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Intervention Summary

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Cocaine-Specific Coping Skills Training

Cocaine-Specific Coping Skills Training (CST), an adaptation of a treatment approach used for alcoholism, teaches cocaine users how to identify high-risk situations associated with past episodes of cocaine use and modify their behavior to avoid or counteract those influences in the future. Topics covered by this manualized treatment technique include frustration, anger, and other negative feelings; social pressure to use; internal pressure to use based on urges; assertiveness skills; and methods for enhancing positive moods. Working individually or in a group with a trained psychologist, participants describe a situation in which they used cocaine, analyze antecedents and consequences, learn anticipatory and reactive coping skills for that type of event, and role-play when possible. Coping skills are linked to specific points in the sequence of actions, or "behavior chain," whenever possible. For example, participants learn ways to escape, avoid, or modify the trigger situation; use cognitive restructuring to change their thoughts and affect; use alternative behaviors to attain desired consequences; and imagine the consequences of using versus not using while in the situation. CST is delivered in up to eight 45-minute sessions three to five times per week.

Descriptive Information

Areas of Interest Substance abuse treatment
Outcomes Review Date: March 2008
1: Number of cocaine use days
2: Maximum number of cocaine use days in a row
3: Relapse to cocaine use
4: Alcohol use
Outcome Categories Alcohol
Drugs
Ages 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Settings Residential
Outpatient
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History Cocaine-Specific Coping Skills Training, first implemented in 1990, has been used by two sites and evaluated in two studies. Nearly 300 individuals have participated in the intervention. It has been used as an adjunct to substance use treatment programs.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: March 2008

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Monti, P. M., Rohsenow, D. J., Michalec, E., Martin, R. A., & Abrams, D. B. (1997). Brief coping skills treatment for cocaine abuse: Substance use outcomes at three months. Addiction, 92(12), 1717-1728.  Pub Med icon

Rohsenow, D. J., Monti, P. M., Martin, R. A., Michalec, E., & Abrams, D. B. (2000). Brief coping skills treatment for cocaine abuse: 12-month substance use outcomes. Journal of Consulting and Clinical Psychology, 68(3), 515-520.  Pub Med icon

Study 2

Rohsenow, D. J., Monti, P. M., Martin, R. A., Colby, S. M., Myers, M. G., Gulliver, S. B., et al. (2004). Motivational enhancement and coping skills training for cocaine abusers: Effects on substance use outcomes. Addiction, 99(7), 862-874.  Pub Med icon

Supplementary Materials

Rohsenow, D. J. (2001, August). Cocaine relapses: Categories of relapse situations. Presented at the annual meeting of the New Zealand Psychological Society, Auckland, New Zealand.

Rohsenow, D. J., Martin, R. A., & Monti, P. M. (2005). Urge-specific and lifestyle coping strategies of cocaine abusers: Relationships to treatment outcomes. Drug and Alcohol Dependence, 78(2), 211-219.  Pub Med icon

Rohsenow, D. J., & Monti, P. M. (2001). Relapse among cocaine abusers: Theoretical, methodological, and treatment considerations. In F. M. Tims, C. G. Leukefeld, & J. J. Platt (Eds.), Relapse and recovery in addictions (pp. 355-378). New Haven, CT: Yale University Press.

Varney, S. M., Rohsenow, D. J., Dey, A. N., Myers, M. G., Zwick, W. R., & Monti, P. M. (1995). Factors associated with help seeking and perceived dependence among cocaine users. American Journal on Drug and Alcohol Abuse, 21(1), 81-91.  Pub Med icon

  • Outcomes

    Outcome 1: Number of cocaine use days
    Description of Measures The Timeline Followback structured interview was administered to assess the number of days on which cocaine was used, with urine drug screens to identify false reporters.
    Key Findings In one study, CST participants reported significantly fewer days of cocaine use at the 3-month (p < .01) and 6-month (p < .02) follow-up than participants in the comparison group, who received meditation and relaxation therapy. The number of days of cocaine use did not differ significantly between the two groups at the 9- and 12-month follow-up.

    In another study, women who received CST used cocaine on fewer days the year after the intervention than women from the comparison group, who received drug education (p < .02). Women who received CST also used cocaine on fewer days than men who received CST (p < .001).
    Studies Measuring Outcome Study 1, Study 2
    Study Designs Experimental
    Quality of Research Rating 3.2 (0.0-4.0 scale)
    Outcome 2: Maximum number of cocaine use days in a row
    Description of Measures The Timeline Followback structured interview was administered to assess the maximum number of consecutive days on which cocaine was used.
    Key Findings At the 3-month follow-up, the maximum number of cocaine use days in a row was significantly lower among CST participants than among participants from the comparison group, who received meditation and relaxation training (p < .02).
    Studies Measuring Outcome Study 1
    Study Designs Experimental
    Quality of Research Rating 3.2 (0.0-4.0 scale)
    Outcome 3: Relapse to cocaine use
    Description of Measures The Timeline Followback structured interview was administered to assess participants' relapse to cocaine use, with urine drug screens to identify false reporters.
    Key Findings At the 3-month follow-up, women who received CST were less likely to report relapse to cocaine use than women from the comparison group, who received drug education (p < .02). These groups did not differ significantly on relapse at the 6-, 9-, and 12-month follow-up.
    Studies Measuring Outcome Study 2
    Study Designs Experimental
    Quality of Research Rating 3.2 (0.0-4.0 scale)
    Outcome 4: Alcohol use
    Description of Measures The Timeline Followback structured interview was administered to assess the number of days on which alcohol was used. A family member or friend was interviewed in addition to the participant.
    Key Findings Women who received CST drank less alcohol the year after the intervention than women from the comparison group, who received drug education (p < .01). Women who received CST also drank less alcohol the year after the intervention than men who received CST (p < .03).
    Studies Measuring Outcome Study 2
    Study Designs Experimental
    Quality of Research Rating 3.2 (0.0-4.0 scale)

