title: A randomized factorial trial of disulfiram and contingency management to enhance cognitive behavioral therapy for cocaine dependence.
abstract: BACKGROUND
  This study evaluated the extent to which the addition of disulfiram and contingency management for adherence and abstinence (CM), alone and in combination, might enhance the effects of cognitive behavioral therapy (CBT) for cocaine use disorders.
  
  
  METHODS
  Factorial randomized double blind (for medication condition) clinical trial where CBT served as the platform and was delivered in weekly individual sessions in a community-based outpatient clinic. 99 outpatients who met DSM-IV criteria for current cocaine dependence were assigned to receive either disulfiram or placebo, and either CM or no CM. Cocaine and other substance use was assessed via a daily calendar with thrice weekly urine sample testing for 12 weeks with a one-year follow-up (80% interviewed at one year).
  
  
  RESULTS
  The primary hypothesis that CM and disulfiram would produce the best cocaine outcomes was not confirmed, nor was there a main effect for disulfiram. For the primary outcome (percent days of abstinence, self report), there was a significant interaction, with the best cocaine outcomes were seen for the combination of CM and placebo, with the two groups assigned to disulfiram associated with intermediate outcomes, and poorest cocaine outcome among those assigned to placebo and no CM. The secondary outcome (urinalysis) indicated a significant effect favoring CM over no CM but the interaction effect was not significant. One year follow-up data indicated sustained treatment effects across conditions.
  
  
  CONCLUSIONS
  CM enhances outcomes for CBT treatment of cocaine dependence, but disulfiram provided no added benefit to the combination of CM and CBT.
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, United States. Electronic address: Kathleen.carroll@yale.edu.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, United States.
authors.forename: Charla
authors.initials: C
authors.lastname: Nich
authors.affiliation: University of Connecticut Health Center, Calhoun Cardiology Center, United States.
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Petry
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, United States.
authors.forename: Dorothy A
authors.initials: DA
authors.lastname: Eagan
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, United States; The APT Foundation, United States.
authors.forename: Julia M
authors.initials: JM
authors.lastname: Shi
authors.affiliation: Yale University School of Medicine, Department of Psychiatry, United States; The APT Foundation, United States; The National Center for Alcohol and Substance Abuse (CASA), United States.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Ball
mesh_terms: D000328:Adult; D000427:Alcohol Deterrents / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004221:Disulfiram / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D057566:Self Report; D016896:Treatment Outcome
chemical_list: D000427:Alcohol Deterrents; D004221:Disulfiram
keywords: Cocaine dependence; Cognitive therapies; Contingency management; Disulfiram therapy; Randomized trial
references.citation: Arch Gen Psychiatry. 2005 Oct;62(10):1148-56
references.pmid: 16203960
references.citation: Addiction. 2006 Feb;101(2):192-203
references.pmid: 16445548
references.citation: J Clin Psychopharmacol. 2006 Jun;26(3):290-302
references.pmid: 16702894
references.citation: Drug Alcohol Depend. 2007 Mar 16;87(2-3):202-9
references.pmid: 16979847
references.citation: Drug Alcohol Depend. 2007 Apr 17;88(1):54-63
references.pmid: 17056206
references.citation: J Consult Clin Psychol. 2007 Aug;75(4):556-67
references.pmid: 17663610
references.citation: J Stud Alcohol. 2000 Jan;61(1):55-63
references.pmid: 10627097
references.citation: Drug Alcohol Depend. 2000 Jan 1;57(3):225-38
references.pmid: 10661673
references.citation: Drug Alcohol Depend. 2000 Feb 1;58(1-2):9-25
references.pmid: 10669051
references.citation: J Consult Clin Psychol. 2000 Feb;68(1):64-72
references.pmid: 10710841
references.citation: Addiction. 2000 Feb;95(2):219-28
references.pmid: 10723850
references.citation: J Consult Clin Psychol. 2000 Apr;68(2):250-7
references.pmid: 10780125
references.citation: Biol Psychiatry. 2000 Jun 15;47(12):1080-6
references.pmid: 10862808
references.citation: Addiction. 2000 Sep;95(9):1335-49
references.pmid: 11048353
references.citation: J Gen Intern Med. 2000 Dec;15(12):841-7
references.pmid: 11119180
references.citation: Am J Psychiatry. 2001 May;158(5):694-702
references.pmid: 11329388
references.citation: Arch Gen Psychiatry. 2001 Aug;58(8):755-61
references.pmid: 11483141
references.citation: Arch Gen Psychiatry. 2004 Mar;61(3):264-72
references.pmid: 14993114
references.citation: Drug Alcohol Depend. 2004 Aug 16;75(2):123-34
references.pmid: 15276217
references.citation: Control Clin Trials. 1984 Dec;5(4 Suppl):497-504
references.pmid: 6394211
references.citation: Schizophr Res. 1991 Dec;6(1):49-53
references.pmid: 1686184
references.citation: Alcohol Clin Exp Res. 1992 Dec;16(6):1035-41
references.pmid: 1471757
references.citation: Arch Gen Psychiatry. 1994 Mar;51(3):177-87
references.pmid: 8122955
references.citation: Drug Alcohol Depend. 1994 Apr;35(2):127-32
references.pmid: 8055734
references.citation: Arch Gen Psychiatry. 1994 Dec;51(12):989-97
references.pmid: 7979888
references.citation: J Stud Alcohol Suppl. 1994 Dec;12:70-5
references.pmid: 7723001
references.citation: Alcohol Clin Exp Res. 1996 Nov;20(8):1412-7
references.pmid: 8947318
references.citation: Addiction. 1997 Jun;92(6):717-27
references.pmid: 9246799
references.citation: J Consult Clin Psychol. 1998 Apr;66(2):290-303
references.pmid: 9583332
references.citation: Addiction. 1998 May;93(5):713-27
references.pmid: 9692270
references.citation: Biol Psychiatry. 1998 Aug 15;44(4):250-9
references.pmid: 9715356
references.citation: Am J Psychiatry. 2005 Aug;162(8):1452-60
references.pmid: 16055766
references.citation: J Consult Clin Psychol. 2007 Dec;75(6):983-91
references.pmid: 18085914
references.citation: Am J Psychiatry. 2008 Feb;165(2):179-87
references.pmid: 18198270
references.citation: Expert Opin Drug Saf. 2008 Jul;7(4):459-72
references.pmid: 18613809
references.citation: J Consult Clin Psychol. 2009 Oct;77(5):993-9
references.pmid: 19803579
references.citation: Drug Alcohol Depend. 2011 Jan 15;113(2-3):184-91
references.pmid: 20828943
references.citation: Drug Alcohol Depend. 2011 Dec 1;119(1-2):37-45
references.pmid: 21696894
references.citation: Addiction. 2012 Apr;107(4):694-708
references.pmid: 21781202
references.citation: Drug Alcohol Depend. 2014 Apr 1;137:3-19
references.pmid: 24556275
references.citation: Psychol Addict Behav. 2014 Mar;28(1):154-62
references.pmid: 23276315