Disulfiram and cognitive behavioral therapy appear effective for treating cocaine dependence

Disulfiram (a drug used to help selected patients with alcohol disorders remain sober) and cognitive behavioral therapy appear effective in reducing cocaine use, especially among cocaine users who are not dependent on alcohol, according to an article in the March issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.

Patients taking disulfiram who ingest even small amounts of alcohol develop a reaction that produces nausea, flushing, vomiting, and throbbing headache. At times, this reaction can be severe and can lead to critical illness, such as severe respiratory problems, circulatory problems, or even death. According to the article, alcohol is a powerful “cue” for using cocaine, and can impair judgment and lower resistance to cravings for cocaine. Researchers hypothesize that by reducing alcohol use with disulfiram, users might be less likely to abuse cocaine. However, use of disulfiram has not been evaluated in general populations of cocaine users.

Kathleen M. Carroll, Ph.D., from Yale University School of Medicine, New Haven, Conn., and colleagues randomly assigned 121 cocaine-dependent adults (average age, 34.6 years) to receive either disulfiram or placebo over a 12-week period. Participants were also randomized to participate in either cognitive behavioral therapy (CBT) or interpersonal psychotherapy (IPT, a less structured form of behavioral therapy).

“Participants assigned to disulfiram reduced their cocaine use significantly more than those assigned to placebo, and those assigned to CBT reduced their cocaine use significantly more than those assigned to IPT,” the authors found. The benefits of disulfiram and CBT were most pronounced in participants who were not alcohol-dependent and who did not drink during the study.

The authors write, “This is the first placebo-controlled trial, to our knowledge, to demonstrate that disulfiram therapy is effective in nonalcoholic cocaine-dependent outpatients. Moreover, these findings suggest that disulfiram therapy is especially effective for nonalcoholic cocaine users, as the effects of disulfiram treatment were most pronounced in participants who did not meet the criteria for current alcohol abuse or dependence and in those who abstained from alcohol during the trial.”

(Arch Gen Psychiatry. 2004;61:264-272. Available post-embargo at archgenpsychiatry.com)
Editor’s Note: This study was supported by grants from the National Institute on Drug Abuse, Bethesda, Md.

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .

To contact Kathleen M. Carroll, Ph.D., call Jacqueline Weaver at 203-432-8555.