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Frank H. Gawin, MD; Herbert D. Kleber, MD; Robert Byck, MD; Bruce J. Rounsaville, MD; Thomas R. Kosten, MD; Peter I. Jatlow, MD; Cynthia Morgan

Arch Gen Psychiatry. 1989;46(2):117-121.

Abstract
• We conducted a double-blind, random assignment, six-week comparison of desipramine hydrochloride (n = 24), lithium carbonate (n = 24), and placebo (n = 24) treatments for cocaine dependence. Subjects were 72 outpatient cocaine abusers who met DSM-III-R dependence criteria for cocaine but not for other substance abuse. Subjects in each treatment group were similar in history of cocaine and other substance abuse, cocaine craving, sociodemographics, and other psychiatric comorbidity. Desipramine, compared with both other treatments, substantially decreased cocaine use. Lithium treatment outcome did not differ from that of placebo. Desipramine-treated subjects attained contiguous periods of abstinence substantially more frequently than subjects receiving lithium or placebo. Fifty-nine percent of the desipramine-treated subjects were abstinent for at least three to four consecutive weeks during the six-week study period, compared with 17% for placebo and 25% for lithium. Cocaine craving reductions were also substantially greater in the desipraminetreated subjects. Establishment of initial abstinence is the first stage in recovery from cocaine dependence. Our findings indicate that desipramine is an effective general treatment, for this first treatment stage, in actively cocaine-dependent oupatients.

Author Affiliations
From the Departments of Psychiatry (Drs Gawin, Kleber, Byck, Rounsaville, Kosten, and Jatlow and Ms Morgan), Pharmacology (Dr Byck), and Laboratory Medicine (Dr Jatlow), School of Medicine, Yale University, and the APT Foundation (Drs Gawin, Kleber, Rounsaville, and Kosten and Ms Morgan), New Haven, Conn.

Footnotes
Accepted for publication Oct 27, 1988.

Reprint requests to the Department of Psychiatry, Yale University School of Medicine, 34 Park St, New Haven, CT 06510 (Dr Gawin).

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