Psychotherapy and Pharmacotherapy for Ambulatory Cocaine Abusers

Carroll, Kathleen M.; Rounsaville, Bruce J.; Gordon, Lynn T.; Nich, Charla; Jatlow, Peter; Bisighini, Roseann M.; Gawin, Frank H.

doi:10.1001/archpsyc.1994.03950030013002

Cited by 326 publications

(188 citation statements)

References 26 publications

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“…The latter measure has been used in a number of studies because it is thought to represent a primary goal of short-term treatment, which is to get patients to achieve a stable period of continuous abstinence. Abstinence from cocaine for approximately 3-4 consecutive weeks was been shown to be predictive of long-term cocaine abstinence (Carroll, Rounsaville, Gordon, Nich et al, 1994;Kosten, Morgan, Falcione, & Schottenfeld, 1992). We, therefore, evaluated the proportion of patients in each of the four treatment groups (DISULF, NTX, DISULF + NTX, PLAC) that were able to attain 3 consecutive weeks of abstinence from both cocaine and alcohol while in treatment.…”

Section: 22mentioning

confidence: 99%

A double blind, placebo-controlled trial that combines disulfiram and naltrexone for treating co-occurring cocaine and alcohol dependence

Pettinati

Kampman

Lynch

et al. 2008

Addictive Behaviors

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BACKGROUND-This is a double blind, placebo-controlled trial that evaluated the efficacy of disulfiram, naltrexone and their combination in patients with co-occurring cocaine and alcohol dependence.METHODS-208 patients were randomized to disulfiram (250mg/day), naltrexone (100mg/day), the combination, or placebo for 11 weeks. Outcomes were in-trial abstinence from cocaine and/or alcohol.RESULTS-Few safety concerns were reported, although medication adherence was low in a number of patients for both medications, alone or in combination. In the primary analyses (GEE modeling), abstinence from cocaine as measured by cocaine-negative urines and days of self-reported abstinence from cocaine or alcohol did not differ between placebo and any of the medication groups. However, patients taking disulfiram (alone or in combination) were most likely to achieve combined abstinence from cocaine and alcohol. Secondary analyses revealed that patients taking the disulfiramnaltrexone combination were most likely to achieve 3 consecutive weeks of abstinence from cocaine and alcohol.CONCLUSION-There was an association between disulfiram treatment and abstinence from cocaine and alcohol. More patients taking the disulfiram-naltrexone combination achieved 3 consecutive weeks of abstinence in treatment than placebo-treated patients.

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Section: 22mentioning

confidence: 99%

A double blind, placebo-controlled trial that combines disulfiram and naltrexone for treating co-occurring cocaine and alcohol dependence

Pettinati

Kampman

Lynch

et al. 2008

Addictive Behaviors

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“…All participants attended weekly individual cognitive behavioral relapse prevention therapy (Carroll et al 1994), delivered by masters and doctoral level psychologists. The therapy was manual-guided (Carroll et al 1994), and sessions were audiotaped and reviewed during supervision with a senior clinical psychologist to insure fidelity to the treatment manual. Every week to two weeks, patients met with a research psychiatrist to review overall progress in treatment and to adjust medication.…”

Section: Study Proceduresmentioning

confidence: 99%

“…Depressed patients may respond well to the supportive milieu of a clinic. Further, the cognitive-behavioral relapse prevention therapy, received by the patients studied here (Carroll et al 1994), addresses symptoms of depression through modules on coping with dysphoric moods and their role in drug relapse, and this would likely help maintain treatment engagement for such patients.…”

Section: Effect Of Co-occurring Disorders On Treatment Retentionmentioning

confidence: 99%

Effects of major depressive disorder and attention-deficit/hyperactivity disorder on the outcome of treatment for cocaine dependence

