The Pharmacotherapy of Relapse Prevention Using Anticonvulsants
In this pilot study, compliance with the medication was a critical determinant of treatment outcome. The target medication dose was 600 mg daily of carbamazepine, and the average dose ingested was 350 mg per day. Compliance was correlated with both reduced drug use and reduced craving. Using a 100-point scale to assess cocaine craving, those patients with zero days of compliance per week averaged 58 on this scale, those patients with 1-2 days of compliance per week averaged 50, those with 3-5 days averaged 37, and those with 6-7 days of compliance per week averaged a score of 40. This produced a highly significant correlation between days of compliance per week and reported cocaine craving scores. A similar association was shown between self-reported cocaine use and compliance. Those subjects with more than 75% compliance with daily carbamazepine use showed a 66% reduction in cocaine use, whereas those showing between 25% and 75% compliance showed only a
50% reduction in cocaine use. While the authors ascribed some of the success to the medication itself, a causal association could as easily be drawn between compliance with treatment in general and reduction in cocaine use. The one clear association between compliance and carbamazepine effects was found in methadone-maintained patients, where carbamazepine compliance was clearly associated with the precipitation of opiate withdrawal symptoms.