Elsevier

Addictive Behaviors

Volume 26, Issue 2, March–April 2001, Pages 167-180
Addictive Behaviors

Original article
Naltrexone and relapse prevention treatment for cocaine-dependent patients

https://doi.org/10.1016/S0306-4603(00)00098-8Get rights and content

Abstract

A double-blind, placebo-controlled clinical trial examining the joint action of naltrexone (NTX) in combination with relapse prevention (RP) therapy for the treatment of cocaine dependence was conducted. Eighty-five participants who achieved initial abstinence during the intake evaluation and detoxification phase of the study were randomized into 1 of 4 combined NTX (0 vs. 50 mg) by therapy (RP vs. Drug Counseling) experimental conditions for the 12-week outpatient treatment phase of the study. A random effects regression model to test for group differences on percentage of cocaine-positive urines indicated a significant time by medication by therapy interaction, suggesting less cocaine use over time among subjects receiving RP-50mg than those in the other conditions. No differences were found for retention or time until first cocaine-positive urine. Naltrexone was well tolerated by participants, with acceptable rates of medication compliance observed. Treatment integrity measures confirmed successful manipulation of the psychotherapy. These results are consistent with the notion that substance use in dependent patients can be reduced with a combination of coping skills training and pharmacologic treatments.

Section snippets

Participants

Eighty-five men and women between the ages of 18 and 50 years who met current DSM-IV criteria (American Psychiatric Association, 1994) for dependence on cocaine were enrolled in this treatment study after completing an intake evaluation and detoxification program. Potential patients were excluded if they met DSM-IV criteria for current dependence on alcohol or any other psychoactive substance (except nicotine or cannabis), or for past opioid abuse or dependence. Also excluded were patients with

Sociodemographics

Table 1 shows that the four treatment groups did not differ sociodemographically. Overall, the sample was primarily male (72.9%), Black (58.8%), and employed (50.6%). The mean age (±SD) was 34.2 ± 7.1 with 12.8 ± 1.9 years of education. Lifetime (years) and current (last 30 days) cocaine use reported at intake was 8.6 ± 4.8 and 12.4 ± 9.4, respectively. The groups reported similar levels of problem severity as assessed by the ASI subscales.

Retention

Of the 85 randomized participants (intent-to-treat

Discussion

In cocaine-dependent patients, naltrexone appears to interact with the type of therapy received. Participants receiving the combination of naltrexone 50 mg and relapse prevention therapy evidenced significantly fewer cocaine-positive urines than participants receiving other treatment combinations. Predicted differences on secondary outcomes, including retention, quantitative cocaine use, and craving, were not found. Treatment integrity measures suggest that the independent variables of

Acknowledgements

Support for this research was provided by Grant DA-09262-04 from the National Institute on Drug Abuse, and from the Department of Psychiatry and Behavioral Sciences, University of Texas—Houston. Portions of this work were presented at the 62nd Annual Scientific Meeting of the College on Problems of Drug Dependence, Acapulco, Mexico, 1999. The authors would like to acknowledge the dedicated efforts of the staff at the Treatment Research Clinic of the Substance Abuse Medications Development

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