title: Modafinil and sleep architecture in an inpatient-outpatient treatment study of cocaine dependence.
abstract: OBJECTIVE
  To determine whether the increase in slow-wave sleep associated with modafinil treatment in chronic cocaine users mediates improved clinical outcomes.
  
  
  METHODS
  57 cocaine dependent participants were randomized to receive modafinil 400mg or placebo daily during a period of inpatient treatment followed by six weeks of outpatient treatment. Participants underwent polysomnographic sleep recording during inpatient treatment prior to and after starting modafinil. Outpatient treatment consisted of weekly cognitive behavioral therapy. Contingency management was used to promote participation in treatment and research demands, including thrice weekly visits during the outpatient phase for urine toxicology screens and other assessments. The primary clinical outcome was the percent of urine toxicology screens that were negative for cocaine.
  
  
  RESULTS
  Modafinil treatment was associated with a higher mean percentage (52% vs. 26%) of cocaine-free urine screens (p=0.02) and an increase in N3 sleep time (p=0.002). The change in N3 sleep time mediated the higher rate of cocaine-free urine screens. Modafinil treatment was also associated with more consecutive days abstinent during outpatient treatment, greater survival of abstinence, higher daily rates of abstinence, and less sleep degradation typically associated with abstinence from chronic cocaine use.
  
  
  CONCLUSIONS
  Morning-dosed modafinil improves slow-wave sleep in abstinent cocaine users in the inpatient setting, and this effect is a statistical mediator of improved clinical outcomes associated with continued modafinil treatment. The high rates of abstinence achieved in this trial suggest that promoting healthy sleep physiology in an inpatient setting may be important in the effective treatment of cocaine dependence.
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States. Electronic address: peter.morgan@yale.edu.
authors.forename: Peter T
authors.initials: PT
authors.lastname: Morgan
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Gustavo A
authors.initials: GA
authors.lastname: Angarita
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Sofija
authors.initials: S
authors.lastname: Canavan
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Brian
authors.initials: B
authors.lastname: Pittman
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Oberleitner
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Malison
authors.affiliation: Section of Pulmonary, Critical Care and Sleep Medicine, Yale Center for Sleep Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06520, United States.
authors.forename: Vahid
authors.initials: V
authors.lastname: Mohsenin
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hodges
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Caroline
authors.initials: C
authors.lastname: Easton
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Sherry
authors.initials: S
authors.lastname: McKee
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bessette
authors.affiliation: Connecticut Mental Health Center, Yale University Department of Psychiatry, 34 Park Street, New Haven, CT 06519, United States.
authors.forename: Erica
authors.initials: E
authors.lastname: Forselius
mesh_terms: D000328:Adult; D001559:Benzhydryl Compounds / Q000494:pharmacology / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000188:drug therapy* / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D000077408:Modafinil; D010045:Outpatients; D012890:Sleep / Q000187:drug effects; D012893:Sleep Wake Disorders / Q000150:complications* / Q000188:drug therapy*; D016896:Treatment Outcome; D064690:Wakefulness-Promoting Agents / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D001559:Benzhydryl Compounds; D064690:Wakefulness-Promoting Agents; D000077408:Modafinil
keywords: Cocaine; Modafinil; Sleep; Slow-wave sleep; Treatment