There was an enormous increase in the number of people seeking treatment for cocaine addiction during the 1980s and 1990s. Treatment providers in most areas of the country, except in the West and Southwest, report that cocaine is the most commonly cited drug of abuse among their clients. The majority of individuals seeking treatment smoke crack and are likely to be users of more than one substance.
The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse. Cocaine abuse and addiction is a complex problem involving biological changes in the brain as well as a myriad of social, familial, and environmental factors. Therefore, treatment of cocaine addiction is complex. Like any good treatment plan, cocaine treatment strategies need to assess the psychobiological, social, and pharmacological aspects of the patient's drug abuse.
There are no medications currently available to treat cocaine addiction specifically. Consequently, NIDA is aggressively pursuing the identification and testing of new cocaine treatment medications. Several emerging compounds are being investigated to assess their safety and efficacy. Topiramate and modafanil, two marketed medications, have shown promise. Additionally, baclofen, a GABA-B agonist, showed promise in a subgroup of cocaine addicts with heavy use patterns. Antidepressant drugs are of some benefit with regard to mood changes experienced during the early stages of cocaine abuse. Medical treatments are also being developed to deal with acute emergencies resulting from excessive cocaine abuse.
Many behavioral treatments have been found effective for cocaine addiction, including both residential and outpatient approaches. Indeed, behavioral therapies are often the only available effective treatment for many drug problems, including cocaine addiction. However, integration of both pharmacological and behavioral treatments may ultimately prove to be the most effective approach. Disulfiram (a medication that has been used to treat alcoholism), in combination with behavioral treatment, is effective in reducing cocaine abuse. It is important that patients receive services that match all of their treatment needs. For example, if a patient is unemployed, it may be helpful to provide vocational rehabilitation or career counseling. Similarly, if a patient has marital problems, it may be important to offer couples counseling. A behavioral therapy component that may be particularly useful for helping patients achieve initial abstinence from cocaine is contingency management. Some contingency management programs use a voucher-based system to give positive rewards for staying in treatment and remaining cocaine-free.
Cognitive-behavioral treatment is a focused approach to helping cocaine-addicted individuals abstain—and remain abstinent—from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and dependence. The same learning processes can be employed to help individuals reduce drug use and successfully cope with relapse. This approach attempts to help patients recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems associated with drug abuse. This therapy is also noteworthy because of its compatibility with a range of other treatments patients may receive, such as pharmacotherapy.
Therapeutic communities (TCs), or residential programs with stays of 6 to 12 months, offer another alternative to those in need of treatment for cocaine addiction. TCs focus on resocialization of the individual, and can include on-site vocational rehabilitation and other supportive services. Of course, there is variation in the types of therapeutic processes offered in TCs.
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- National Institute of Drug Abuse
- American Council for Drug Education
Cocaine. Last reviewed 04/15/2008