Feelings of low personal control and meaninglessness in life have ben implicated in both the onset and maintenance of substance abuse. If we were able to help cocaine dependent individuals develop an internal sense of the control over relapse generating stimuli, the ability of these stimuli to produce renewed substance use might be lessened, and feelings of helplessness might give way to a sense of personal efficacy, and the clinical course could be altered. Recent de-conditioning studies with substance dependent patients indicate that not only does the pairing of substance use triggering stimuli with the absence of substance use extinguish physiologic and subjective craving responses, but evidence also suggests that a sense of personal control and efficacy develops during these extinction trials. However, these grains have failed to generalize to the natural environment. The primary aim of this proposed five ear research project is to determine whether a Cocaine Stimulus Control Training (CSCT) program which, unlike the extinction studies, features immediate feedback regarding physiological control in the presence of cocaine use related stimuli, impacts on feelings of helplessness, abstinence efficacy, retention nd outcome. Volunteers (N=120) will be recruited from individuals who have relapsed to cocaine use and are seeking readmission to our inner city, publicly funded, intensive group treatment program. Of the 120 volunteers, 60 will be randomly assigned to twelve weeks of intensive group therapy plus the CSCT add on module and 60 will be assigned to twelve weeks of intensive group therapy;plus educational programming about cocaine triggers and the risks and the risks and consequences of continued cocaine use. Hypotheses to be tested are as follow: a) patients assigned to CSCT will show greater gains in psychological functioning (i.e., efficacy to remain abstinent) than those in the comparison group, and b) individuals in the CSCT procedures will remain in treatment longer and be functioning better at nine month follow-up.
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