Sex differences in cocaine-dependent individuals' response to disulfiram treatment

Yale University School of Medicine, VA Connecticut Health Care System, West Haven, USA.
Addictive Behaviors (Impact Factor: 2.76). 09/2004; 29(6):1123-8. DOI: 10.1016/j.addbeh.2004.03.004
Source: PubMed


The objective of this study is to evaluate differential response to disulfiram treatment of cocaine dependence by sex. Sex by treatment interactions from two pooled randomized clinical trials involving 191 cocaine-dependent subjects (36% female) were evaluated. Primary outcomes were days of abstinence and percentage of drug-free urine specimens. Significant sex by treatment interactions were found, where men treated with disulfiram had better outcomes than those who were not. Women had an intermediate outcome regardless of whether they received disulfiram. Sex differences in response to disulfiram treatment have important clinical and theoretical implications. Reasons for this apparent sex-based response are not clear, but possible mechanisms worthy of greater study include differences in alcohol use by sex as well as differences in dopamine-mediated responses to cocaine and disulfiram.

Download full-text


Available from: Kathleen Carroll,
8 Reads
  • Source
    • "There is also evidence that genotypes for ANKK1, DRD2, or both, may be used to identify cocaine users for whom disulfiram may be effective (Spellicy et al., 2013). The effectiveness of disulfiram may also be greater for men than for women (Nich et al., 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Treatment of psychostimulant addiction has been a major, and not fully met, challenge. For opioid addiction, there is strong evidence for the effectiveness of several medications. For psychostimulants, there is no corresponding form of agonist maintenance that has met criteria for regulatory approval or generally accepted use. Stimulant-use disorders remain prevalent and can result in both short-term and long-term adverse consequences. The mainstay of treatment remains behavioral interventions. In this paper, we discuss those interventions and some promising candidates in the search for pharmacological interventions.
    Neuropharmacology 04/2014; 87. DOI:10.1016/j.neuropharm.2014.04.002 · 5.11 Impact Factor
  • Source
    • "Several other randomized controlled trials showed the efficacy of DSF in treating cocaine dependence [202] [203] with significantly better outcomes in men than those found in women [204]. A recent meta-analysis [205] included seven studies of those reported in the literature, selected according to pre-established criteria. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Cocaine dependence is characterized by compulsive drug seeking and high vulnerability to relapse. Overall, cocaine remains one of the most used illicit drugs in the world. Given the difficulty of achieving sustained recovery, pharmacotherapy of cocaine addiction remains one of the most important clinical challenges. Recent advances in neurobiology, brain imaging and clinical trials suggest that certain medications show promise in the treatment of cocaine addiction. The pharmacotherapeutic approaches for cocaine dependence include medications able to target specific subtypes of dopamine receptors, affect different neurotransmitter systems (i.e. noradrenergic, serotonergic, cholinergic, glutamatergic, GABAergic and opioidergic pathways), and modulate neurological processes. The systematic reviews concerning the pharmacological treatment of cocaine dependence appear to indicate controversial findings and inconclusive results. The aim of future studies should be to identify the effective medications matching the specific needs of patients with specific characteristics, abandoning the strategies extended to the entire population of cocaine dependent patients. In the present review we summarize the current pharmacotherapeutic approaches to the treatment of cocaine dependence with a focus on the new patents.
    05/2011; 6(2):146-60. DOI:10.2174/157488911795933893
  • Source
    • "Accumulating data have suggested that men and women with alcohol or drug dependence can respond differently to the same pharmacological treatment, typically with men having better treatment outcomes than women (Garbutt et al., 2005; Hernandez-Avila et al., 2006; Nich et al., 2004; Pettinati, Dundon, & Lipkin, 2004). However, at least one naltrexone study has suggested that alcohol-dependent women treated with 50mg/day of naltrexone abstained from alcohol for a longer duration than men (Kiefer, Jahn, & Wiedemann, 2005). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This is a randomized, double-blind, placebo-controlled clinical trial that evaluated the efficacy of a higher-than-typical daily dose of naltrexone (150 mg/day), taken for 12 weeks, in 164 patients (n = 116 men and n = 48 women) with co-occurring cocaine and alcohol dependence. Patients were stratified by gender and then randomly assigned to either naltrexone or placebo, and to either cognitive-behavioral therapy or a type of medical management. The two primary outcomes were cocaine use and alcohol use. Significant Gender x Medication interactions were found for cocaine use via urine drug screens (three way, with time) and self-reports (two way) for drug severity (two way) and alcohol use (two way). The type of psychosocial treatment did not affect outcomes. Thus, 150 mg/day naltrexone added to a psychosocial treatment resulted in reductions in cocaine and alcohol use and drug severity in men, compared to higher rates of cocaine and alcohol use and drug severity in women.
    Journal of Substance Abuse Treatment 07/2008; 34(4):378-90. DOI:10.1016/j.jsat.2007.05.011 · 3.14 Impact Factor
Show more