A Sequenced Behavioral and Medication Intervention for Cocaine Dependence

New York State Psychiatric Institute

Status and phase: Completed; Phase 2; Phase 1

Conditions: Cocaine Dependence

Treatments: Drug: Mixed-Amphetamine Salts- Extended Release (MAS-ER); Behavioral: Computer-assisted behavior therapy; Drug: Placebo

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT01986075

#6850

R01DA034087-01A1 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

This study will investigate a treatment strategy in which a computer-assisted behavioral intervention will be used to help individuals stop their use of cocaine. A medication will be combined with the behavioral treatment among those individuals who do not respond to the behavioral intervention alone. The primary hypothesis of the study is that among cocaine dependent individuals who fail to respond to an initial trial of behavioral therapy, a greater proportion of individuals will benefit from the combined treatment (behavior therapy plus medication) compared to individuals in the comparison group.

Full description

Cocaine Dependence is associated with substantial social, physical, and neurobiological problems. Psychosocial treatments can be helpful for many individuals. However, a significant proportion of individuals do not benefit from counseling alone. Our research group has demonstrated that deficient dopamine transmission, predicts poor response to a behavioral treatment and that a regiment that included an agonist replacement strategy with stimulants maybe effective for promoting abstinence in severe cocaine dependent patients.

In this 15-week study 145 treatment-seeking cocaine dependent participants will receive a computer-assisted behavioral intervention based on the community reinforcement approach with contingency management (CRA + CM). The counseling approach will include both computer-assisted life skills training via and counseling. Individuals who fail to achieve abstinence will continue the behavioral treatment (CRA + CM) and will be randomly assigned to a behavioral therapy enhancement strategy that will include either Mixed Amphetamine Salts-Extended Release (80mg) or placebo.

Enrollment: 145 patients

Sex: All

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. Meets DSM-V criteria for cocaine use disorder.
2. Used cocaine at least four days in the past month.
3. Age 18-60.
4. Able to give informed consent and comply with study procedures

Exclusion criteria

1. Meets DSM-V criteria for bipolar disorder, schizophrenia or any psychotic disorder other than transient psychosis due to drug abuse.
2. Participants with MDD, with symptom severity that exceeds a HAM-D score of 20, and/or any other current Axis I psychiatric disorder as defined by DSM-V supported by the MINI that in the investigator's judgment are unstable, would be disrupted by study medication, or are likely to require specialized pharmacotherapy or psychotherapy during the study period.
3. History of seizures, unexplained loss of consciousness, or traumatic brain injury.
4. History of allergic reaction to candidate medication (amphetamine).
5. Significant current suicidal risk.
6. Pregnancy, lactation, or failure in sexually active female patients to use adequate contraceptive methods.
7. Unstable physical disorders which might make participation hazardous such as uncontrolled hypertension, acute hepatitis, uncontrolled diabetes.
8. Elevated transaminase levels (> 3x the normal limit).
9. Coronary vascular disease
10. History of failure to respond to a previous adequate trial of the candidate medication.
11. Current physiological dependence on any other substance other than nicotine or cannabis that would require a medically supervised detoxification.
12. Currently being prescribed psychotropic medication by another physician.
13. Are legally mandated (e.g. to avoid incarceration, monetary or other penalties, etc.) to participate in substance abuse treatment program.
14. Body Mass Index (BMI) < 18kg/m2. (amphetamine may produce weigh loss thus a minimum BMI cut-off is being used for study inclusion).

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Sequential Assignment

Masking: Quadruple Blind

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145 participants in 2 patient groups, including a placebo group

Computer-assisted CBT plus Mixed-Amphetamine Salts- Extended Release (MAS-ER)

Experimental group

Description:

Patients who are randomized to the computer-assisted behavior therapy plus mixed amphetamine salts (extended release) arm will have their dose titrated to 80 mg or the maximum tolerated extended release mixed amphetamine salts daily. Participants will be asked to take the medication once per day in the morning or early afternoon and will be maintained on this schedule through week 14 of the trial. Computer-assisted behavior therapy based on the Community Reinforcement Approach (CRA) to treating cocaine dependence. CRA is skills based treatment program that incorporates coping skills development and contingency management. Participants will attend the clinic 3x per week and receive counseling 2x per week.

Treatment:

Behavioral: Computer-assisted behavior therapy

Drug: Mixed-Amphetamine Salts- Extended Release (MAS-ER)

Computer-assisted CBT plus placebo

Placebo Comparator group

Description:

Patients who are randomized to the Computer-assisted CBT plus placebo arm will have their medication dose titrated in a fix-flexible dose schedule matching the active medication arm. Participants will be asked to take the medication once per day in the morning or early afternoon and will be maintained on this schedule through week 14 of the trial. Computer-assisted behavior therapy based on the Community Reinforcement Approach (CRA) to treating cocaine dependence. CRA is skills based treatment program that incorporates coping skills development and contingency management. Participants will attend the clinic 3x per week and receive counseling 2x per week.

Treatment:

Drug: Placebo

Behavioral: Computer-assisted behavior therapy