Cocaine abuse represents a serious and growing problem in American society. Effective treatments are needed that both address problems of drug use and abuse and that adequately address concomitant and frequently observed depression in this group. This stage 1 research proposal is a preliminary step toward conducting a large scale, randomized clinical trial comparison of a treatment that selectively combines effective procedures from several different treatment approaches. Specifically, Prescriptive Therapy (PT) uses subject distress level, externalizing coping style, and resistance tendencies to individualize treatment and guide the selection of interventions drawn from supportive counseling, cognitive therapy, and experimental treatment models. In anticipation of the larger study, PT will be refined and contrasted with two manualized treatments, Cognitive Therapy (CT) and Supportive/Self-Directed Therapy (S/SD) through four preparatory phases. In Phase 1, we will select instruments and refine the rules of applying Prescriptive Therapy and the contrasting interventions. In Phase 2, we will test procedures for selecting and training therapists in the three treatment procedures. In Phase 3, we will select a sample of patients presenting with cocaine abuse and mild to moderate dysphoria within the depressive spectrum. This phase will be used to answer questions of subject availability and representativeness as well as to select participants in the final phase of the current project. In Phase 4, we will pilot test the ability to deliver the modified PT, CT, and S/SD treatments to co-morbid, cocaine abusing and depressed patients.
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