Predictors of abstinence maintenance after cocaine inpatient detoxification: A prospective study

Margaux Poireau (1) , Virgile Clergue-Duval (1, 2) , Angéline Maillard (3) , Romain Icick (4, 5) , J. Azuara (6) , Pauline Smith (7) , Mathieu Faurent (8) , Emmanuelle Volle (9) , Christine Delmaire (1) , Julien Cabé (10, 11) , Vanessa Bloch (2, 1, 12) , Florence Vorspan (1, 2)

1 OPTeN (UMR_S 1144 / U1144) - Optimisation thérapeutique en Neuropsychopharmacologie
2 Hôpital Lariboisière-Fernand-Widal [APHP]
3 NIMH - Neuropsychologie et imagerie de la mémoire humaine
4 CONSTANCES - Cohortes épidémiologiques en population
5 Fondation FondaMental [Créteil]
6 UFC - Université de Franche-Comté
7 GU - Georgetown University [Washington]
8 Département de Psychiatrie et de Médecine Addictologique
9 ICM - Institut du Cerveau = Paris Brain Institute
10 Service Addictologie et Pathologie Duelles [CHU Clermont-Ferrand]
11 IP - Institut Pascal
12 UPCité - Université Paris Cité

Background and Objectives Cocaine is a highly addictive substance, and with no approved medication for cocaine use disorder (CUD), leading to a heavy burden. Despite validated psychosocial treatments, relapse rates after detoxification are very high in CUD. Few consistent factors can predict abstinence after detoxification. Our study, therefore, aimed at identifying factors predicting abstinence among CUD patients after inpatient detoxification. Methods Eighty‐one CUD inpatients were included during detoxification and characterized for clinical and sociodemographic data at baseline and at a follow‐up of 3 months after discharge, including a standard measure of their abstinence duration from cocaine. We performed Cox univariate analyzes to determine the factors associated with abstinence maintenance, followed by a multivariate Cox regression to identify independent predictors. Results Abstinence maintenance was shorter in patients injecting cocaine (hazard ratio [HR] = 5.16, 95% confidence interval [CI]: 2.01–13.27, p < .001) and using cocaine heavily in the month before inclusion (HR = 1.03, 95% CI: 1.00–1.06, p = .046). Conversely, abstinence maintenance was longer in patients with longer inpatient detoxification stays (HR = 0.96, 95% CI: 0.94–0.99, p = .015) and prescribed with selective serotonin reuptake inhibitors (SSRIs) (HR = 0.30, 95% CI: 0.16–0.56, p < .001). Discussion and Conclusions Patients with severe CUD may require longer inpatient stays to achieve abstinence. Regarding SSRI prescription, more specific studies are needed to provide stronger recommendations about their use in clinical practice. Scientific Significance Our findings suggest several modifiable factors to improve inpatient treatment response in CUD. As there are no specific recommendations about the optimal duration of inpatient stay, our results could pave the way for evidence‐based guidelines.

Domaines: Psychiatrie et santé mentale; Psychologie et comportements; Santé publique et épidémiologie

Margaux Poireau, Virgile Clergue-Duval, Angéline Maillard, Romain Icick, J. Azuara, et al.. Predictors of abstinence maintenance after cocaine inpatient detoxification: A prospective study. American Journal on Addictions, 2024, 33 (5), pp.576-582. ⟨10.1111/ajad.13571⟩. ⟨hal-04686049⟩