International Journal of Drug Policy 11 (2000) 203 – 215 Review Cocaine misuse treatment in England Nicholas Seivewright a, *, Michael Donmall b , Julie Douglas b , Tamara Draycott a , Tim Millar b a Substance Misuse Serice, Community Health Sheffield NHS Trust, Norfolk House, 4 Norfolk St., Sheffield S12JB, UK b Uniersity of Manchester Drug Misuse Research Unit, Manchester, UK Received in revised form 24 November 1999; accepted 20 February 2000 Abstract Three methods were used to identify the treatments given to cocaine misusers in England, and to make a preliminary assessment of effectiveness. First, a postal survey of all known drug misuse treatment services ascertained approximate numbers of cocaine misusers presenting and receiving a specified range of treatments. Secondly, staff at selected services were interviewed regarding treatment policies, and asked to subjectively rate short-term and long-term effectiveness. Thirdly, a cohort of individuals in treatment were studied prospectively to assess changes in drug usage and associated problems. Fifty percent of services responded to the survey, but there was known to be significant duplication in service listings and it is considered that a representative pattern of clinical activity has been detected. Approximately half those services had recently treated cocaine misusers, mainly using counselling, residential rehabilitation, and pharmacological treatments, in which 32 different medications were identified. Acupuncture was prominent in a minority of services. Staff interviews suggested several principles in managing cocaine misusers, while all treatments were rated as being more effective in short-term relief of withdrawal features than in enabling longer-term abstinence. The treatment cohort were mostly in residential rehabilitation, and marked reductions in drug use and related clinical and social problems were demonstrated. © 2000 Elsevier Science B.V. All rights reserved. Keywords: Cocaine misuse; Treatments; Effectiveness www.elsevier.com/locate/drugpo 1. Introduction Most literature on cocaine misuse is from the USA, where this form of drug-taking has occurred on a large scale, peaking in the mid-1980s (National Institute of Drug Abuse, 1985). Major concerns have derived from not only the extent of usage, but also the transi- tion from use of cocaine hydrochloride pow- der to the ‘crack’ form, which is more potent in its effects and withdrawal effects, and is * Corresponding author. Tel.: +44-114-2716802; fax: +44- 114-2716814. 0955-3959/00/$ - see front matter © 2000 Elsevier Science B.V. All rights reserved. PII:S0955-3959(00)00045-1