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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA004505-02
Application #
3210215
Study Section
Drug Abuse Clinical and Behavioral Research Review Committee (DACB)
Project Start
1987-07-01
Project End
1990-06-30
Budget Start
1988-07-01
Budget End
1989-06-30
Support Year
2
Fiscal Year
1988
Total Cost
Indirect Cost
Name
Yale University
Department
Type
Schools of Medicine
DUNS #
082359691
City
New Haven
State
CT
Country
United States
Zip Code
06520
Leal, J; Ziedonis, D; Kosten, T (1994) Antisocial personality disorder as a prognostic factor for pharmacotherapy of cocaine dependence. Drug Alcohol Depend 35:31-5
Kosten, T R (1993) Clinical and research perspectives on cocaine abuse: the pharmacotherapy of cocaine abuse. NIDA Res Monogr 135:48-56
Rosen, M I; Kosten, T (1992) Cocaine-associated panic attacks in methadone-maintained patients. Am J Drug Alcohol Abuse 18:57-62
Kosten, T R; Morgan, C M; Falcione, J et al. (1992) Pharmacotherapy for cocaine-abusing methadone-maintained patients using amantadine or desipramine. Arch Gen Psychiatry 49:894-8
Closser, M H; Kosten, T R (1992) Alcohol and cocaine abuse. A comparison of epidemiology and clinical characteristics. Recent Dev Alcohol 10:115-28
Kosten, T R (1991) Client issues in drug abuse treatment: addressing multiple drug abuse. NIDA Res Monogr 106:136-51
Ziedonis, D M; Kosten, T R (1991) Depression as a prognostic factor for pharmacological treatment of cocaine dependence. Psychopharmacol Bull 27:337-43
Kosten, T A; Kosten, T R (1991) Pharmacological blocking agents for treating substance abuse. J Nerv Ment Dis 179:583-92
Ziedonis, D M; Kosten, T R (1991) Pharmacotherapy improves treatment outcome in depressed cocaine addicts. J Psychoactive Drugs 23:417-25
Kosten, T R (1990) Neurobiology of abused drugs. Opioids and stimulants. J Nerv Ment Dis 178:217-27

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