Disulfiram (currently a common option for alcohol abuse) and cognitive behavioral therapy appear to be effective in reducing cocaine use, especially among cocaine users who are not dependent on alcohol, according to an article in the March issue of The Archives of General Psychiatry.

Patients taking disulfiram who ingest even small amounts of alcohol develop a reaction that produces nausea, flushing, vomiting, and throbbing headache. At times, this reaction can be severe and can lead to critical illness, such as severe respiratory problems, circulatory problems, or even death. According to the article, alcohol is a powerful "cue" for using cocaine, and alcohol can impair judgment and lower resistance to cravings for cocaine.

In the current study, an American research group hypothesized that by reducing alcohol intake with use of disulfiram, people with cocaine dependence might be less likely to abuse cocaine. However, use of disulfiram had not previously been evaluated in general populations of cocaine users.

Kathleen M. Carroll, PhD, and her colleagues randomized 121 cocaine-dependent adults (average age, 34.6 years) to receive either disulfiram or placebo over a 12-week period. Participants were also randomized to participate in either cognitive behavioral therapy or interpersonal psychotherapy (a less structured form of behavioral therapy).

"Participants assigned to disulfiram reduced their cocaine use significantly more than those assigned to placebo, and those assigned to cognitive behavioral therapy reduced their cocaine use significantly more than those assigned to interpersonal psychotherapy," the authors wrote. The benefits of disulfiram and cognitive behavioral therapy were most pronounced in participants who were not alcohol dependent and who did not drink during the study.

The authors concluded, "This is the first placebo-controlled trial, to our knowledge, to demonstrate that disulfiram therapy is effective in nonalcoholic cocaine-dependent outpatients. Moreover, these findings suggest that disulfiram therapy is especially effective for nonalcoholic cocaine users, as the effects of disulfiram treatment were most pronounced in participants who did not meet the criteria for current alcohol abuse or dependence and in those who abstained from alcohol during the trial."