Identifying more effective treatment strategies tailored to individual responses for patients overcoming addiction to cocaine is the focus of a new clinical trial at McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).
The study, funded with a $1.9 million grant from the National Institute on Drug Abuse (NIDA; R01DA039125), is led by Joy M. Schmitz, Ph.D., Louis A. Faillace Professor in the Department of Psychiatry and Behavioral Sciences and director of the Center for Neurobehavioral Research on Addiction (CNRA) at McGovern Medical School at UTHealth.
"What we have found is that no single treatment is appropriate for everyone," Schmitz said. "Addiction treatments need to be adjusted based on patient characteristics and response in order to be most effective."
Studies have shown that the most effective treatment to date for cocaine addiction is behavior therapy involving motivational incentives, which can result in initial abstinence rates of 40 percent. This approach uses small reward incentives such as gift cards to encourage positive behavior change, such as abstaining from drugs.
"Chronic cocaine use can throw off the balance of the brain reward system to the point where behavior is fully directed or motivated toward using the drug. Incentive-based therapy is used to help rebalance response to reward by offering natural or non-drug incentives that can compete with that of cocaine," Schmitz said.
The study aims to boost the effectiveness of motivational incentives in certain individuals by adding a therapy that teaches mindfulness skills.
"Acceptance and commitment therapy is a new evidence-based behavioral therapy that focuses on helping the individual handle difficult feelings and thoughts without using drugs to escape. Acceptance is about being willing to experience negative feelings, like strong sensations of craving, without letting the feeling take control or interfere with valued living," Schmitz said.
Researchers predict that for a certain subgroup of patients, the combination of motivational incentives and skills training to tolerate distress will improve patients' chances of achieving abstinence, Schmitz said. "For those who do not respond, however, a third phase of the trial will test whether adding a dopamine-enhancing medication, modafinil, is beneficial," she said.
The clinical trial, called Developing Adaptive Interventions for Cocaine Cessation and Relapse Prevention (ClinicalTrials.gov NCT02896712), will enroll 160 patients. NIDA is part of the National Institutes of Health (NIH).
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