    Study Populations

    The following populations were identified in the studies reviewed for Quality of Research.

    Study Age Gender Race/Ethnicity
    Study 1 18-25 (Young adult)
    26-55 (Adult)
    55+ (Older adult)
    69% Male
    31% Female
    86% White
    8% Black or African American
    4% Hispanic or Latino
    1% American Indian or Alaska Native
    1% Asian
    Study 2 26-55 (Adult)
    55+ (Older adult)
    68% Male
    32% Female
    88% White
    11% Black or African American
    1% Asian

    Quality of Research Ratings by Criteria (0.0-4.0 scale)

    External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

    1. Reliability of measures
    2. Validity of measures
    3. Intervention fidelity
    4. Missing data and attrition
    5. Potential confounding variables
    6. Appropriateness of analysis

    For more information about these criteria and the meaning of the ratings, see Quality of Research.

    Outcome Reliability
    of Measures
    Validity
    of Measures
    Fidelity Missing
    Data/Attrition
    Confounding
    Variables
    Data
    Analysis
    Overall
    Rating
    1: Number of cocaine use days 3.5 3.5 2.5 3.0 3.0 3.5 3.2
    2: Maximum number of cocaine use days in a row 3.5 3.5 2.5 3.0 3.0 3.5 3.2
    3: Relapse to cocaine use 3.5 3.5 2.5 3.0 3.0 3.5 3.2
    4: Alcohol use 3.5 3.5 2.5 3.0 3.0 3.5 3.2

    Study Strengths

    The studies used the Timeline Followback interview developed by Sobell and Sobell, which has well-documented reliability. Researchers followed procedures recommended by the instrument's authors for maximizing the validity of self-reports (e.g., assuring participants that no family member, legal authority, or treatment staff would have access to the data; using a nonjudgmental interviewing style; using different staff members for assessment and treatment). Analyses adequately addressed attrition, missing data, and confounding variables.

    Study Weaknesses

    Intervention fidelity was insufficiently documented. Researchers provided limited information on the training and certification of psychologists who conducted the program. They also did not indicate whether they taped the sessions or used fidelity measures or an independent rating of adherence or competence.

    Readiness for Dissemination
    Review Date: March 2008

    Materials Reviewed

    The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

    Rohsenow, D. (1994). Cocaine-Specific Coping Skills Treatment: Supervisor's monitoring sheets for monitoring fidelity of treatment delivery in sessions.

    Rohsenow, D. (1994). Cocaine-Specific Coping Skills Treatment: Therapists tip sheets for sessions.

    Rohsenow, D., & Monti, P. M. (1994). Cocaine-Specific Coping Skills Treatment: Therapists manual for treatment.

    Rohsenow, D., & Monti, P. M. (n.d.). Cocaine-Specific Coping Skills Treatment: Workshop for therapists and trainers of therapists.

    Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

    External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

    1. Availability of implementation materials
    2. Availability of training and support resources
    3. Availability of quality assurance procedures

    For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

    Implementation
    Materials
    Training and Support
    Resources
    Quality Assurance
    Procedures
    Overall
    Rating
    2.3 1.9 2.0 2.0

    Dissemination Strengths

    The therapist manual is well organized and coherent. Workshops are available to support intervention training. General guidance is provided to supervisors for monitoring intervention fidelity.

    Dissemination Weaknesses

    Implementation materials do not discuss desired qualifications of therapists and supervisors. No guidance is provided for incorporating the intervention into existing organizational services or selecting clients to receive the intervention. No formal training curriculum, coaching, or support is available for program implementers. Additional guidance is needed for using quality assurance tools to measure outcomes and improve intervention delivery.

    Costs

    The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

    Item Description Cost Required by Developer
    Program materials Free Yes
    1-day, on-site training $1,250 per day plus travel expenses No
    Fidelity manual Free No
    Contact Information

    To learn more about implementation, contact:
    Damaris J. Rohsenow, Ph.D.
    (401) 863-6648
    Damaris_Rohsenow@brown.edu

    To learn more about research, contact:
    Damaris J. Rohsenow, Ph.D.
    (401) 863-6648
    Damaris_Rohsenow@brown.edu

    Peter M. Monti, Ph.D.
    (401) 863-6648
    Peter_Monti@brown.edu

    Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.