Combining a drug used to treat alcoholism with a drug treatment for opiate addiction may be the key to treating cocaine addicts, a Yale study finds.
When buprenorphine, an alternative to methadone for treating opiate addiction, was combined with disulfiram-marketed as Antabuse for treating alcoholism-the combination was more effective than buprenorphine alone in reducing cocaine use in persons with dual alcohol and cocaine addictions.
Tony P. George, M.D., assistant professor of psychiatry at Yale School of Medicine and principal investigator on the study, said participants who received a combination of disulfiram and buprenorphine abstained from cocaine use for longer periods of time than those who received only buprenorphine.
These same participants also achieved three weeks of continuous cocaine abstinence sooner than those who received buprenorphine alone. George's team found no significant differences in the total weeks of opiate abstinence between disulfiram in combination with buprenorphine, and buprenorphine alone.
"Our work reinforces previous research that suggests administering disulfiram prior to cocaine use may block the pleasurable and rewarding effects caused by an excessive release of dopamine in the brain," said George. "Instead of experiencing euphoria and other feelings of well being associated with cocaine use, a person who has taken disulfiram before using cocaine will experience reactions such as anxiety, dysphoria or paranoia."
Past studies show that either buprenorphine or methadone alone is effective in reducing opiate use, but neither is effective in reducing concurrent cocaine use by opiate-dependent individuals.
In the study, which appears in the spring 2000 issue of Biological Psychiatry, 20 individuals addicted to both opiates and cocaine were placed on buprenorphine therapy. While all the participants continued to receive buprenorphine, 11 were randomly assigned to receive disulfiram and nine were assigned to receive a placebo for 12 weeks. George said larger, controlled studies of disulfiram for treating cocaine addiction are planned in participants being maintained by buprenorphine.
George's study was funded by the National Institute on Drug Abuse (NIDA) , a component of the National Institutes of Health, U.S. Department of Health and Human Services. Other authors on the Yale study include Marek C. Chawarski, Juliana Pakes, Kathleen M. Carroll, Thomas R. Kosten and Richard S. Schottenfeld.
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