The long-term objectives of this program are to develop more effective treatment approaches for cocaine use by evaluating promising interventions derived from social learning theory. The last decade has seen important advances in the theory and treatment of cocaine abuse. In particular certain cognitive behavioral approaches such as coping skills training or relapse prevention training have demonstrated improved outcome. In our current project, preliminary results indicate that cocaine abusers who received Cocaine Specific Coping Skills Training (CST) were almost twice as likely to abstain from cocaine and had significantly fewer cocaine use days than did subjects who received the comparison treatment (standard treatment with meditation added). This suggests that this intervention is worth further investigation. In the field of alcoholism, a motivational interviewing approach developed by William Miller has shown strong promise as a brief treatment intervention. The rationale behind this approach is that while some cocaine abusers may be ready to change when they enter treatment and therefore benefit from coping skills training, other cocaine abusers enter treatment for a variety of reasons and may not be ready to change or may have considerable ambivalence about changing their cocaine use. Traditionally, this lack of motivation has been attributed to the character of the cocaine user and aggressive confrontational techniques have been used to try to increase motivation. However, Miller et al. (1985; in press) demonstrated that an aggressive confrontational style caused more resistance on the part of the client and resulted in poorer outcome than did a supportive client- centered style of presenting material. Therefore, the motivational interviewing approach which uses a more client-centered approach warrants investigation with cocaine abusers as well. The proposed renewal is to extend the work accomplished by providing cocaine abusers with Motivation Enhancement Treatment (ME) versus a control procedure and our CST package or a control procedure and evaluating the effectiveness of the ME, alone or in combination with CST, in reducing substance use during follow-up. We hypothesize that ME will improve treatment outcomes, that the combination of ME and CST will be more effective than either procedure alone, and that pretreatment motivational measures such as stage of change will interact with treatment such that those with lower initial motivation will benefit more from ME and from the combination of ME and CST. Follow-up interviews will be conducted at 3, 6 and 12 months after treatment completion, confirmed with urine screens and reports of family or friends. A battery of newly developed cocaine specific assessment instruments will be used to assess baseline individual differences and change in potential mediating processes.
