Prognostic factors of a multidisciplinary rtms-based treatment for cocaine use disorder: A large cohort study

Abstract

Introduction

This study investigated psychological and clinical factors influencing treatment outcomes for Cocaine Use Disorder (CocUD) patients undergoing a multidisciplinary approach, including repetitive Transcranial Magnetic Stimulation (rTMS), addiction counseling, pharmacological treatment, and psychotherapeutic support. Multidisciplinary treatments appear to be more effective than stand-alone programs in addiction recovery.

Methods

This is a retrospective observational study of 1011 patients meeting DSM-5 criteria for CocUD undergoing a multidisciplinary treatment rTMS-based. The primary outcomes were (1) the time to the first lapse, (2) the time to dropout from the program, and (3) the monthly cocaine use pattern for up to one year since clinical admission. The secondary indices were the variations in the withdrawal symptoms. The influence of various factors on the time to first lapse and treatment dropout was analyzed using multivariate Cox proportional hazard models, which helps understand how different factors influence the time until an event, such as relapse or dropout, occurs. Concerning cocaine use patterns and secondary outcomes, linear mixed models were applied.

Results

Protective factors comprise personal initiative in seeking treatment, starting with inpatient care, a higher number of high frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC), and referral to psychotherapy. In contrast, risk factors were psychiatric comorbidity (e.g., personality disorder, other addictions, alcohol use disorder), craving intensity, last use before treatment admission, and number of pharmacological prescriptions. Moreover, an increase in the number of high frequency rTMS over the left DLPFC sessions was a significant predictor of the reduction of severity on self-reported measures of psychiatric symptoms.

Conclusions

Personal initiative in seeking treatment and psychotherapy emerged as protective factors along with high frequency rTMS over the left DLPFC in determining positive outcomes, including a reduction in the severity of co-occurring psychiatric CocUD symptoms, underlining the benefit of a multidimensional approach to treating CocUD.