Treatment of Hardcore Cocaine Users

Pursuant to a congressional request, GAO provided information on the effectiveness of drug treatment for hardcore cocaine users, focusing on the: (1) types of clients categorized as hardcore users; and (2) results of recent national cocaine treatment outcome studies (CTOS). GAO noted that: (1) there is no consensus on or clinical acceptance of the term hardcore user and current diagnostic manuals do not make reference to the term; (2) the working definition of a hardcore user is an individual reporting using cocaine weekly or more often in the year before treatment; and (3) CTOS results indicate that hardcore cocaine users are making sizable gains in reducing their drug use and arrests and in improving their health and employment status. In addition, GAO noted that preliminary CTOS findings do not provide an adequate basis for making conclusions about the success of hardcore cocaine treatment, since: (1) discrepancies exist between self-reported drug use and urine test results; (2) clinical trials do not support the high rates of continuous abstinence found in CTOS at 12-month followups; (3) drug treatment experts believe that hardcore users underreport cocaine use in the year following treatment; and (4) inaccurate recall over a 2-year period is problematic, making before and after treatment comparisons unreliable.