we studied striatal functional alterations in long-term abstinent cocaine-dependent patients and striatal functioning as a function of abstinence and treatment duration. Eighteen patients and 20 controls underwent functional magnetic resonance imaging during a Monetary Incentive Delay task. Region of interest analyses based on masks of the dorsal and ventral striatum were conducted to test between-group differences and the functional effects in the cocaine group of time (in months) with no more than two lapses from the first time patients visited the clinical service to seek treatment at the scanning time (duration of treatment), and the functional effects of the number of months with no lapses or relapses at the scanning session time (length of abstinence). We applied a voxel-wise and a cluster-wise FWE-corrected level (pFWE) at a threshold of P < 0.05. The patient group showed lower activation in the right caudate during reward anticipation than the control group. The regression analyses in the patients group revealed a positive correlation between duration of treatment and brain activity in the left caudate during reward anticipation. Likewise, length of abstinence negatively correlated with brain activity in the bilateral nucleus accumbens during monetary outcome processing. In conclusion, caudate and nucleus accumbens show a different brain response pattern to non-drug rewards during cocaine addiction, which can be modulated by treatment success.

A Randomized, Controlled, Pilot Trial of Methylphenidate and Cognitive-Behavioral Group Therapy for Cocaine Dependence in Heroin Prescription

Cocaine dependence has proved difficult to treat, whether it occurs alone or in combination with opiate dependence. No intervention has been demonstrated to be uniquely effective. Patients might benefit most from combined pharmacotherapeutic and psychotherapeutic interventions. The present study sought to evaluate the feasibility, tolerability, and efficacy of methylphenidate (MP) and cognitive-behavioral group therapy (CBGT) for cocaine dependence in diacetylmorphine-maintained patients. Sixty-two cocaine-dependent diacetylmorphine-maintained patients participated in a dual-site, double-blind, placebo-controlled pilot trial with 4 treatment conditions. The participants were randomly assigned to receive MP or a placebo each combined with either CBGT or treatment as usual for 12 weeks. Methylphenidate 30 mg and a placebo in identical capsules were administered onsite twice daily under supervision in a fixed-dose regimen without titration. Manual-guided CBGT consisted of 12 weekly sessions. Participation in the CBGT sessions was voluntary. Primary outcome measures were retention in pharmacologic treatment, cocaine-free urine samples, self-reported cocaine use, and adverse effects. Urine screens were performed thrice weekly. Seventy-one percent of the participants completed the study protocol. Methylphenidate was well tolerated with similar retention rates compared with the placebo. No serious adverse effects occurred. No difference in cocaine-free urine screens was found across the 4 treatment groups. Self-reported cocaine use was reduced in all 4 study groups. Methylphenidate and CBGT did not provide an advantage over a placebo or treatment as usual in reducing cocaine use. There were no signs of additive benefits of MP and CBGT. Because of the small sample size, the results are preliminary.

Error-Related Brain Activity Predicts Cocaine Use After Treatment at 3-Month Follow-up

Relapse after treatment is one of the most important problems in drug dependency. Several studies suggest that lack of cognitive control is one of the causes of relapse. In this study, a relative new electrophysiologic index of cognitive control, the error-related negativity, is investigated to examine its suitability as a predictor of relapse. The error-related negativity was measured in 57 cocaine-dependent patients during their first week in detoxification treatment. Data from 49 participants were used to predict cocaine use at 3-month follow-up. Cocaine use at follow-up was measured by means of self-reported days of cocaine use in the last month verified by urine screening. A multiple hierarchical regression model was used to examine the predictive value of the error-related negativity while controlling for addiction severity and self-reported craving in the week before treatment. The error-related negativity was the only significant predictor in the model and added 7.4% of explained variance to the control variables, resulting in a total of 33.4% explained variance in the prediction of days of cocaine use at follow-up. A reduced error-related negativity measured during the first week of treatment was associated with more days of cocaine use at 3-month follow-up. Moreover, the error-related negativity was a stronger predictor of recent cocaine use than addiction severity and craving. These results suggest that underactive error-related brain activity might help to identify patients who are at risk of relapse as early as in the first week of detoxification treatment.

