Medications for Stopping Cocaine Dependence and Preventing Relapse
Condition: Cocaine Abuse; Cocaine-Related Disorders
MeSH terms: Recurrence; Cocaine-Related Disorders
Study type: Interventional
Phase: Phase 2

Summary: 
      Cocaine dependence is a major public health problem; an effective primary treatment for
      cocaine dependent individuals has yet to be found. The purpose of this study is to identify
      subpopulations and baseline conditions that are most responsive to treatment for cocaine
      dependent individuals.
    

Detailed description: 
      Cocaine is a strong central nervous system stimulant that is widely abused throughout the
      United Sates. Due to its widespread use, it is important to develop an effective treatment
      for cocaine dependence. Motivational Interviewing (MI) is often effective when combined with
      drug treatment. Baseline condition (e.g., abstinence status) and population type (e.g.,
      ethnicity and gender) often affect how an individual responds to treatment for drug
      dependence. The purpose of this study is to determine the influence of baseline status and
      population type on treatment response in cocaine dependent individuals. In addition, this
      study will examine how various cocaine abuse medications target different neuronal systems,
      withdrawal symptoms, and relapse to drug use.

      This study will take place in two phases. Phase I will last 4 weeks; participants will
      receive MI and undergo contingency-based urine tests in order to achieve the desired baseline
      condition. Phase II will last 12 weeks. Participants in Phase II will be randomly assigned to
      receive one of four treatments: 1) 50 mg naltrexone, 2) 800/200 mg levodopa/carbidopa, 3) 400
      mg modafinil, or 4) placebo. During Phase II, all participants will receive psychotherapy and
      contingency management. Participants will complete urine drug screening tests 3 times each
      week. Follow-up study visits will occur between 3 and 6 months following Week 12, and will
      include objective and self-reported drug use.
    

Intervention name(s): Modafinil; Levodopa/Carbidopa; Naltrexone HCl; Placebo; Motivational Interviewing (MI); Contingency management (CM); Cognitive-Behavioral Therapy (CBT)
Intervention type(s): Drug; Drug; Drug; Drug; Behavioral; Behavioral; Behavioral
Intervention description(s): The modafinil dose began at 200 mg (day 1) and increased to the fixed dose of 200 mg twice daily (day 2) during the 12 weeks of Phase I.; Levodopa-carbidopa, in the sustained-release formulation (Sinemet CR), began at a dose of levodopa/carbidopa 400/100 mg (day 1) and increased to the fixed dose of 400/100 mg twice daily (day 2) during the 12 weeks of Phase I.; Naltrexone hydrochloride (HCl) doses began at 25 mg (day 1) and increased to the fixed dose of 25 mg twice daily (day 2) during the 12 weeks of Phase I.; Placebo capsules were identical in appearance to active drug capsules, and each contained 50 mg riboflavin for subsequent evaluation of medication compliance.; The primary goal of motivational interviewing (MI) was to assist patients in achieving initial abstinence by increasing motivation and commitment to change. The MI intervention consisted of two 1-h individual therapy sessions on the first and eighth day of Phase I. The client-centered, MI-style sessions focused on building motivation for change, exploring ambivalence, obtaining a commitment to change, making a plan for abstinence (Session 1), providing personalized feedback, reassessing commitment for change, and reevaluating the change plan (Session 2). Masters-level therapists were trained and supervised by the therapy supervisor (ALS), an expert in motivation-based therapies.; Contingency management (CM) is a voucher-based intervention. Subjects earned vouchers for cocaine abstinence (during phase I) and medication compliance (during phase II).; Subjects received weekly, 1-h, individual Cognitive-Behavioral Therapy (CBT) sessions during Phase II. This therapy component focused on coping-skills training for resisting cocaine use in high-risk situations, based on relapse-prevention theory and manual-guided techniques. Therapy sessions were conducted by master's-level licensed professional counselors supervised by a licensed clinical psychologist, who monitored manual adherence and competency.
Other intervention name(s): Provigil; Simemet CR; Naltrexon hydrochloride
Intervention MeSH terms: Naltrexone; Levodopa; Carbidopa; Modafinil
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: cocaine; cocaine addiction; cocaine abuse; relapse prevention