Levin¹,

Bisaga²,

Raby³

et al. 2008

Journal of Substance Abuse Treatment

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Co-occurring psychiatric disorders have been associated with poor prognosis among substance dependent patients, but few studies have examined this association among patients with cocaine dependence (CD). Baseline characteristics and treatment outcome were compared between cocainedependent patients with major depression (MDD) (N = 66), attention-deficit/hyperactivity disorder (ADHD) (N = 53), or cocaine dependence without comorbid disorders (CD alone) (N = 48), who had been randomized to the placebo arms of clinical trials of venlafaxine, methylphenidate, and gabapentin, respectively. The three groups differed significantly in racial makeup, with more Caucasians and Hispanics among patients with MDD or ADHD, and more African Americans among those with CD alone. The groups did not differ significantly in treatment retention, with retention rates ranging from 42-47%, or in the rates of achieving 2 consecutive weeks of urine-confirmed abstinence, with rates ranging from 40-50%. Using logistic regression for repeated measures with general estimating equations, modeling the likelihood of a cocaine positive week over time in treatment, diagnostic group was found to interact with the baseline level of cocaine use and time. Among cocaine dependent patients who achieved abstinence at baseline, the groups with MDD or ADHD had better outcome over time than those with CD alone. However, among patients with cocaine positive urines at baseline, MDD or ADHD were associated with poor outcome compared to patients with CD alone. The findings suggest that diagnosis and treatment of co-occurring disorders such as depression and ADHD may be an important component of treatment planning for cocaine dependence, and that baseline level of cocaine use should be included as a covariate in studies evaluating the impact of such treatment.

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“…Trials that combine pharmacologic treatments with psychotherapy report dropout rates of 30-40% (Carroll et al, 1994;Elkashef et al, 2005). Variables related to treatment dropout include a number of demographic and socioeconomic factors such as low education, African-American ethnicity, female gender, reporting cocaine as the drug of choice, younger age of subjects, current unemployment, high level of cocaine use during the lead-in period, history of arrests, longer drug use histories, abstinence symptoms, and previous treatment enrollment (Alterman et al, 1996;Siqueland et al, 1998;Mulvaney et al, 1999;King and Canada, 2004;Bisaga et al, 2005).…”

Section: Introductionmentioning

confidence: 99%

Performance on the Stroop Predicts Treatment Compliance in Cocaine-Dependent Individuals

Streeter

Terhune

Whitfield

et al. 2007

Neuropsychopharmacol

170

128

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Treatment dropout is a problem of great prevalence and stands as an obstacle to recovery in cocaine-dependent (CD) individuals. Treatment attrition in CD individuals may result from impairments in cognitive control, which can be reliably measured by the Stroop color-word interference task. The present analyses contrasted baseline performance on the color-naming, word-reading, and interference subtests of the Stroop task in CD subjects who completed a cocaine treatment trial (completers: N ¼ 50) and those who dropped out of the trial before completion (non-completers: N ¼ 24). A logistic regression analysis was used to predict trial completion using three models with the following variables: the Stroop task subscale scores (Stroop model); the Hamilton depression rating scale (HDRS) scores (HDRS model); and both the Stroop task subscale scores and HDRS scores (Stroop and HDRS model). Each model was able to significantly predict group membership (completers vs non-completers) better than a model based on a simple constant (HDRS model p ¼ 0.02, Stroop model p ¼ 0.006, and Stroop and HDRS model p ¼ 0.003). Models using the Stroop preformed better than the HDRS model. These findings suggest that the Stroop task can be used to identify cocaine-dependent subjects at risk for treatment dropout. The Stroop task is a widely available, reliable, and valid instrument that can be easily employed to identify and tailor interventions of at risk individuals in the hope of improving treatment compliance.

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Psychotherapy and Pharmacotherapy for Ambulatory Cocaine Abusers

Abstract: These findings underscore the significance of heterogeneity among cocaine abusers and the need to develop specialized treatments for clinically distinct subgroups of cocaine abusers.

Cited by 326 publications

References 26 publications

A double blind, placebo-controlled trial that combines disulfiram and naltrexone for treating co-occurring cocaine and alcohol dependence

A double blind, placebo-controlled trial that combines disulfiram and naltrexone for treating co-occurring cocaine and alcohol dependence

Effects of major depressive disorder and attention-deficit/hyperactivity disorder on the outcome of treatment for cocaine dependence

Performance on the Stroop Predicts Treatment Compliance in Cocaine-Dependent Individuals

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