Cocaine Rehabilitation
Studies that have compared the efficacy of inpatient/residential versus outpatient treatment programs have produced mixed results. Khalsa et al. (1996), for example, found that inpatients who had long-term follow-up improved more than those in other programs.
Lam et al. (1995) compared the efficacy of a sheltered residential program with stages of privileges to a community-based treatment program for homeless cocaine-abusing men. Their results showed that, although both groups improved, the residential program produced much higher reductions in cocaine use at the 6, 9 and 21 months follow-ups and greater residential stability at 6 and 9 months in comparison with the control group.
A study by Alterman et al. (1996) found equivalent effects for inpatient and day-patient programs. Similarly, in a comparison of day versus inpatient treatment for cocaine-dependent patients following an initial brief inpatient detox, Schneider et al. (1996), found that there were significant differences in rates of total abstinence in favour of the inpatient group at three months, but these differences had disappeared by six months. The authors conclude that the study results support the use of day treatment as a viable and cost-effective alternative to inpatient treatment for this group. However, it should be noted that the day-treatment group had a higher treatment drop-out rate.
Schneider et al. (1996), in an especially well-designed program, found that, at three months follow-up, the inpatient group had a significantly higher rate of abstinence (63%) compared to those in the day-treatment program (38%).
Finally, it is worth noting the findings from the recent U.S. Drug Abuse Treatment Outcome Study (DATOS) (NIDA , 1998). When four different types of treatment programs were compared (outpatient methadone programs, long-term residential programs, outpatient drug-free programs and short-term inpatient programs), there were substantial reductions in drug use among clients in all types of programs. The primary drug of abuse in these programs was cocaine, and, even in the outpatient methadone programs, 42% of clients abused cocaine. The percentages of clients reporting weekly or more frequent cocaine use prior to treatment was higher in both residential settings (66% and 67%) versus 42% in the outpatient settings. Thus reduction to approximately 20% across all four settings in reported weekly or more frequent cocaine use was more significant for the residential settings than for the outpatient settings.
