Crack cocaine in the Dublin region - Health Research Board

note that providing information on cocaine itself and its associated treatment optionsdid encourage some respondents to seek help. Indeed, despite the title of this paper,the differences in abstinence rates for the two interventions were neither clinicallynor statistically significant. The data presented in this paper indicate that informationor brief intervention would be effective if provided at accident and emergency, harmreduction and opiate treatment services. The information brief or leaflet should coverthe dangers of cocaine use, the symptoms of dependence and the treatment servicesavailable.Cognitive behavioural therapy and counsellingCognitive behavioural therapy is a system of psychotherapy which attempts to reduceexcessive emotional reactions and self-defeating behaviours by modifying underlyingerroneous thinking and maladaptive beliefs. According to experts in this area, thecognitive approach, when applied to substance abuse, helps individuals deal with theproblems leading to emotional distress and gain a better perspective on their relianceon drugs. Specific cognitive strategies are said to help individuals establish strongerinternal controls and reduce their urges to take drugs. In addition, cognitive therapycan help patients to combat depression, anxiety or anger, which increase addictivebehaviours.Since there were no systematic reviews in the Cochrane Library that examined theevidence of effectiveness of psychotherapeutic interventions (such as cognitivebehavioural therapy) in the treatment of cocaine dependence, some individual studieswere reviewed for the purposes of this article.Crits-Christoph and colleagues (1999) examined combinations of psychosocialtreatments for cocaine dependence. They compared four different treatments –cognitive therapy, psychodynamic therapy, individual drug counselling, and groupdrug counselling alone. The first three treatments mentioned included group drugcounselling along with the specific individual therapy. Treatments were intensive andprovided over a six-month period. The clients were followed up at six and at twelvemonths. The authors found that, when compared to the two forms of psychotherapyand to group drug counselling alone, individual drug counselling plus group workshowed the greatest improvement in the number of days the clients did not use cocaineover a one-month period. The authors were surprised by this finding because in 1991Carroll and colleagues reported that relapse-prevention therapy (a form of cognitivebehaviour therapy) was more effective than interpersonal psychotherapy, and hadhigher abstinence and recovery rates. In 1994, Higgins and colleagues reported thatrelapse prevention therapy with the addition of incentives was more effective thanrelapse prevention therapy alone. The clients who received incentives were more likelyto complete their treatment and had a longer duration of cocaine-negative urines.128 Crack cocaine in the Dublin region: an evidence base for a crack cocaine strategy