Compulsive sexual behavior in cocaine use disorder: Treatment outcomes and clinical challenges

BACKGROUND: Emotion regulation (ER) difficulties, overall psychopathological burden and poor impulse control may explain the comorbidity between compulsive sexual behavior (CSB) and cocaine use disorder (CUD). Although some studies have assessed the prevalence of CSB in CUD patients, more data are needed to better understand their relationship. This study first examined whether ER difficulties at treatment entry for CUD predict CSB after outpatient treatment. Second, it explored whether CSB and psychopathological burden are associated with worse treatment outcomes after inpatient and outpatient treatment in CUD patients. METHODS: Seventy participants entered a 14-day inpatient detoxification treatment followed by an 8-week outpatient treatment. At entry, cocaine use, psychopathology, CSB, ER, and personality traits were assessed. These measures were administered again after the inpatient and outpatient programs. RESULTS: At baseline, participants screening positive for CSB had fewer years of cocaine use, higher psychopathology, more depressive symptoms, greater impulsivity, reward sensitivity, and ER difficulties than those without CSB. Impulse control difficulties, limited access to ER strategies, and low emotional awareness at hospital admission predicted probable CSB after outpatient treatment. Probable CSB at treatment entry predicted dropout after inpatient treatment but did not predict dropout or relapse following outpatient treatment. Psychopathological burden did not predict any treatment outcomes. DISCUSSION: These findings suggest that comorbid CUD and probable CSB may lead to poorer treatment outcomes after inpatient detoxification. Screening for CSB and ER deficits at treatment entry may prevent the development of CSB, limiting the likelihood of poor outcomes and enhancing the psychotherapeutic management of CUD.