Cocaine Dependence Clinical Trial
Official title:
Combined Treatment of Modafinil and Cognitive Behavioral Therapy for Cocaine Dependence
The purpose of this study is to test whether a cognitive behavioral therapy (CBT) and a medication called modafinil, which is approved to treat sleep disorders, will help individuals who are abusing cocaine.
Chronic cocaine abuse has been documented to produce cognitive impairments in various
domains. The observed cognitive deficits in the substance abuse population include, but are
not restricted to, attention, concentration, verbal and nonverbal memory, problem solving
and abstract reasoning. Our recent studies (IRB Protocol # 3998) demonstrated that in
cocaine dependent participants such cognitive deficits have been shown to: 1) negatively
effect retention and 2) impede the ability of the drug abuser to benefit from cognitive
behavioral therapy- relapse prevention (CBT-RP) that requires participant to attend to novel
stimuli, integrate new information with existing stores, and translate information into
behavior change (Aharonovich, Hasin & Nunes, 2003; Aharonovich et al, in press).
Furthermore, the toxic effects of cocaine together with withdrawal symptoms, such as fatigue
and hypersomnia make it difficult to fully engage in any psychosocial intervention including
CBT-RP.
Recent findings indicate that cocaine dysregulates reward-related glutamate pathways (Dackis
& O'Brien, 2003; Kalivas et al, 2003). Modafinil is a medication known to improve attention,
increase wakefulness, energy, and alertness in part by increasing glutamate levels. In light
of this work and the negative affect of cognitive impairments on treatment outcomes, testing
cognitive enhancing medications that act on glutamate pathways is a novel promising strategy
for improving treatment for cocaine dependence. Modafinil is approved for sleep disorders
and is a relatively safe medication for cocaine-dependent participants as it has a low abuse
potential and has shown promise in a double blind placebo controlled trial for cocaine
dependence (Rush et al, 2002; Jasinski, 2000, Dackis et al, 2005). We therefore propose a
double blind placebo controlled 12-week exploratory pilot study of modafinil, a "wakefulness
agent," in conjunction with sessions of CBT-RP enhanced with motivational interviewing
components.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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