title: Psychotherapy and pharmacotherapy for ambulatory cocaine abusers.
abstract: BACKGROUND
  At present, there is no consensus regarding effective treatment for cocaine abuse or the most productive roles for the two major forms of treatment, pharmacotherapy and psychotherapy. We conducted the first randomized clinical trial evaluating psychotherapy and pharmacotherapy, alone and in combination, as treatment for ambulatory cocaine abusers.
  
  
  METHODS
  One hundred thirty-nine subjects were assigned to one of four conditions offered over a 12-week abstinence initiation trial: relapse prevention plus desipramine hydrochloride, clinical management plus desipramine, relapse prevention plus placebo, and clinical management plus placebo. All treatments were manual-guided, delivered by experienced therapists, and monitored to promote the integrity of both forms of treatment.
  
  
  RESULTS
  First, although all groups showed significant improvement, significant main effects for medication or psychotherapy, or their combination, were not found for treatment retention, reduction in cocaine use, or other outcomes at 12 weeks. Second, baseline severity of cocaine use interacted differently with psychotherapy and pharmacotherapy: higher-severity patients had significantly better outcome when treated with relapse prevention than with clinical management, while desipramine was associated with improved abstinence initiation among lower-severity subjects. Third, desipramine was significantly more effective than placebo in reducing cocaine use over 6, but not 12, weeks of treatment. Fourth, depressed subjects had greater reduction in cocaine use than nondepressed subjects and had better response to relapse prevention than to clinical management.
  
  
  CONCLUSIONS
  These findings underscore the significance of heterogeneity among cocaine abusers and the need to develop specialized treatments for clinically distinct subgroups of cocaine abusers.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine.
authors.forename: K M
authors.initials: KM
authors.lastname: Carroll
authors.forename: B J
authors.initials: BJ
authors.lastname: Rounsaville
authors.forename: L T
authors.initials: LT
authors.lastname: Gordon
authors.forename: C
authors.initials: C
authors.lastname: Nich
authors.forename: P
authors.initials: P
authors.lastname: Jatlow
authors.forename: R M
authors.initials: RM
authors.lastname: Bisighini
authors.forename: F H
authors.initials: FH
authors.lastname: Gawin
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000704:Analysis of Variance; D003042:Cocaine; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000150:complications / Q000188:drug therapy / Q000628:therapy; D003891:Desipramine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D010919:Placebos; D011613:Psychotherapy; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D010919:Placebos; D003042:Cocaine; D003891:Desipramine