Pharmacotherapy & CM for Opioid and Cocaine Dependence

Inclusion Criteria:

• Male and female opioid-dependent patients between the ages of 18-65 will be entered into the study. Females must not be pregnant as determined by pregnancy screening, nor breast feeding, and must be using acceptable birth control methods during study participation.
• Current opioid dependence as evidenced by documentation of prior treatment for opioid dependence or signs of withdrawal, self-reported history of opioid dependence for consecutive 12 month period and a positive urine for opiates.
• Subjects must fulfill DSM-IV criteria for opioid and cocaine dependence.
• Subjects must have a history of cocaine use, with a reported street cocaine use of a minimum of 1/2 gram during the preceding 30 days. Additionally, laboratory confirmation of recent cocaine use (positive urine for cocaine) within 2 weeks prior to admission to the study is required.
• Subjects must be treatment-seekers for opioid and cocaine use.

Exclusion criteria:

• Current DSM-IV diagnosis of other drug or alcohol dependence (other than opiates, cocaine, or tobacco)
• History of heart disease, left ventricular hypertrophy, ischemic ECG changes, chest pain, arrhythmia, hypertension.
• History of severe renal, endocrine or hepatic diseases.
• History of psychosis, schizophrenia, or bipolar type I.
• History of seizure disorder.
• Current use of over-the-counter or prescription psychoactive drugs (antidepressant, anxiolytics, antipsychotics, mood stabilizers, psychostimulants).
• Liver function tests (SGOT,SGPT) greater than 3 times normal.
• Current use of modafinil
• Current suicidality
• Pregnancy or breast-feeding;
• Medical contraindication to treatment with study medication (e.g. for modafinil, history of heart disease, ischemic ECG changes, arrhythmia, hypertension).
• Women of child-bearing potential must agree to use other means of birth control and to have a pregnancy test repeated at least once monthly.
• Known allergy to modafinil or methadone.