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In the detoxification phase the patient has to reduce and finally stop the consumption of cocaine and become abstinent, and the relapse prevention phase is targeted at preserving abstinence.
Counseling is recommended all throughout the process. Behavioral techniques are very important as well as the therapist' attitude. The therapist should be flexible, empathic, directive, but collaborative, and should provide social reinforcement frequently for all appropriate efforts and changes exhibited by patient.
The most effective behavioral techniques for cocaine addictions have been suggested the following: behavioral contracting, effective goal-setting, modeling/role playing, shaping successive approximations, self-monitoring, therapist prompting/monitoring, the Premack principle, skills training (e.g., social skills, problem solving, task analysis, relaxation, time management) (cited in Therapy Manuals for Drug Abuse: Manual 2). Key interventions in cocaine addictions are: understanding, describing and coping with craving, establishing goals and motivation to change, refusal skills / assertiveness, decision making skills, case management, HIV risk reduction etc.
In this specific case, it is important to show the patient how consumption of cocaine and his thoughts about cocaine influence his behaviors and emotions (if the intervention is made from a cognitive behavioral point-of-view). Moreover, emphasis will be placed on the cocaine consumption as a dysfunctional behavior, which has been modeled by his father's alcoholism. The patient may be taught techniques of distraction or self-talk to cope with craving. Role-play may be used to develop refusal and assertiveness skills....
Being a dependant person, these skills will help him to also gain a feeling of independence. The patient should be provided with a list of support phone numbers to call in times of need or crisis. It would be very good to identify a person that may support his efforts, but this is a difficult task with this patient who is rather isolated. Therefore, community support (Cocaine anonymous) or group activities may prove beneficial for him. In order to promote recovery it is very important to suggest the advantages of changing the negative behavior, which will reinforce a more adaptive coping. A very good coping strategy besides using distracters and avoiding high risk situations is learning a relaxation technique.
Recovery is defined by improvements in behavior, and affective states. In this case, becoming involved in positive activities such as employment, and giving up cocaine or substituting it with low doses of alcohol would mean the patient has recovered. After 5 years of abstinence studies show relapse is rare (Flynn, 2003).
References
Wojtowicz, J.P., Liu T., Hedgpeth, G.W. (2007) Factors of Addiction: New Jersey Correctional Population, Crime Delinquency 53; 471
Hirschman E.C. (1995). Professional, Personal, and Popular Culture Perspectives on Addiction, American Behavioral Scientist; 38; 537
Goodman, a (2007) Neurobiology of addiction an integrative review Biochemical Pharmacology, xxx, Retrieved from www.sciencedirect.com
Newcomb, M.D., & Bentler, P.M. (1986). Cocaine use among young adults. Advances in Alcohol and Substance Abuse, 6, 73-96.
Chinese Addiction Programs Adopt U.S. Model, Retrieved at http://www.camprecovery.com/content/8993/Chinese+Addiction+Programs+Adopt+U.S.+Model
Therapy Manuals for Drug Abuse: Manual 2, Retrieved at http://www.nida.nih.gov/TXManuals/CRA/CRA5.html van den Brink, W. van Ree, J.M. (2003) Pharmacological treatments for heroin and cocaine addiction, European Neuropsychopharmacology, 13, 476-487
Cognitive-Behavioral Approach: Treating Cocaine Addiction Retrieved from site: http://www.drugabuse.gov/TXManuals/CBT/CBTX9.html
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