Desipramine treatment for cocaine dependence. Role of antisocial personality disorder.
As a test of the efficacy of desipramine (DMI) in the treatment of cocaine dependence, 59 cocaine-dependent males, maintained on methadone for the treatment of opiate dependence, completed a 12-week, random-assignment, placebo-controlled trial of this medication. At the end of treatment, there were no overall differences between the placebo and DMI groups on a range of outcome measures, including urine toxicology tests. However, an interaction between psychiatric diagnosis and outcome was seen when the sample was divided into those with (51%) and those without (49%) antisocial personality disorder (ASP). Patients with ASP made few gains with either DMI or placebo. Those without ASP made a number of gains with DMI but not placebo, particularly in the areas of psychiatric symptoms, legal status, and family problems. DMI had a significant effect on the psychiatric symptoms and personal adjustment problems, but not the cocaine use, of non-antisocial cocaine abusers. The negative influence of ASP that has been seen in studies of psychosocial therapies for substance-use disorders may also apply to pharmacological therapies.
Arndt
I O
IO
University of Pennsylvania School of Medicine, Philadelphia.
McLellan
A T
AT
Dorozynsky
L
L
Woody
G E
GE
O'Brien
C P
CP
D000328:Adult; D000987:Antisocial Personality Disorder / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D003042:Cocaine; D015897:Comorbidity; D003891:Desipramine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000534:rehabilitation; D010555:Personality Inventory; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000534:rehabilitation; D016896:Treatment Outcome
D010919:Placebos; D003042:Cocaine; D003891:Desipramine; D008691:Methadone