Extreme Learning Machines for Feature Selection and Classification of Cocaine Dependent Patients on Structural MRI Data

In this paper, we present a Computer Aided Diagnosis and image biomarker identification system for cocaine dependence, which selects relevant regions from a set of brain structural magnetic resonance images (sMRI). After sMRI volume preprocessing for spatial normalization, we compute Pearson's correlation between pixel values across volumes and the indicative variable, obtaining a volume of correlation values (VCV). We calculate the gradient of the VCV which is used to perform a watershed segmentation of the brain volume into regions. A region selection stage finds the most relevant watershed regions. We propose two different approaches to characterize region relevance: (a) a wrapper procedure using extreme learning machines (ELM), and (b) apply correlation distribution percentiles to select most discriminant regions. Next, we consider three different procedures to extract the image features corresponding to selected regions: (1) collecting the sMRI intensity values of all the voxels that compose each region, compute (2) the mean or (3) the median of the sMRI intensity value of the voxels contained in each selected region. Extracted feature vectors are used to build a classifier aiming to discriminate between cocaine dependent patients and healthy controls. We compare results of several classifiers: ELM, OP-ELM, SVM and 1NN. Also, we visualize the brain locations of selected regions, checking if these locations are in accordance with previous findings in the medical literature.

Association study of 37 genes related to serotonin and dopamine neurotransmission and neurotrophic factors in cocaine dependence

Cocaine dependence is a neuropsychiatric disorder in which both environmental and genetic factors are involved. Several processes, that include reward and neuroadaptations, mediate the transition from use to dependence. In this regard, dopamine and serotonin neurotransmission systems are clearly involved in reward and other cocaine-related effects, whereas neurotrophic factors may be responsible for neuroadaptations associated with cocaine dependence. We examined the contribution to cocaine dependence of 37 genes related to the dopaminergic and serotoninergic systems, neurotrophic factors and their receptors through a case-control association study with 319 single nucleotide polymorphisms selected according to genetic coverage criteria in 432 cocaine-dependent patients and 482 sex-matched unrelated controls. Single marker analyses provided evidence for association of the serotonin receptor HTR2A with cocaine dependence [rs6561333; nominal P-value adjusted for age = 1.9e-04, odds ratio = 1.72 (1.29-2.30)]. When patients were subdivided according to the presence or absence of psychotic symptoms, we confirmed the association between cocaine dependence and HTR2A in both subgroups of patients. Our data show additional evidence for the involvement of the serotoninergic system in the genetic susceptibility to cocaine dependence.

Impulsivity is associated with treatment non-completion in cocaine- and methamphetamine-dependent patients but differs in nature as a function of stimulant-dependence diagnosis

Greater impulsivity, assessed by the Barratt Impulsiveness Scale–11 (BIS-11) and Stroop interference scores, has been associated with treatment completion in cocaine-dependent patients. This study evaluated the relationships among impulsivity, stimulant-dependence diagnosis, and treatment completion. Six sites evaluating 12-step facilitation for stimulant abusers obtained the BIS-11 and Stroop from 182 methamphetamine- and/or cocaine-dependent participants. Methamphetamine-dependent, relative to cocaine-dependent, participants evidenced significantly greater BIS-11 non-planning and total scores. There was a trend for poorer response inhibition, measured by the Stroop, in cocaine-dependent, relative to methamphetamine-dependent, participants. Accounting for other factors related to treatment completion, BIS-11 motor score, assessing the tendency to act without thinking, predicted treatment completion for both cocaine-dependent and methamphetamine-dependent patients. These results suggest that methamphetamine-dependent and cocaine-dependent patients may have different impulsivity profiles but that the BIS-11 may be useful in identifying both methamphetamine-dependent and cocaine-dependent patients who are at risk for treatment non-completion.

Individual Differences in Anterior Cingulate Activation Associated with Attentional Bias Predict Cocaine Use After Treatment

Drug-dependent patients often relapse into drug use after treatment. Behavioral studies show that enhanced attentional bias to drug cues is a precursor of relapse. The present functional magnetic resonance imaging (fMRI) study examined whether brain regions involved in attentional bias are predictive of cocaine use after treatment. Attentional bias-related brain activity was measured-with a cocaine Stroop task-in cocaine-dependent patients during their first week in detoxification treatment and was used to predict cocaine use at 3-month follow-up. The predictive value of attentional bias-related brain activity in a priori defined regions of interest, in addition to other measures such as self-reports of substance severity, craving, and behavioral attentional bias were examined. The results show that craving in the week before treatment and individual variability in attentional bias-related activity in the dorsal anterior cingulate cortex (dACC) were significant predictors of days of cocaine use at 3-month follow-up and accounted for 45% in explained variance. Brain activity in the dACC uniquely contributed 22% of explained variance to the prediction model. These findings suggest that hyperactive attentional bias-related brain activity in the dACC might be a biomarker of relapse vulnerability as early as in the first week of detoxification treatment. Ultimately, this may help to develop individually tailored treatment interventions to reduce relapse risk.

