Levodopa pharmacotherapy for cocaine dependence: choosing the optimal behavioral therapy platform
Open accessAbstract
Background The dopamine precursor levodopa has shown some, albeit relatively weak, promise in treating cocaine dependence. This study sought to identify the most appropriate behavioral therapy platform for levodopa pharmacotherapy by evaluating its effect when administered in combination with behavioral platforms of varying intensities.Method A total of 161 treatment-seeking cocaine dependent subjects received sustained release levodopa/carbidopa (400/100mg bid, Sinemet) or placebo delivered in combination with Clinical Management (ClinMan); ClinMan+cognitive behavioral therapy (CBT); or ClinMan+CBT+voucher-based reinforcement therapy (VBRT) in a 12-week randomized, placebo-controlled, double-blind (for medication condition) trial. Medication compliance was monitored with riboflavin (100mg/capsule) and the Medication Event Monitoring System. Protocol compliance was addressed in weekly, 10-min nurse-delivered ClinMan sessions. Weekly, 1-h CBT sessions focused on coping skills training. VBRT (with escalating reinforcer value) provided cash-valued vouchers contingent on cocaine-negative urine toxicology results. Urine benzoylecgonine assays collected thrice-weekly were analyzed by intention-to-treat criteria using generalized linear mixed models.Results Levodopa main effects were found on all outcome measures of cocaine use. Contrasts testing the levodopa-placebo difference within each behavioral platform found reliable effects, favoring levodopa, only in the VBRT platform. Levodopa treatment with vouchers produced higher proportions of cocaine-negative urines and longer periods of consecutive abstinence compared to other treatment combinations.Conclusion This is the first study to find a significant treatment effect for levodopa and, in doing so, to demonstrate that the magnitude of this effect is dependent upon conditions of the behavioral therapy platform. The data support use of levodopa with abstinence-based reinforcement therapy as one efficacious combination in cocaine dependence disorder treatment.
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Levodopa/carbidopa was most effective when combined with a behavioral treatment that uses positive reinforcement to shift behavior.
“a recent study showed that levodopa/carbidopa was most effective when combined with a behavioral treatment that uses positive reinforcement to shift behavior (Schmitz et al., 2008)”
From Imaging addiction: D2 receptors and dopamine signaling in the striatum as biomarkers for impulsivity (2014) · cites this paper as Schmitz et al., 2008
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- Authors
- Schmitz, J. M., Mooney, M. E., Moeller, F. G., Stotts, A. L., Green, C., & Grabowski, J.
- Affiliations
- University of Minnesota (US)
- University of Minnesota, Duluth (US)
- Corresponding author
- Schmitz, Joy M.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2008-04
- Volume
- 94
- Issue
- 1-3
- Pages
- 142-150
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC2293271
- OpenAlex
- W2069296272
- Cited by
- 124
- References
- 70
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 4 · 2022: 3 · 2021: 3 · 2020: 48 · 2019: 4 · 2018: 2 · 2017: 1 · 2016: 5 · 2015: 5 · 2014: 9 · 2013: 6 · 2012: 8
- FWCI
- 4.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5p50da009262-20)
- National Institute on Drug Abuse (K02DA000403, #P50 DA009262, K02DA00403, K01DA019446, R01DA030787, P50-DA-9262)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- levodopa, cocaine dependence, cocaine dependence treatment, cognitive behavioral therapy, clinical management, dopamine precursor, medication adherence
- MeSH terms
- Adult, Combined Modality Therapy, Double-Blind Method, Female, Humans, Levodopa, Male, Patient Acceptance of Health Care, Patient Compliance, Retention, Psychology, Severity of Illness Index, Cognitive Behavioral Therapy, Dopamine Agonists, Cocaine-Related Disorders, Diagnostic and Statistical Manual of Mental Disorders
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