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Cocaine addiction update 2008

Clinical bottom line

Information on interventions for cocaine addictions is sparse. No intervention had any effect on abstinence rates between one and six months. About 1 patient in every 2 was abstinent without therapy or with placebo.


Data

Information from seven systematic reviews and meta-analyses (six Cochrane reviews) of cocaine cessation studies had information on over 4,200 participants with cessation rates between one and six months. Three had over 300 participants in the comparison, and one examined carbamazepine separately from other anticonvulsants. All used only properly randomised trials in patients with defined cocaine addiction, used a mixture of non-use of cocaine by measurement or retention in a programme to assess abstinence, and used placebo or counselling. Studies using validated non-use by measurement or maintenance in programme appeared not to differ in cessation rates with placebo.

A summary of the reviews is available as a downloadable PDF (32kb).

Results

Table 1 shows the main results in terms percentage of abstinent patients with intervention and placebo, the relative benefit, and the NNT for one participant to be abstinent at six months who would not have been if treated with placebo. The order is by numbers of participants in the reviews. No interevention had a statistically greater abstinence rate than placebo, tough numbers of patients were relatively small in each analysis.

Table 1: Results of cocaine cessation reviews, ordered by number of participants

Percent abstinent with
Intervention
Number of patients
Active
Placebo
Relative benefit
(95%CI)
NNT
(95% CI)
CNS stimulants
640
51
53
1.0 (0.8 to 1.1)
not calculated
Cognitive behavioural therapy
570
54
46
1.2 (1.0 to 1.4)
not calculated
Anticonvulsants
468
47
52
0.9 (0.8 to 1.1)
not calculated
Carbamazepine
313
39
32
1.3 (0.9 to 1.7)
not calculated
Desipramine
266
43
50
0.9 (0.7 to 1.1)
not calculated
Amantidine
215
39
27
1.4 (1.0 to 2.1)
not calculated
Antipsychotics
208
58
45
1.3 (1.0 to 1.7)
not calculated

 

Figure 1 shows the same information graphically, ordered by the proportion of patients abstinent at six months or longer with treatment.

Figure 1: Percentage of patients abstinent from cocaine at 1-6 months or longer, ordered by success rate with treatment (numbers in parenthesis are numbers in the comparison)

The response for placebo varied between 27% and 53%, with an overall average cessation rate of 47% in 1,134 participants on placebo (not double counting carbamazepine results with those of anticonvulsants).

Comment

No intervention had any effect on abstinence rates between one and six months. About one patient in every two was abstinent without therapy or with placebo.