2346 – Cocaine-induced psychosis and impulsivity in cocaine-dependent patients

Cocaine induced psychosis (CIP) is common but not developed in all cases. Many risk factors have been linked with CIP. A lifetime diagnosis of ADHD has been associated with the categorical presence of CIP. The objective of this study is to determinate the relationship between impulsivity and impulsivity-realetd disorders (BPD, BN and ADHD) and CIP. We study the presence of psychotic symptoms using a clinical interview for psychotic symptoms in a large sample of cocaine-dependent patients. Patients suffering from schizophrenia or bipolar disorders were excluded. Finally we included 287 patients in the study. A structured interview about psychotic symptoms were systematically conducted. The Structured Clinical Interview for DSM IV Axis I and Axis II disorders were used in order to identify the comorbidity. CAADID-II (Conners’ Adult ADHD Diagnostic Interview for DSM-IV) were used in order to identify ADHD comorbidity. Barrat impulsivity scale were used for evaluate impulsivity. BIS total were 63.78. We identify a significant association between CIP and BIS cognitive subscale p < 0.003 and BIS total p < 0.021. We also identify a significant association between CIP and adult ADHD in cocaine-dependent patients p < .0.002. We fail to identify association between CIP and BPD and BN. CIP is related with BIS cognitive subscale and BIS total scores, and with ADHD comorbidity in cocaine-dependent patients. As well these findings could be useful for a clinical approach to the risks of psychotic states in cocaine-dependent patients.

2365 – Cocaine-induced psychotic symptoms prevalence in cocaine-dependent patients

Cocaine consumption can induce transient psychotic symptoms. Cocaine induced psychosis (CIP) is common but not developed in all cases. However, prevalence and clinical features are not well known. In psychiatry settings different studies have reported prevalence ranging between 29%–86.5%.There are few samples including more than 150 patients for studding this topic. The objective of this study is to d eterminate the CIP prevalence and the most prevalent psychotic symptoms . We study presence of psychotic symptoms using a clinical interview for psychotic symptoms in a large sample of 287 cocaine-dependent patients. We study the presence of psychotic symptoms using a clinical interview for psychotic symptoms in a large sample of cocainedependent patients. Patients suffering from schizophrenia or bipolar disorders were excluded. Finally we included 287 patients in the study. (80.8% men and 35.77 yo). A structured interview were systematically conducted. The Structured Clinical Interview for DSM IV Axis I and Axis II disorders were used in order to identify the comorbidity. Psychotic symptoms were detected in 59.9% of the sample. The most frequent symptoms reported lifetime was suspiciousness 38.6% and paranoid beliefs 27.2% Auditory hallucinations were reported by 23.6%, visual hallucinations by 13.3%, and kinesthetic hallucinations by 7.8%. Motor alterations were not evaluated. Our dates confirm previous study. CIP prevalence is high. Motor alterations were not evaluated, so symptoms could be underestimated. Identifying this kind of symptoms can be useful in order to minimize risks of psychotic states for the patients or others.

2651 – Behavioural changes in cocaine dependent patients after group-therapy

Frequent and increasing relations among psychiatric and substance dependence disorders, have made, to date, more complex the treatment of this dependence, especially when the patient is facing the difficult task of maintaining abstinence, which requires a work of self-awareness, motivation to change and active modification of dysfunctional lifestyles. Our study has the aim to detect patients’ changes in personality between the beginning of the rehabilitative therapy and its end, trying to get information on aspects of addiction on which the treatment affects the most. Our sample was formed by 153 patients, recruited at the Department of Psychiatry of Gemelli General Hospital, who were subjected to an integrated approach of treatment, both pharmacological and rehabilitative group-therapy, according to Minnesota rehabilitation model, that considers addiction as a bio-psycho-social problem. Patients, after a first psychiatric evaluation, were asked to fill out two psychometric tests, the SymptomCheckList-90 R and the Structural Clinical Interview for DSM-IV , in two times, at the first meeting and at the last one, after 20 meetings of group therapy. At the end of the group therapy 39 patients dropped-out, 114 patients had a significant improvement in depressive symptoms (DEP item), greater responsibility perseverance and attention in their activities and habitual contexts (GSI, DIS, W/S items), as well as better management of compulsion and impulsivity (OC item) and a lower sense of inferiority, inadequacy and discomfort in interpersonal relationships (PAR, ANX, IS, SOC. A., PSY. A. items).

