Cocaine abuse - treatment of a growing problem

At this time , there is no definitive treatment for the growing problem of cocaine addiction [see Reactions 247.' 2, 22 Apr 1989]. Withdrawal symptoms can not only be uncomfortable for the patient but can also be life-threatening . Treatment should include behavioural , supportive , psychodynamic and psychopharmacological Interventions. The type of medication used should help alleviate the effects that occur during cocaine withdrawal.

Ant idepressant treatment has been used to reduce the cravi ng of cocaine whether or not depression was present. Desipramine was found to promote abstinence in patients In several studies but did not significantly affect cocaine­induced euphoria . One brief study using low doses showed tha t desipramine was no different than placebo in reducing cocaine craving . The combination of imipramine , L-tryptophan and L-tyrosine caused abstinence in 12 of 14 patients and blocked cocaine-induced euphoria in 3 of 4 patients in another study.

Maprotiline and trazodone have also been effective in achieving abstinence and reduced cocaine craving in a few studies . Monoamine oxidase inhibitors have been used when previous treatments have failed but the combination of cocaine and monoamine oXidase inhibitors can precipitate a hypertensive criSIS . Therefore this treatment should be used in a controlled setting when other therapies have failed .

A few studies have indicated that lithium may be effective in alleviating cocaine-Induced euphoria or promoting abstinence but most studies have shown that lithium has little effect and should be reserved for use in patients with a history of bipolar or cyclothymic disorders not related to cocaine withdrawal.

A small study of 7 cocaine abusers showed that bromocriptine 2 to 12.5 mgj day decreased cocaine craving but bromocriptine has some adverse effects such as nausea, headaches , dizziness , sedation and hallucinations. that are similar to cocaine withdrawal. Bromocriptine has not been studied In long term use and may have abuse potential. whereas reduced craving and promot ion of abstinence with amantadine have been demonstrated in 1 study.

Stimulants , especially methylphenidate. have been shown to promote abstinence and reduce cocaine craving in patients with attention deficit disorder-residual type . The use of methylphenidate should be restncted to these patients . Neuroleptic therapy should be limited to those patients with cocaine-induced psychosis since neuroleptic agents mainly reduce the paranoid delusions that can occur but have not demonstrated any effect on cocaine-induced euphoria.

Buspirone, L-trytophan and L-tyrosine have all been used to decrease cocaine craving but studies need to be performed to determine their effectiveness. The incidence of cocaine abuse will

probably Increase, so effect ive treatments need to be found . All treatments to date work on the symptoms or adverse effects of the addiction rather than the addiction of cocaine itself. Pollack MH Brotman AW Rosenbaum JF Cocaine abuse and treatment Comprehensive Psychiatry 30 31 -44 Jan Feb t989 [82 references] 902'