Efficacy of disulfiram and Twelve Step Facilitation in cocaine-dependent individuals maintained on methadone: a randomized placebo-controlled trial.
BACKGROUND
Cocaine use remains a major problem within methadone maintenance programs. Disulfiram's efficacy in reducing cocaine use has been demonstrated in several trials, but its relative efficacy among individuals who use versus abstain from alcohol remains unclear. Treatment approaches which seek to enhance substance users' involvement in self-help activities (Twelve Step Facilitation, TSF) have been associated with better outcomes among alcohol and cocaine users, but have rarely been evaluated among methadone-maintained cocaine-opioid users.


METHODS
We conducted a randomized, placebo-controlled, double blind (for medication condition), factorial (2×2) trial with 4 treatment conditions: Disulfiram plus TSF, disulfiram plus standard counseling only, placebo plus TSF, and placebo plus standard counseling in the context of a community-based methadone maintenance program. Participants (N=112) received either disulfiram (250 mg/d) or placebo in conjunction with daily methadone maintenance.


RESULTS
Assignment to TSF was associated with less cocaine use throughout treatment and a higher number of cocaine-negative urines. While there were no significant main effects of disulfiram versus placebo, individuals without an alcohol use disorder demonstrated greater reductions in cocaine use over time when assigned to disulfiram.


CONCLUSIONS
TSF appears feasible in this methadone maintenance program and was associated with modest reductions in cocaine use, an often intractable problem in this setting. Support for the efficacy of disulfiram was weaker, as it appeared effective only for those without a current alcohol use disorder for this sample.
Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516, USA. kathleen.carroll@yale.edu
Kathleen M
KM
Carroll
Charla
C
Nich
Julia M
JM
Shi
Dorothy
D
Eagan
Samuel A
SA
Ball
D000328:Adult; D000427:Alcohol Deterrents / Q000009:adverse effects / Q000627:therapeutic use*; D000428:Alcohol Drinking / Q000188:drug therapy / Q000523:psychology; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D003376:Counseling; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004221:Disulfiram / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D010349:Patient Compliance; D012044:Regression Analysis; D012657:Self-Help Groups; D012959:Socioeconomic Factors; D015813:Substance Abuse Detection; D016896:Treatment Outcome
D000427:Alcohol Deterrents; D009294:Narcotics; D004221:Disulfiram; D008691:Methadone