In hospital cognitive rehabilitation was as effective as home rehabilitation in moderate to severe traumatic brain injury.

QUESTION: What is the effectiveness of disulfiram for cocaine dependence in patients who are also opioid addicts treated with methadone?DesignRandomised (allocation concealed}*,**, blinded (investigator and patient)-, placebo controlled trial with 12 weeks of follow up.SettingUrban substance abuse treatment centre in the US.Patients69 outpatients (mean age 35 y, 53% women, 74% white}* with DSM-III-R criteria for cocaine dependence who were on methadone treatment and using cocaine frequently (defined as having >/=3 urine toxicology screens positive for cocaine in the 1 mo before study). Exclusion criteria were psychotic or bipolar disorders, serious psychiatric symptoms, or contraindications to disulfiram use. Follow up was 75%. 97% were included in the analysis.InterventionPatients were allocated to disulfiram, 250 mg/day (dissolved directly in the methadone) in=37)*, or placebo in=32)* for 12 weeks. Patients used a mean methadone dose of 88.6 mg/day, and were counselled about the risk of a disulfiram alcohol interaction and advised not to drink alcohol. During the study, patients adhered to a behavioural contract with a reductiori of methadone dose for violations.Main outcome measuresFrequency and quantity of cocaine, alcohol, and other substance use were self reported and verified by urine tests and breathalyser readings.Main resultsPatients who received disulfiram had a lower mean number of days of cocaine use than those who received placebo (5.0 v 6.7 d, p = 0.04). Furthermore, those who received disulfiram had a greater mean decrease in quantity (p=0.02) of cocaine use than those who received placebo; groups did not differ for alcohol or heroin use. The effectiveness of disulfiram did not differ in patients who did and did not use alcohol at baseline.ConclusionDisulfiram was effective in patients with cocaine abuse who were also methadone treated opioid addicts with or without comorbid alcohol abuse.*Information provided by author. **See glossary. [ABSTRACT FROM AUTHOR]