Cocaine Dependence Clinical Trial
Official title:
Imaging the Neurobiology of a Behavioral Treatment for Cocaine Dependence
The purpose of this study is to determine whether patients with the greatest loss of dopamine transmission due to cocaine dependence at pre-treatment PET and MRI scans will be those who fail to respond to substance abuse treatment. This study will also determine whether patients who do respond to treatment will experience a recovery of dopamine function.
Previous studies have shown that cocaine dependence is associated with a decrease in
dopamine release in response to a psychostimulant challenge. We have recently completed a
study demonstrating that this loss of pre-synaptic dopamine function is associated with the
choice to self-administer cocaine in the presence of an alternative reinforcer. This finding
consistent with animal models of reinforcement and which show that dopamine transmission
serves to modulate reward based behavior, and in this case, allows for a more adaptive
response to be made in the presence of a competing reinforcer.
The previous study was performed in non-treatment seeking cocaine dependent subjects using
an inpatient laboratory model to measure the choice for cocaine. Thus, the goal of the
present proposal is to investigate this association in a more realistic setting where
cocaine dependent out patients face the choice between using cocaine and the alternative
reinforcers presented to them in a therapeutic setting. The Community Reinforcement Approach
with voucher incentives is a treatment for cocaine dependence that has been shown success in
a number of controlled studies. Since the basis of this therapy is to reduce the reinforcing
value of cocaine by increasing the density of alternative, healthy reinforcers, we have
chosen to correlate outcome from this treatment with measures of presynaptic dopamine
function. We propose to scan cocaine dependent patients with [11C]raclopride and oral
methylphenidate in order to measure dopamine release. Patients will be scanned before
treatment and at 12 weeks into therapy. We predict that the patients with the greatest loss
of dopamine transmission at the pre-treatment scan will be those who fail to respond to
treatment. Furthermore, we hypothesize that the patients who do respond to treatment will
experience a recovery of dopamine function, measured at the post-treatment scan.
In addition, subjects enrolled in this study will undergo fMRI and spectroscopy studies in
order to asses differences in neuronal integrity, learning, and impulse control.
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Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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