Comparison of most effective strategies among cocaine-dependent patients

At a community-based, outpatient, substance abuse treatment program, 121 patients meeting the criteria for current cocaine dependence were randomly assigned to four treatment conditions: disulfiram (Antabuse) plus CBT, disulfiram plus IPT, placebo plus CBT, and placebo plus IPT.

Patients received either disulfiram (250 mg/d) or placebo in identical capsules. Medication compliance was monitored using a riboflavin marker procedure. Both behavioral therapies (CBT and IPT) were manual-guided and were delivered in individual sessions for 12 weeks. Outcomes were measured through random regression analyses of self-reported frequency of cocaine use and results of urine toxicology screens.

The study found that participants assigned to disulfiram reduced their cocaine use significantly more than those assigned to placebo, and those assigned to CBT reduced their cocaine use significantly more than those assigned to IPT (P<.01 for both). Findings were consistent across all study samples (eg, intention to treat, treatment initiators, and treatment completers).

Benefits of disulfiram use and CBT were most pronounced in participants who were not alcohol dependent at baseline or who fully abstained from drinking alcohol during treatment. Adverse effects experienced by participants who received disulfiram were mild and were not considerably different from those experienced by participants who received placebo.

The study concludes that Disulfiram and CBT are effective therapies for general populations of cocaine-dependent individuals. Disulfiram seems to exert a direct effect on cocaine use rather than through reducing concurrent alcohol use.

Citation: Carroll KM, Fenton LR, Ball SA, Nich C, Frankforter TL, Shi J, Rounsaville BJ. Efficacy of disulfiram and cognitive behavior therapy in cocaine-dependent outpatients: a randomized placebo-controlled trial. Arch Gen Psychiatry. 2004 Mar;61(3):264-72. kathleen.carroll@yale.edu