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Adaptive Treatment for Alcohol and Cocaine Dependence

This study has been completed.
Sponsor:
Information provided by (Responsible Party):
University of Pennsylvania
ClinicalTrials.gov Identifier:
NCT01032135
First received: December 14, 2009
Last updated: March 28, 2017
Last verified: March 2017
  Purpose
  1. Primary objective #1: Determine the relative effectiveness of MI-IOP and MI-PC in the full study sample with regard to treatment engagement over weeks 1-12 and cocaine/alcohol use over weeks 1-24.

    • Hypothesis 1: An intervention that explores several possible treatment options with the patient and provides the chosen option (e.g., MI-PC) will produce higher rates of treatment engagement than an intervention focused on engagement in IOP only (e.g., MI-IOP).
    • Hypothesis 2: An intervention that explores several possible treatment options with the patient and provides the chosen option (e.g., MI-PC) will produce better cocaine/alcohol use outcomes than an intervention focused on engagement in IOP only (MI-IOP).
    • Secondary analysis 1: Among the Non-engaged patients, determine rates of selection of each of the three options in MI-PC, retention rates within each option, and cocaine/alcohol use outcomes in each option.
    • Secondary analysis 2: Among the Engaged patients, determine rates of selection of each of the three options in MI-PC, retention rates within each option, and cocaine/alcohol use outcomes in each option.
  2. Primary objective #2: Determine whether the relative effectiveness of MI-IOP and MI-PC varies as a function of engagement group, with regard to treatment engagement over weeks 1-12 and cocaine/alcohol use outcomes over weeks 1-24.

    • Hypothesis 1: The predicted main effect on retention favoring MI-PC over MI-IOP will be significantly larger among patients in the Non-engaged group than among those in the Engaged group.
    • Hypothesis 2: The predicted main effect on cocaine/alcohol use outcomes favoring MI-PC over MI-IOP will be significantly larger among patients in the Non-engaged group than among those in the Engaged group.

Condition Intervention Phase
Substance Use Disorders Behavioral: Motivational Interviewing Behavioral: Telephone counseling Behavioral: Cognitive Behavioral Therapy (CBT) Counseling Drug: medication management Behavioral: Intensive OutPatient Therapy Phase 2 Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Adaptive Treatment for Alcohol and Cocaine Dependence

Resource links provided by NLM:


Further study details as provided by University of Pennsylvania:

Primary Outcome Measures:
  • Treatment Engagement [ Time Frame: weeks 3 - 12 ]
    Number of treatment sessions attended

  • Treatment Engagement for Participants Engaged at 2 Weeks, But Disengage Before 8 Weeks [ Time Frame: weeks 9 - 12 ]
    Number of treatment sessions attended

  • Treatment Engagement of Those Non-engaged at 2 Weeks and at 8 Weeks [ Time Frame: weeks 9 - 12 ]
    Number of treatment sessions attended

  • Any Drinking [ Time Frame: Month 2 ]
    Any drinking at follow up, as reported on Time Line Follow Back

  • Any Drinking [ Time Frame: Month 3 ]
    Any drinking at follow up, as reported on Time Line Follow Back

  • Any Drinking [ Time Frame: Month 4 ]
    Any drinking at follow up, as reported on Time Line Follow Back

  • Any Drinking [ Time Frame: Month 5 ]
    Any drinking at follow up, as reported on Time Line Follow Back

  • Any Drinking [ Time Frame: Month 6 ]
    Any drinking at follow up, as reported on Time Line Follow Back

  • Percent Days Drinking [ Time Frame: Month 2 ]
    Percent days of any drinking at follow up, from Time Line Follow Back

  • Percent Days Drinking [ Time Frame: Month 3 ]
    Percent days of any drinking at follow up, from Time Line Follow Back

  • Percent Days Drinking [ Time Frame: Month 4 ]
    Percent days of any drinking at follow up, from Time Line Follow Back

  • Percent Days Drinking [ Time Frame: Month 5 ]
    Percent days of any drinking at follow up, fromTime Line Follow Back

  • Percent Days Drinking [ Time Frame: Month 6 ]
    Percent days of any drinking at follow up, from Time Line Follow Back

