A randomized factorial trial of disulfiram and contingency management to enhance cognitive behavioral therapy for cocaine dependence
A randomized factorial trial of disulfiram and contingency management to enhance cognitive behavioral therapy for cocaine dependence
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DOI：
10.1016/j.drugalcdep.2015.12.036
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发表时间：
2016-03-01
影响因子：
4.2
通讯作者：
Ball, Samuel A.
中科院分区：
文献类型：
--
作者：
Carroll, Kathleen M.;Nich, Charla;Ball, Samuel A.
工作背景：本研究评估了在何种程度上，除了双硫仑和应急管理的遵守和禁欲（CM），单独和组合，可能会提高认知行为疗法（CBT）的可卡因使用disorders.Methods的影响：析因随机双盲（药物治疗条件）临床试验，CBT作为平台，并提供在每周一次的个人会议在社区为基础的门诊。99名符合DSM-IV可卡因依赖标准的门诊患者被分配接受双硫仑或安慰剂，CM或无CM。可卡因和其他物质的使用进行了评估，通过每日日历与每周三次尿样检测12周，为期一年的随访（80%的受访者在一年）。结果：CM和双硫仑将产生最好的可卡因结果的主要假设没有得到证实，也没有双硫仑的主要影响。对于主要结局（禁欲天数百分比，自我报告），存在显著的相互作用，CM和安慰剂组合的可卡因结局最好，分配给双硫仑的两组与中间结局相关，分配给安慰剂和无CM的可卡因结局最差。次要结局（尿分析）表明CM优于无CM的显著效应，但相互作用效应不显著。一年的随访数据表明，持续的治疗效果在整个conditions.Conclusions：CM提高可卡因依赖的CBT治疗的结果，但双硫仑提供了CM和CBT的组合没有额外的好处。(C)2016爱思唯尔爱尔兰有限公司版权所有。
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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.