Disulfiram unexpectedly embarked upon a new career in the cocaine dependence treatment field [52]. Most of the trials testing the efficacy of disulfiram in cocaine addicts enrolled subjects with comorbid alcohol and cocaine abuse or dependence, suggesting that the effect of disulfiram on alcohol would have a positive effect on cocaine use. Our decision to include this population is based on the high rates of comorbid alcohol/cocaine use. Numerous studies have shown that the majority of patients who abuse cocaine also abuse alcohol, ranging from 50% to 90% [53], [54], [55], [56], [57], [58]. This can be explained by the effect of cocaethylene, a pharmacologically active metabolite that is produced when cocaine and alcohol are used together that enhances and prolongs cocaine euphoria [59]. Our meta-analysis showed that treating these subjects with disulfiram for their cocaine problem resulted in a significant improvement of their alcohol condition. Disulfiram also showed its efficacy as compared to a control condition in the studies primarily enrolling alcoholics. The cocaine studies comprised 152 subjects from three studies. We did not include the results of three other cocaine studies because of their blind design [10], [14], [26].
