Treatment of cocaine dependence

August 6, 2011

The treatment of addiction in general and cocaine in particular requires a focus on eliminating all use of cocaine and all other mood-altering drug use. Abstinence is the treatment goal. The reason for abstinence from other mood-altering drugs in addition to cocaine is the common pattern of initially quitting cocaine only to continue to use alcohol or marijuana, with the rapid relapse back to cocaine use. The disinhibition associated with other drug or alcohol use, combined with a rapid intense escalation of cocaine cravings, frequently results in a relapse. For more information on general principles of addiction treatment and the maintenance of abstinence, see the entry Substance use—”Abuse” and “Dependence.”

Cocaine addiction can involve a high degree of physical dependence—primarily affecting the brain. Cocaine withdrawal symptoms are virtually all mediated by brain changes and thus have historically been termed “psychological or psychiatric,” but given that the brain is a physical organ, it is most appropriate to consider these physical effects. The symptoms include mood swings, depression, irritability, difficulty concentrating, vivid dreams and intrusive thoughts about using cocaine, sleep disorder, periodic increased heart rate and hand tremor and sweating, and a persistent urge to use cocaine. Detoxification from cocaine frequently involves physical removal from “using” opportunities, provision of a supportive therapeutic sober environment, and treatment of psychological or psychiatric symptoms that may precipitate relapse. In addition, a trial of detoxification medications is common, including possibly beta-blockers or alpha agents, and medications used to treat Parkinson’s disease. Medications are in clinical study that may be able to block cocaine’s effect, or even work like an anticocaine immunization or vaccine.

Rehabilitation refers to an inpatient residential or outpatient program that commonly lasts a month or more and entails daily counseling to develop skills to avoid cocaine and all drug and alcohol use for life. Maintaining abstinence can be quite difficult when faced by cocaine cravings and dreams, especially in a society where the majority of people are social or lowrisk users of alcohol. There are special self-help meetings specifically developed for cocaine dependence called Cocaine Anonymous or “CA.” For more information regarding self-help “12-step” meetings, see the entry Substance use.

SEE ALSO: Addiction, Addiction ethics, Chemical dependence, Heroin, Injection drug use

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Category: Cocaine