The goal of this project is to evaluate the efficacy of amantadine and propranolol for the treatment of cocaine pendence in patients who present with severe cocaine withdrawal symptoms, as measured by scores on the Cocaine Selective Severity Assessment (CSSA), and have trouble initiating abstinence from cocaine. The initiation of abstinence in outpatient cocaine dependence treatment can be difficult. Treatment dropout rates are high and many patients continue to use cocaine. Preliminary data from our Center suggest that patients with high scores on the CSSA at treatment entry are much more prone to dropout and are less likely to achieve abstinence during the first several weeks of treatment. Amantadine is an indirect dopamine agonist that has been shown to be able to reduce dysphoria during early cocaine abstinence. In a recent double- blind trial, arnantadine was able to improve abstinence rates in a subgroup of patients with high CSSA scores at baseline. Among patient with initial CSSA scores above the 67th percentile, those treated with arnantadine submitted 50% benzoylecgonine-negative urines throughout the 4 week trial, whereas placebo treated patients submitted only 8% benzoylecgonine-negative urines. Propranolol is a beta adrenergic blocker that may be capable of reducing autonomic arousal associated with cocaine craving during early abstinence. In a recent trial, patients with high baseline CSSA scores treated with propranolol were significantly more likely to be retained in treatment than placebo treated patients (75% vs. 35%). Propranolol treated patients with high baseline CSSA scores also had significantly lower urinary benzoylecgonine levels during the 8 week trial than did placebo-treated, high CSSA patients. Amantadine, propranolol and the combination of the two medications will be evaluated in an 8 week, double-blind, placebo-controlled trial. For this trial, we will select cocaine dependent outpatients with high CSSA scores at intake who demonstrate a poor response to treatment by continuing to use cocaine during a two week baseline evaluation period. Continued use will be determined by two urine toxicology screens positive for benzoylecgonine during the 2 week baseline. Treatrnent will include weekly individual cognitive behavioral relapse prevention psychotherapy. Outcome measures will include quantitative urinary benzoylecgonine levels, self-reported cocaine use by timeline followback, and results from the Addiction Severity Index.
Showing the most recent 10 out of 56 publications
