A randomized factorial trial of disulfiram and contingency management to enhance cognitive behavioral therapy for cocaine dependence. (1st March 2016)

• Record Type: Journal Article
• Authors: Carroll, Kathleen M.; Nich, Charla; Petry, Nancy M.; Eagan, Dorothy A.; Shi, Julia M.; Ball, Samuel A.
• Is Part Of: Drug and alcohol dependence. Volume 160(2016)
• Page Start: 135
• Page End: 142
• Publication Date: 2016-03-01
• Subjects: Cocaine dependence -- Disulfiram therapy -- Contingency management -- Cognitive therapies -- Randomized trial; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2015.12.036
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Disulfiram and contingency management may improve cocaine treatment outcomes. In a sample of cocaine users, these treatments were evaluated alone and in combination. Adding contingency management (CM) to cognitive behavior therapy (CBT) improved cocaine outcomes both within treatment and through follow-up. The addition of disulfiram did not enhance the effects of CBT or CM in this sample. Abstract: Background: This study evaluated the extent to which the addition of disulfiram and contingency management for adherence and abstinence (CM), alone and in combination, might enhance the effects of cognitive behavioral therapy (CBT) for cocaine use disorders. Methods: Factorial randomized double blind (for medication condition) clinical trial where CBT served as the platform and was delivered in weekly individual sessions in a community-based outpatient clinic. 99 outpatients who met DSM-IV criteria for current cocaine dependence were assigned to receive either disulfiram or placebo, and either CM or no CM. Cocaine and other substance use was assessed via a daily calendar with thrice weekly urine sample testing for 12 weeks with a one-year follow-up (80% interviewed at one year). Results: The primary hypothesis that CM and disulfiram would produce the best cocaine outcomes was not confirmed, nor was there a main effect for disulfiram. For the primary outcome (percent days of abstinence, self report), there was a significant interaction, with the best cocaine outcomes were seen for the combination of CM and placebo, with the two groups assigned to disulfiram associated with intermediate outcomes, and poorest cocaine outcome among those assigned to placebo and no CM. The secondary outcome (urinalysis) indicated a significant effect favoring CM over no CM but the interaction effect was not significant. One year follow-up data indicated sustained treatment effects across conditions. Conclusions: CM enhances outcomes for CBT treatment of cocaine dependence, but disulfiram provided no added benefit to the combination of CM and CBT.