? This application requests renewal of a Senior Research Scientist Award to enable the candidate to continue with full time research and research training activities. With the goal of improving diagnostic and treatment strategies for drug abusers, the candidate directs an interdisciplinary program of research projects of two general types: (a) efficacy/effectiveness research on promising psychosocial and pharmacological interventions and (b) projects to improve methods of classifying substance abusers with the aim of defining clinically meaningful subtypes. ? ? The Research Plan provides a detailed description of one of these projects, a clinical trial of Twelve Step Facilitation (TSF) to enhance disulfiram for cocaine dependence. Cocaine use remains epidemic among most methadone maintenance patients and is associated with a host of concurrent problems, particularly high risk of intravenous drug use and HIV. Preliminary studies suggest that disulfiram is a promising treatment for cocaine abuse in this setting but replication is needed in a larger sample, Moreover, it is critical to evaluate whether disulfiram's effectiveness can be enhanced through adding a more potent psychotherapeutic approach. Manualized TSF is a promising but understudied psychotherapeutic approach worthy of extended empirical evaluation. The proposed 2 x 2 design will permit evaluation of TSF as adjunct to standard methadone maintenance as well as its benefits in combination with disulfiram. ? ? In this Stage II study, 180 cocaine-dependent, methadone-maintained opioid addicts will be assigned, using urn randomization, to one of four treatments:(1) Twelve-Step Facilitation (TSF) in addition to standard methadone counseling (SMC) + disulfiram, (2) TSF with SMC plus placebo, (3)SMC plus disulfiram or (4) SMC plus placebo. The primary outcome will be reduction in cocaine use, as assessed by self-report and thrice-weekly urine analysis. Secondary outcomes will include reductions in illicit opioid use and alcohol use, as well as improvements in psychosocial functioning. ? ? ? ?
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