During a 2.5-year follow-up of
opioid addicts, we examined psychosocial antecedents and consequences of the onset and remission of
cocaine abuse. Patients who never used
cocaine were compared with those whose use increased or decreased along several dimensions of treatment outcome including
drug abuse, legal, employment, family, social, psychological, and medical problems.
Cocaine abuse had a marked impact on almost every outcome area except medical problems. Patients whose
cocaine use increased during follow-up had more severe problems than either those whose use decreased or those who never used
cocaine. Furthermore, the attainment of
cocaine abstinence among abusers was associated with improved psychosocial functioning, whereas the onset of
cocaine abuse was associated with increased problem severity. Compared with
drug-free and detoxification alone treatments,
methadone maintenance may minimize legal complications of
cocaine abuse, but otherwise it did not significantly reduce psychosocial morbidity from increasing
cocaine abuse. These findings suggest that treatment-seeking
opioid addicts are vulnerable to wide-ranging deterioration when they become increasingly involved with
cocaine but that with the attainment of abstinence many problem areas improve.