A controlled trial of the adjunct use of D-Cycloserine to facilitate cognitive behavioral therapy outcomes in a cocaine-dependent population

• Authors: Ashley P. Kennedy, Emory University; Robin E. Gross, Emory University; Natasha Nicole Whitfield, Emory University; Karen Drexler, Emory University; Clinton D. Kilts, Emory University
• Journal Title: Addictive Behaviors
• Volume: Volume 37, Number 8
• Publisher: Elsevier | 2012-08-01, Pages 900-907
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.addbeh.2012.03.008
• Subjects: Psychology, Behavioral; Health Sciences, General; Psychology, Clinical
• Keywords: Social Sciences; Science & Technology; Life Sciences & Biomedicine; Psychology, Clinical; Substance Abuse; Psychology; D-Cycloserine; Addiction; Cognitive behavioral therapy; Cocaine; Clinical trial; Memory; CONDITIONED PLACE PREFERENCE; D-ASPARTATE RECEPTOR; OBSESSIVE-COMPULSIVE DISORDER; EXPOSURE THERAPY; SYNAPTIC PLASTICITY; RANDOMIZED-TRIAL; DRUG-SEEKING; FOLLOW-UP; EXTINCTION; ADDICTION

Abstract

Cocaine dependence is a chronically relapsing disorder for which its predominant behavioral therapies are associated with only partial efficacy. The goal of this study was to determine if the N-methyl- d-aspartate (NMDA) glutamate receptor partial agonist and cognitive enhancer, d-cycloserine (DCS), could boost the cocaine abstinence and treatment retention goals of cognitive behavioral therapy (CBT). This study employed a placebo-controlled, randomized double-blind trial design of 44 cocaine-dependent men enrolled in a 4-week outpatient Substance Abuse Treatment Program (SATP) at the Atlanta Veteran's Administration Medical Center. Subjects received 50. mg of DCS or placebo prior to four weekly sessions of a condensed version of a manual-based CBT for cocaine dependence. Cocaine abstinence and treatment retention measures represented primary outcome variables. Relative to a 12-step based treatment-as-usual, an under-dosed CBT was associated with significant improvements in drug abstinence and treatment retention at 4-weeks and for maintenance of drug abstinence after four more weeks of follow-up. The robust response to the under-dosed CBT was not enhanced by the adjunct administration of DCS at either the 4- or 8-week endpoints. This controlled clinical trial failed to demonstrate an ability of DCS to boost the relapse prevention or treatment retention goals of CBT.