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. Set ting. Urban substance abuse treatment center. Participants. Ninety-six of 1 22 subjects randomized to treatment. Interventions. One of five treatments delivered over 12 weeks. Cognitive-behavioral treatment (CBT) plus disulfir am; Twelve-Step facilitation (TSF) plus disulfiram; clinical management (CM ) plus disulfiram; CBT without disulfiram; TSF without disulfiram. Measurem ents. Percentage of days of cocaine and alcohol use during follow-up, verif ied by urine toxicology screens and breathalyzer tests. Results. First, as a group, participants reported significant decreases in frequency of cocain e, but not alcohol, use after the end of treatment. Secondly, the main effe cts of disulfiram on cocaine and alcohol use were sustained during follow-u p. 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.