This submission is in response to NIDA's Program Announcement 92-110: """"""""Development of Theoretically Based Psychosocial Therapies for Drug Dependence."""""""" We propose to adapt, refine, and pilot-test Beck's model of cognitive behavior therapy (CBT) for treatment of crack cocaine addiction complicated by persistent depression. The comorbid presentation of cocaine addiction and depression is increasingly prevalent and patients are at particularly high risk for relapse and subsequent suicide. Existing treatments are ineffective, unproven, and/or poorly complied with. Our treatment is adapted from two existing CBT treatment manuals, one guiding ambulatory treatment of cocaine addiction and the other specifying inpatient therapy for severe primary depression. The latter model was developed by our group as an alternative to pharmacotherapy, and we are gaining expertise with the former approach in a NIDA-funded, multisite collaborative study (DA- 07673). We request 5 years of support, with 3 overarching aims: 1) development and refinement of a theoretically based, procedurally specified form of individual CBT for cocaine dependent inpatients who continue to meet syndromal criteria for major depression after 7 days of detoxification. The protocol consists of greater than or equal to 2 weeks of inpatient treatment, followed by 6 months of outpatient therapy and 6 subsequent monthly """"""""booster"""""""" sessions. The treatment protocol will be enhanced by development of a self-help recovery manual tailored specifically to reinforce the goals and strategies of the therapy; 2) standardization of procedures, methods, and techniques so that CBT is delivered with a high degree of competence and adherence. In order to accomplish this, we will prepare a detailed treatment manual, provide extensive supervision and training, and refine existing methods to assess protocol fidelity; and 3) to conduct a pilot study comparing this new treatment approach with an operationalized Treatment as Usual (TAU) condition. During the first year (Phase 1) , the inpatient and outpatient components of the treatment protocol will be implemented and refined through intensive and collaborative, expert review of 12 """"""""pre- pilot"""""""" cases. During the second year (Phase 2), 2 new therapists will be trained and the treatment and self-help manuals will be finalized. During years 03-05 (Phase 3), we will conduct a randomized, parallel group controlled study testing the relative efficacy of CBT (n=30) against TAU (n=30). Patients in the TAU condition will receive individual drug counseling and antidepressant pharmacotherapy. This research is likely to lead to more effective methods of psychosocial treatment of crack cocaine addition. It builds logically on our past and current work and will complement, not conflict with, the aims of the ongoing NIDA-Collaborative study.
