One-year follow-up of disulfiram and psychotherapy for cocaine-alcohol users: sustained effects of treatment.

AIM

To evaluate outcomes 1 year after cessation of treatment for cocaine- and alcohol-dependent individuals.

DESIGN

Randomized controlled trial.

SETTING

Urban substance abuse treatment center.

PARTICIPANTS

Ninety-six of 122 subjects randomized to treatment.

INTERVENTIONS

One of five treatments delivered over 12 weeks. Cognitive-behavioral treatment (CBT) plus disulfiram; Twelve-Step facilitation (TSF) plus disulfiram; clinical management (CM) plus disulfiram; CBT without disulfiram; TSF without disulfiram.

MEASUREMENTS

Percentage of days of cocaine and alcohol use during follow-up, verified by urine toxicology screens and breathalyzer tests.

RESULTS

First, as a group, participants reported significant decreases in frequency of cocaine, but not alcohol, use after the end of treatment. Secondly, the main effects of disulfiram on cocaine and alcohol use were sustained during follow-up. Finally, initiation of abstinence for even brief periods of time within treatment was associated with significantly better outcome during follow-up.

CONCLUSIONS

These findings support the efficacy of disulfiram with this challenging population and suggest that comparatively brief treatments that facilitate the initiation of abstinence may have long-term benefits.