Psychosocial functioning and cocaine use during treatment: strength of relationship depends on type of urine-testing method

Abstract

Although improvement in psychosocial functioning is a common goal in substance-abuse treatment, the primary outcome measure in most cocaine trials is urinalysis-verified cocaine use. However, the relationship between cocaine use and psychosocial outcomes is not well documented. To investigate this relationship and identify the optimal urine-screen method, we retrospectively analyzed data from two 25-week randomized controlled trials of abstinence reinforcement (AR) in 368 cocaine/heroin users maintained on methadone. Cocaine use was measured thrice weekly by qualitative urinalysis, benzoylecgonine concentration (BE), and an estimate of New Uses of cocaine by application of an algorithm to BE. Social adjustment (SAS-SR), current diagnosis of cocaine dependence (DSM-IV criteria), and depression symptoms (Beck Depression Inventory) were determined at study exit. Cocaine use was significantly lower in AR groups than in controls. Across groups, in-treatment cocaine use was significantly associated with worse social adjustment, current cocaine dependence, and depression at exit. Significant differences were detected more frequently with New Uses than qualitative urinalysis or BE. Nevertheless, the amount of variance accounted for by the urine screens was typically <15%. Cocaine use during treatment, especially when measured with New Uses criteria, can predict psychosocial functioning, but cannot substitute for direct measures of psychosocial functioning.

Figure 1

Results of three urine-testing measures of cocaine use expressed mean percentage of specimens cocaine-positive by qualitative urinalysis (EMIT) (top panel), percentage of specimens identified as New Uses (middle panel), and BE concentration (ng/ml) (bottom panel) during baseline, intervention, and post-intervention maintenance phases by classification of current cocaine dependence by DSM-IV criteria at study exit (total number of participants, N=368). Asterisk indicates significant differences (p<0.05) between groups.

Figure 2

Results of three urine-testing measures of cocaine use expressed mean percentage of specimens cocaine-positive by qualitative urinalysis (EMIT) (top panel), percentage of specimens identified as New Uses (middle panel), and BE concentration (ng/ml) (bottom panel) during baseline, intervention, and post-intervention maintenance phases by depression classification at study exit (BDI score 13 or above = depression) (Lasa et al. 2000). Asterisk indicates significant differences (p<0.05) between groups.

Figure 3

Results of three urine-testing measures of cocaine use expressed mean percentage of specimens cocaine-positive by qualitative urinalysis (EMIT) (top panel), percentage of specimens identified as New Uses (middle panel), and BE concentration (ng/ml) (bottom panel) during baseline, intervention, and post-intervention maintenance phases by treatment group: Abstinence Reinforcement (N=267) and Control (N=101). Asterisks (one - p<0.05; two - p<0.01) indicate significant differences between groups.