Social Learning Theory (SLT) has been a useful model for understanding substance abuse. While based on learning principles such as coping skills and relapse prevention (RP) have been promising, they have had varied results in recent empirical treatment studies involving alcohol and cocaine abuse. We have developed a modification and extension of a RP approach using expectancies as the organizing structure and as a major focus of treatment for cocaine addiction. We believe that this approach, Expectancy-based Coping Skills therapy (ECS) is likely to substantially improve treatment efficacy for the following reasons: (l) Expectancies are a central construct that holds much promise for clinical research involving the assessment, etiology, and treatment of cocaine addiction; (2) Cocaine- related expectancies are readily measured using a validated, multifactorial, self-report instrument developed by the principal investigator of this study (Cocaine Expectancy Questionnaire, CEQ) and represent a domain that is amenable to change with talking therapy; and (3) An extensive pilot study conducted by the principal investigator and this research group strongly supports the feasibility, acceptability, and efficacy of manualized ECS therapy for the treatment of cocaine addiction. For these reasons we believe that expectancies have profound implications for treatment and that expectancy-based treatment warrants further evaluation and development. Because prior to our current pilot work, expectancies had received minimal cinical and empirical treatment emphasis, their implications for treatment need to be explored in a systematic fashion. Instruments such as the CEQ, combined with our manualized intervention of ECS, make it possible to assess and use expectations about cocaine in a clearly specified treatment that can be reliably delivered, monitored, and evaluated. This study proposes to conduct a randomized clinical trial with 168 ambulatory cocaine dependent participants to evaluate whether ECS therapy improves treatment efficacy substantially in comparison to two other manualized approaches: Rp and addiction counseling, a reference control condition.
