The proposed study is a placebo controlled, randomized clinical trial of desipramine, a tricyclic antidepressant, and amantadine, a dopaminergic agonist, for cocaine abuse among methadone maintained patients. One-hundred and five patients in our treatment program who meet DSM-III-R criteria for cocaine dependence will be entered into this 12 week trial (35 patients per cell). Pilot data have demonstrated in open trials that desipramine significantly reduces cocaine use and craving compared to unmedicated controls. Other pilot data have shown that amantadine acutely decreases cocaine use and craving. Thus, two potentially effective treatments are available for this trial. The significance of this trial includes not only a potential treatment for cocaine abuse, but a preventative intervention for AIDS among IV drug users. Most of the cocaine abusers in our methadone program use cocaine IV,and although they may be effectively treated for IV opiod abuse by the methadone program, they continue to use IV cocaine, share needles and be exposed to HIV infection. Because in New Haven the rate of HIV antibodies is currently 22% in applicants to methadone maintenance, the risk of contracting AIDS from sharing needles is substantial. Psychological symptoms, psychiatric diagnoses, psychosocial adjustment, treatment retention, and AIDS related behaviors will be used as outcome measures. A final significant aspect of the current study is the context of research in which it is embedded. Concurrent studies of physiological effects of cocaine challenges and of HIV seropositivity in IV drug users as well as the previous diagnostic and 2.5 year followup studies will provide a rich database for analyses that draw on results from these various investigations.
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