This research is designed to evaluate the feasibility of administering a consummatory aversion therapy to cocaine dependent individuals in an outpatient setting. This therapy, known as emetic or chemical aversion therapy, has been successfully implemented as an adjunctive treatment for cocaine dependent inpatients during the PI's ongoing Phase II project. It involves pairings of nausea and vomiting, induced by an oral dose of emetine hydrochloride, with the consumption of highly realistic placebo cocaine. The treatment led to decreased cocaine craving during treatment and to elevated postdischarge abstinence. The absence of unexpected adverse reactions plus the subjects' typical prompt recovery from emetically induced nausea and emesis strongly support the treatment's applicability to outpatient delivery. Subjects will be recruited from patients of the Regional Medical Hospital at Augusta and through local newspaper advertisements and referrals. After determination of cocaine dependency, medical clearance and extensive psychological testing, subjects will be randomly assigned to emetic therapy or to one of two comparison conditions, faradic therapy or group therapy. Faradic therapy, which pairs the placebo cocaine with a mild but uncomfortable electric shock, involves patient-therapist contact time as well as cue exposure to and consumption of placebo cocaine that is comparable to that of emetic therapy. However, based on the PI's inpatient study, faradic therapy should not produce conditioned consummatory aversions to cocaine, should not eliminate within treatment subjective craving for cocaine nor increase six-month post discharge abstinence rates. The group therapy will focus on abstinence maintenance and relapse prevention. Since aversion therapies are appropriately viewed as adjunctive procedures, all aversion therapy recipients also will receive group therapy. This design (emetic plus group therapy, faradic plus group therapy, and group therapy alone) will address the acceptability of aversion therapy as an adjunctive treatment in comparison to the baseline group only alternative. A rigorous six month posttreatment follow-up will feature six scheduled subject interviews, including three in-person visits with urine collected for drug screens, plus concomitant interviews with collateral contacts. Dependent variables include abstinence performance, drug usage and multiple indices of adjustment.