  • Any Heavy Drinking Days [ Time Frame: Month 2 ]
    heavy drinking days at follow up, from Time Line Follow Back

  • Any Heavy Drinking Days [ Time Frame: Month 3 ]
    heavy drinking days at follow up, from Time Line Follow Back

  • Any Heavy Drinking Days [ Time Frame: Month 4 ]
    heavy drinking days at follow up, from Time Line Follow Back

  • Any Heavy Drinking Days [ Time Frame: Month 5 ]
    heavy drinking days at follow up, from Time Line Follow Back

  • Any Heavy Drinking Days [ Time Frame: Month 6 ]
    heavy drinking days at follow up, from Time Line Follow Back

  • Percent Days Heavy Drinking [ Time Frame: Month 2 ]
    Percent days heavy drinking at follow up, from Time Line Follow Back

  • Percent Days Heavy Drinking [ Time Frame: Month 3 ]
    Percent days heavy drinking at follow up, from Time Line Follow Back

  • Percent Days Heavy Drinking [ Time Frame: Month 4 ]
    Percent days heavy drinking at follow up, from Time Line Follow Back

  • Percent Days Heavy Drinking [ Time Frame: Month 5 ]
    Percent days heavy drinking at follow up, from Time Line Follow Back

  • Percent Days Heavy Drinking [ Time Frame: Month 6 ]
    Percent days heavy drinking at follow up, from Time Line Follow Back

  • Any Cocaine Use [ Time Frame: Month 3 ]
    Any cocaine using self report, binary measure of percent days cocaine use

  • Any Cocaine Use [ Time Frame: Month 4 ]
    Any cocaine using self report, binary measure of percent days cocaine use

  • Any Cocaine Use [ Time Frame: Month 5 ]
    Any cocaine using self report, binary measure of percent days cocaine use

  • Any Cocaine Use [ Time Frame: Month 6 ]
    Any cocaine using self report, binary measure of percent days cocaine use

  • Percent Days Cocaine Use [ Time Frame: Month 3 ]
    Percent days of any cocaine use, self reported

  • Percent Days Cocaine Use [ Time Frame: Month 5 ]
    Percent days of any cocaine use, self reported

  • Percent Days Cocaine Use [ Time Frame: Month 6 ]
    Percent days of any cocaine use, self reported


Secondary Outcome Measures:
  • Effect of Patient Choice of Treatment [ Time Frame: month 6 ]
    Treatment Group Comparisons in Alcohol Dependent Patients


Enrollment: 500
Study Start Date: October 2008
Study Completion Date: December 2013
Primary Completion Date: December 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: 1-MI-IOP Engaged
Randomized to treatment as usual, and they attend regularly but dropped out of treatment after randomization.
Behavioral: Motivational Interviewing
2 sessions at week 2, potential 2 sessions at week 8 if the participant drops out.
Other Name: MI
Experimental: 2-MI-IOP Non-Engaged
Randomized to treatment as usual, and do not attend.
Behavioral: Motivational Interviewing
2 sessions at week 2, potential 2 sessions at week 8 if the participant drops out.
Other Name: MI
Behavioral: Telephone counseling
one telephone counseling session per week for 10 weeks.
Other Name: Telephone based stepped care.
Behavioral: Cognitive Behavioral Therapy (CBT) Counseling
One CBT session per week, for 10 weeks.
Other Name: CBT
Drug: medication management
Prescription for naltrexone
Other Name: MM
Behavioral: Intensive OutPatient Therapy
Return to IOP, group therapy 3 times weekly for about three hours a day.
Other Name: IOP
Active Comparator: 3-MI-PC Engaged
Randomized to treatment choice, but remain attending treatment as usual then dropped out of treatment after randomization.
Behavioral: Motivational Interviewing
2 sessions at week 2, potential 2 sessions at week 8 if the participant drops out.
Other Name: MI
Behavioral: Telephone counseling
one telephone counseling session per week for 10 weeks.
Other Name: Telephone based stepped care.
Behavioral: Cognitive Behavioral Therapy (CBT) Counseling
One CBT session per week, for 10 weeks.
Other Name: CBT
Experimental: 4-MI-PC Non-engaged
Randomized to treatment choice, and do not attend treatment as usual, so the choice option is used.
Behavioral: Motivational Interviewing
2 sessions at week 2, potential 2 sessions at week 8 if the participant drops out.
Other Name: MI
Behavioral: Telephone counseling
one telephone counseling session per week for 10 weeks.
Other Name: Telephone based stepped care.
Behavioral: Cognitive Behavioral Therapy (CBT) Counseling
One CBT session per week, for 10 weeks.
Other Name: CBT
Drug: medication management
Prescription for naltrexone
Other Name: MM
Behavioral: Intensive OutPatient Therapy
Return to IOP, group therapy 3 times weekly for about three hours a day.
Other Name: IOP