Functional brain networks associated with cognitive control, cocaine dependence, and treatment outcome.

Individuals with cocaine dependence often evidence poor cognitive control. The purpose of this exploratory study was to investigate networks of functional connectivity underlying cognitive control in cocaine dependence and examine the relationship of the networks to the disorder and its treatment. Independent component analysis (ICA) was applied to fMRI data to investigate if regional activations underlying cognitive control processes operate in functional networks, and whether these networks relate to performance and treatment outcome measures in cocaine dependence. Twenty patients completed a Stroop task during fMRI prior to entering outpatient treatment and were compared to 20 control participants. ICA identified five distinct functional networks related to cognitive control interference events. Cocaine-dependent patients displayed differences in performance-related recruitment of three networks. Reduced involvement of a "top-down" fronto-cingular network contributing to conflict monitoring correlated with better treatment retention. Greater engagement of two "bottom-up" subcortical and ventral prefrontal networks related to cue-elicited motivational processing correlated with abstinence during treatment. The identification of subcortical networks linked to cocaine abstinence and cortical networks to treatment retention suggests that specific circuits may represent important, complementary targets in treatment development for cocaine dependence.

The MTHFR C677T Variant is Associated with Responsiveness to Disulfiram Treatment for Cocaine Dependency.

Objective: Disulfiram is a one of the few pharmacotherapies for cocaine addiction that shows promise. Since disulfiram and cocaine both affect levels of global methylation we hypothesized the MTHFR gene, whose product is involved in supplying methyl groups for DNA and protein methylation, may be associated with responsiveness to disulfiram in cocaine-dependent individuals. Methods: Sixty-seven cocaine-dependent patients were stabilized on methadone for 2 weeks and then randomized into disulfiram (250 mg/day, N = 32) and placebo groups (N = 35) for 10 weeks. Patients were genotyped for the MTHFR (rs1801133, also known as C677T) polymorphism and the data was evaluated for association with cocaine-free urines in the disulfiram or placebo groups. Data from patients that completed all 10 weeks of the study (N = 56) were analyzed using repeated measures analysis of variance (ANOVA), corrected for population structure. Results: The CT or TT MTHFR genotype group (N = 32) dropped from 73 to 52% cocaine-positive urines on disulfiram (p = 0.0001), while the placebo group showed no treatment effect. The CC MTHFR genotype group (N = 24) showed a smaller, but still significant, reduction in cocaine-positive urines on disulfiram compared to placebo; 81–69% (p = 0.007). Conclusion: This study indicates that a patient’s MTHFR genotype may be used to identify individuals who might show improved response to disulfiram treatment for cocaine dependence. Clinical Trial: Pharmacogenetics of Disulfiram for Cocaine, clinicaltrials.gov/ct2/show/NCT00149630, NIDA-18197-2, NCT00149630.

Sex differences in decreased limbic and cortical grey matter volume in cocaine dependence: a voxel‐based morphometric study

Structural neuroimaging studies have provided evidence of differences in local brain volume between cocaine-dependent and healthy control individuals. While sex differences in aetiology, course and brain dysfunction associated with chronic cocaine abuse have been previously documented, evidence of sex-specific differences in brain volume has not been examined thus far. This study examined sex-related differences in grey matter volume between cocaine-dependent and healthy control subjects using voxel-based morphometry. High-resolution T1 structural scans were obtained from 36 inpatient, treatment-engaged 3-week abstinent cocaine-dependent (CD) individuals. Fifty healthy control subjects were also scanned. Segmentation and registration were performed in SPM8, using New Segment and DARTEL, respectively. The whole-brain statistical analysis was conducted in SPM8 using random field-based cluster-size testing and family-wise error rate correction for multiple comparisons. CD patients were found to have less grey matter volume in anterior prefrontal cortex, including frontopolar and orbitofrontal cortices, and a posterior region surrounding the parietal-occipital sulcus. Female CD patients had less grey matter volume than female controls in left inferior frontal gyrus, insula, superior temporal gyrus and hippocampus. Male CD patients had less grey matter in a superior cortical region that included the precentral gyrus and the mid-cingulate. These sex differences in lower grey matter volume add to the evidence from functional neuroimaging for sex-specific differences in the neurophysiological changes associated with chronic cocaine use.

