This is a revised version of the previously submitted application, #ROI DA09583-01, also entitled Imipramine+Relapse Prevention in Depressed Methadone Pts. Relapse prevention is a widely used cognitive-behavioral skills training approach to the problem of initiating and maintaining drug use abstinence. Imipramine has been shown to have strong antidepressant effects and significant, but qualified, effects on self-reported drug use among depressed cocaine-using methadone patients. Among this substantial subgroup of patients, there are no studies of the efficacy of combination pharmacotherapeutic and psychotherapeutic approaches to the problem of cocaine use. This study will examine the question of whether adding relapse prevention group to imipramine is more effective than imipramine alone in reducing cocaine use among 252 inner-city depressed methadone patients who use cocaine. It will have the methodological advantages of: (1) including a non-specific psychological intervention comparison condition (i.e. support group); and (2) targeting a sample with rigorously diagnosed DSM-IV depressive disorders. It will have the important clinical advantage of using a manualdriven relapse prevention protocol -- that will draw from two programs with demonstrated efficacy. This study will also assess the impact of potential predictors on intervention effects on cocaine use, especially severity of cocaine use and severity of depression. It will also assess the impact of potential mediators, representing acquisition of intervention components, on intervention effects on cocaine use, especially: level of relapse prevention skill and perceived self-efficacy to use these skills. Patients will be assessed on repeated measures of cocaine use and depression at: baseline, end of psychological intervention (at 3 months), end of imipramine maintenance (at 6 months) and 3-month post-intervention follow-up (at 9 months).
