Intravenous (IV) drug users comprise the second largest risk group for AIDS. Recent evidence indicates that IV cocaine use may present a greater risk for AIDS that IV opioid use. Although several treatments for cocaine dependence look promising, controlled studies documenting effective treatments are rare. The proposed studies will develop and validate a behavioral intervention for IV cocaine dependence. All of the studies will involve parallel-group comparisons with random assignment. The behavioral intervention consists of contingency contracting and community reinforcement of abstinence and prosocial behavior. In Study 1 this behavioral treatment will be compared to a standard psychotherapy for cocaine dependence. If the behavioral treatment is more effective than the standard treatment, a component analysis of the behavioral intervention will be conducted comparing the complete behavior intervention vs contingency contracting alone vs community reinforcement alone (Study 2a). If the behavioral treatment is not more effective than standard treatment, it will be revised to include more potent consequences in the contingency contract and compared again to the standard treatment (Study 2b). Finally, we will assess whether the efficacy of our behavioral intervention is enhanced via the addition of desipramine (Study 3). Patients will receive either the behavioral intervention plus desipramine or behavioral intervention plus placebo. All studies will be conducted in an outpatient clinic, although brief inpatient detoxifications will be conducted as needed. Duration for all treatments will be 3 months. Outcome will be measured by (1) urinalysis to validate abstinence during treatment and longer-term abstinence (6 months), (2) patient acceptability of treatment, (3) improvement in marital, family, occupational, and legal status, and (4) changes in AIDS risk behaviors. These studies will provide new information on the efficacy of behavioral interventions with cocaine dependence, demonstrate whether the efficacy of such interventions is enhanced by adding pharmacotherapy, and provide new, sorely needed treatment opportunities for IV cocaine addicts in Vermont.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
1R18DA006113-01
Application #
3441613
Study Section
(SRCD)
Project Start
1989-09-30
Project End
1994-08-31
Budget Start
1989-09-30
Budget End
1990-08-31
Support Year
1
Fiscal Year
1989
Total Cost
Indirect Cost
Name
University of Vermont & St Agric College
Department
Type
Schools of Medicine
DUNS #
066811191
City
Burlington
State
VT
Country
United States
Zip Code
05405
Amass, L; Bickel, W K; Crean, J P et al. (1996) Preferences for clinic privileges, retail items and social activities in an outpatient buprenorphine treatment program. J Subst Abuse Treat 13:43-9
Higgins, S T; Budney, A J; Bickel, W K (1994) Applying behavioral concepts and principles to the treatment of cocaine dependence. Drug Alcohol Depend 34:87-97
Higgins, S T; Budney, A J; Bickel, W K et al. (1994) Participation of significant others in outpatient behavioral treatment predicts greater cocaine abstinence. Am J Drug Alcohol Abuse 20:47-56
Budney, A J; Higgins, S T; Hughes, J R et al. (1993) Nicotine and caffeine use in cocaine-dependent individuals. J Subst Abuse 5:117-30
Higgins, S T; Budney, A J (1993) Treatment of cocaine dependence through the principles of behavior analysis and behavioral pharmacology. NIDA Res Monogr 137:97-121
Amass, L; Bickel, W K; Higgins, S T et al. (1993) The taking of free condoms in a drug abuse treatment clinic: the effects of location and posters. Am J Public Health 83:1466-8
Bickel, W K; DeGrandpre, R J; Higgins, S T (1993) Behavioral economics: a novel experimental approach to the study of drug dependence. Drug Alcohol Depend 33:173-92
Budney, A J; Higgins, S T; Bickel, W et al. (1993) Relationship between intravenous use and achieving initial cocaine abstinence. Drug Alcohol Depend 32:133-42
Budney, A J; Higgins, S T; Hughes, J R et al. (1992) The scientific/clinical response to the cocaine epidemic: a MEDLINE search of the literature. Drug Alcohol Depend 30:143-9
Budney, A J; Higgins, S T; Delaney, D D et al. (1991) Contingent reinforcement of abstinence with individuals abusing cocaine and marijuana. J Appl Behav Anal 24:657-65