Detailed Description:

3. Secondary objective #1: Examine outcomes on three secondary measures: percent days abstinent from all substances, negative consequences of drug use, and HIV high risk behaviors.

  • Hypothesis 1: Outcomes on the secondary measures will be better in MI-PC than in MI-IOP.

    4. Secondary objective #2: Test hypotheses concerning potential mediators of the predicted main effect favoring MI-PC over MI-IOP.

  • Hypothesis 1: The predicted advantage of MI-PC over MI-IOP will be mediated by greater increases in motivation, self-efficacy, commitment to abstinence, and self-help involvement in MI-PC.

    5. Secondary objective #3: Test hypotheses concerning effect of additional MI intervention after initial non-engagement persists through 12 weeks.

  • Hypothesis 1: A second telephone MI intervention will produce higher rates of subsequent engagement and less cocaine use than no further MI.
  Eligibility

Ages Eligible for Study:   18 Years to 75 Years   (Adult, Senior)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. meet DSM-IV criteria for lifetime cocaine or alcohol dependence and have used cocaine or alcohol in the prior 6 months;
  2. be > 18 years of age;
  3. be judged clinically appropriate for IOP (e.g., no current psychotic disorder or evidence of severe dementia, and no acute medical problem requiring inpatient treatment;
  4. have no regular IV heroin use during the past year;
  5. have access to a telephone;
  6. be willing to be randomized and participate in research; and
  7. no current participation in methadone or other forms of DA treatment, other than IOP. Finally, because of study follow-up requirements, subjects will
  8. be required to be metropolitan area residents, and
  9. be able to provide the name, verified telephone number, and address of at least two contacts who can provide locator information on the patient during follow-up. We will include patients with dependence on other substances, provided that they are cocaine dependent and meet other inclusion criteria.

Exclusion Criteria:

  1. have a current psychotic disorder (as assessed with the psychotic screen from the MINI) or evidence of dementia severe enough to prevent participation in outpatient treatment;
  2. have acute medical problem requiring immediate inpatient treatment; or
  3. are currently participating in methadone or other forms of DA treatment, other than IOP.
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01032135

Locations
United States, Pennsylvania
Presbyterian Medical Center
Philadelphia, Pennsylvania, United States, 19104
VAMC
Philadelphia, Pennsylvania, United States, 19104
NorthEast Treatment Center
Philadelphia, Pennsylvania, United States, 19123
Sponsors and Collaborators
University of Pennsylvania
Investigators
Principal Investigator: James R. McKay, Ph.D University of Pennsylvania
  More Information

Responsible Party: University of Pennsylvania
ClinicalTrials.gov Identifier: NCT01032135     History of Changes
Obsolete Identifiers: NCT02689674
Other Study ID Numbers: 807092
IND: 101,486
Study First Received: December 14, 2009
Results First Received: March 28, 2017
Last Updated: March 28, 2017

Additional relevant MeSH terms:
Cocaine-Related Disorders
Substance-Related Disorders
Chemically-Induced Disorders
Mental Disorders
Cocaine
Anesthetics, Local
Anesthetics
Central Nervous System Depressants
Physiological Effects of Drugs
Sensory System Agents
Peripheral Nervous System Agents
Vasoconstrictor Agents
Dopamine Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Dopamine Agents
Neurotransmitter Agents

ClinicalTrials.gov processed this record on August 18, 2017