A randomized study of contingency management in cocaine-dependent patients with severe and persistent mental health disorders

BackgroundContingency management (CM) is efficacious for reducing drug use, but it has rarely been applied to patients with severe and persistent mental health problems. This study evaluated the efficacy of CM for reducing cocaine use in psychiatric patients treated at a community mental health center. MethodsNineteen cocaine-dependent patients with extensive histories of mental health problems and hospitalizations were randomized to twice weekly urine sample testing with or without CM for 8 weeks. In the CM condition, patients earned the chance to win prizes for each cocaine-negative urine sample. Patients also completed an instrument assessing severity of psychiatric symptoms pre- and post-treatment. ResultsPatients assigned to CM achieved a mean (standard deviation) of 2.9 (1.7) weeks of continuous cocaine abstinence versus 0.6 (1.7) weeks for patients in the testing only condition, p=.008, Cohen's effect size d=1.35. Of the 16 expected samples, 46.2% (27.5) were cocaine negative in the CM condition versus 13.8% (27.9) in the testing only condition, p=.02, d=1.17, but proportions of negative samples submitted did not differ between groups. Reductions in psychiatric symptoms were noted over time in CM, but not the testing only, condition, p=.02. ConclusionsCM yielded benefits for enhancing durations of abstinence in dual diagnosis patients, and it also was associated with reduced psychiatric symptoms. These findings call for larger-scale and longer-term evaluations of CM in psychiatric populations.

Diagnosis and Consequences of Cocaine Addiction

Cocaine remains the second most commonly used and trafficked illicit drug in the world after cannabis. This psychostimulant drug has become an essential part of the world drug scene with a different use among countries. Prevalence of cocaine use (lifetime, last year, last month use) is particulary high among males aged between 15 and 34 years. Five per cent of cocaine users will develop a substance- dependence during the first year of use, and 20% of these will become long-term cocaine-dependent patients. The number of patients entering drug treatment for primary cocaine use has been increasing in Europe for several years. Cocaine addiction is a worldwide public health problem, which has somatic, psychological, psychiatric, socio-economic and judicial complications. This article aims to provide the clinician with a detailed description of the clinical aspects, the adverse effects and the complications of cocaine addiction. Literature searches were conducted for the period from January 1985 to February 2012 using PubMed, EMBASE, PsycInfo, and Google Scholar.

Adding Integrative Meditation with Ear Acupressure to Outpatient Treatment of Cocaine Addiction: A Randomized Controlled Pilot Study

Cocaine addiction continues to be a major public health problem in the United States. With no U.S. Food and Drug Administration-approved pharmaceutical therapy, treatment often relies on psychosocial interventions. This pilot therapy development study attempts to examine the feasibility and preliminary efficacy of adding breathing-based Integrative Meditation and Ear Acupressure (IMEA) to outpatient treatment of cocaine addiction. Fifty-six (56) cocaine-dependent patients were recruited from an outpatient addiction treatment facility in Baltimore, MD and randomized into either an IMEA or a treatment as usual (TAU) group for the 12 weeks of study, with weekly meetings to monitor treatment outcomes and to facilitate meditative therapy. The outcome measures consisted of treatment retention rates by week 8 and 12; abstinence rates measured by 6 continuous weeks of negative urinalysis for cocaine, and addiction-related symptoms such as anxiety, craving, depression, and withdrawal symptoms. With the assistance of simplified breath training and a portable MP4 device, 80% of IMEA participants self-reported practicing breathing or meditation 5+ days a week with acceptable compliance and showed strong interest in meditative techniques. Compared to TAU, IMEA participants reported significantly higher treatment completion rates by week 8 (89% versus 63%) and week 12 (81% versus 58%), higher abstinence rates (66% versus 34%), and significantly greater reduction in craving, anxiety, and other addiction-related symptoms. Some participants continued meditation after study completion. It is feasible to add breathing-based IMEA to outpatient treatment of cocaine addiction. Although a number of limitations exist for this pilot study, further large-scale clinical trials and therapy-development studies of IMEA for addiction are warranted.