Intravenous cocaine, crack cocaine, and other stimulant abuse are pervasive problems in the methadone maintenance population. The study will adapt an existing outpatient cocaine treatment model - Rawson's neurobehavioral mode - for use with methadone patients. The model addresses the major problems experienced by patients as they progress through five identifiable stages of recovery from cocaine abuse. The model will be modified by incorporating behavioral contingency management in order to improve subject recruitment and to encourage compliance with the treatment protocol, e.g., attendance, on-time behavior (but not to affect cocaine use directly). This would be th first test of neurobehavioral treatment in a methadone maintenance setting as well as the first independent evaluation of the model. One of the most difficult problems in any cocaine abuse treatment is the initial abstinence syndrome (withdrawal). An adjunctive medication, bromocriptine, intended to reduce craving and withdrawal symptoms, will be administered to two samples of male subjects enrolled in neurobehavioral treatment in a 35-day, placebo-controlled, double-blind randomized trial. (Women will not receive bromocriptine.) The study will determine whether addition of bromocriptine early in therapy improves retention in and the effectiveness of neurobehavioral treatment. The study will voluntarily randomly assign 413 cocaine-using methadone patients to four conditions: neurobehavioral treatment plus bromocriptine (N=67 males), neurobehavioral treatment plus placebo (N=67 males), neurobehavioral treatment only (N=67 males, 68 females) and low-intensity intervention control (N=72 males, 72 females). Data will be collected on al subjects at study entry, 35 days later (post-medication for the medication groups), 6 months later (post-treatment) and at 15 month follow-up. Instruments/tests will include: SCID (for DSM-III-R diagnosis), Addiction Severity Index (ASI), SCL-90-R, Beck Depression Inventory, Profile of Mood States (POMS), and radioimmunoassay of hair for drugs (at 15 month follow-up). The outcome variables will be: drug use (cocaine and heroin injection, crack, other illicit drugs); cocaine craving, withdrawal symptom and mood states (especially at 35 days); length of retention in the study treatments and in the methadone program; drug-using and sexual HIV risk behaviors; psychological states and emotional adjustment; pro-social coping skills; vocational status/employment; and legal status/criminal behavior. A substudy will examine whether reduction/cessation of cocaine use in the first 35 days of treatment is associated with decline in prolactin level an increase in plasma HVA, which would suggest recovery from a hypodopaminergi state.
