One-year follow-up of disulfiram and psychotherapy for cocaine-alcohol users: sustained effects of treatment

Department of Psychiatry, Yale University School of Medicine, USA.
Addiction (Impact Factor: 4.6). 10/2000; 95(9):1335-49. DOI: 10.1046/j.1360-0443.2000.95913355.x
Source: PubMed

ABSTRACT To evaluate outcomes 1 year after cessation of treatment for cocaine- and alcohol-dependent individuals.
Randomized controlled trial.
Urban substance abuse treatment center.
Ninety-six of 122 subjects randomized to treatment.
One of five treatments delivered over 12 weeks. Cognitive-behavioral treatment (CBT) plus disulfiram; Twelve-Step facilitation (TSF) plus disulfiram; clinical management (CM) plus disulfiram; CBT without disulfiram; TSF without disulfiram.
Percentage of days of cocaine and alcohol use during follow-up, verified by urine toxicology screens and breathalyzer tests.
First, as a group, participants reported significant decreases in frequency of cocaine, but not alcohol, use after the end of treatment. Secondly, the main effects of disulfiram on cocaine and alcohol use were sustained during follow-up. Finally, initiation of abstinence for even brief periods of time within treatment was associated with significantly better outcome during follow-up.
These findings support the efficacy of disulfiram with this challenging population and suggest that comparatively brief treatments that facilitate the initiation of abstinence may have long-term benefits.

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    • "Disulfiram at daily doses of 250–500 mg appears to improve treatment retention and duration of abstinence from both alcohol and cocaine (Carroll et al., 1998) (Ib) with a sustained response at 12 months for cocaine, but not alcohol (Carroll et al., 2000) (Ib). The effect of disulfiram on reducing cocaine is independent of its effect on alcohol consumption, although those that did best stopped or reduced their drinking. "
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    • "Because 50–90% of patients who abuse cocaine also abuse alcohol (Weiss et al, 1988; Grant and Harford, 1990; Closser and Kosten, 1992; Khalsa et al, 1992), the belief was that discouraging alcohol consumption in cocaine-and alcoholdependent individuals might lower cocaine use. Indeed, disulfiram was found to reduce alcohol and cocaine intake in this patient population (Carroll et al, 1993, 1998, 2000). Surprisingly, further studies revealed that disulfiram is at least as effective at treating cocaine addicts who do not consume alcohol, and may even be more effective (George et al, 2000; Petrakis et al, 2000; Carroll et al, 2004). "
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    • "Additionally, touching bases with the patient regarding the utilization of skills obtained through cognitive behavioral therapy might help in ongoing clinical assessments and serve as a reminder to the patient about their use over time. Long-term benefits of cognitive behavioral therapy, including a " sleeper " effect (Carroll et al., 2000), have been reported in the treatment of drug dependence, and the extent to which similar long-term positive influences are associated with cognitive behavioral therapy in the treatment of PG warrants further investigation. "
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