Disulfiram has emerged as a promising treatment for cocaine dependence,
but it has not yet been evaluated in general populations of cocaine users.
To compare the effectiveness of disulfiram therapy with that of a placebo
condition in reducing cocaine use and to compare the effectiveness of 2 active
behavioral therapies—cognitive behavior therapy (CBT) and interpersonal
psychotherapy (IPT)—in reducing cocaine use.
Randomized, placebo-controlled, double-masked (for medication condition),
factorial (2 × 2) trial with 4 treatment conditions: disulfiram plus
CBT, disulfiram plus IPT, placebo plus CBT, and placebo plus IPT.
A community-based outpatient substance abuse treatment program.
A total of 121 individuals meeting the criteria for current cocaine
Patients received either disulfiram (250 mg/d) or placebo in identical
capsules. Medication compliance was monitored using a riboflavin marker procedure.
Both behavioral therapies (CBT and IPT) were manual guided and were delivered
in individual sessions for 12 weeks.
Main Outcome Measures
Random regression analyses of self-reported frequency of cocaine use
and results of urine toxicology screens.
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 (P<.01 for both). Findings were consistent across all study samples
(eg, intention to treat, treatment initiators, and treatment completers).
Benefits of disulfiram use and CBT were most pronounced for participants who
were not alcohol dependent at baseline or who fully abstained from drinking
alcohol during treatment. Adverse effects experienced by participants who
received disulfiram were mild and were not considerably different from those
experienced by participants who received placebo.
Disulfiram and CBT are effective therapies for general populations of
cocaine-dependent individuals. Disulfiram seems to exert a direct effect on
cocaine use rather than through reducing concurrent alcohol use.