Considerations in treating cocaine dependence
Successful treatment often occurs in an outpatient setting. Initially, hospitalization may be necessary to treat withdrawal symptoms and prevent continued, compulsive use of cocaine. Outpatient treatment can be very successful; however, there are many important issues that need to be addressed and many interventions that can be helpful in treating drug-dependent patients.
Pharmacotherapy utilizing antidepressants and anticonvulsants, as well as dopaminergic and opioid antagonists/mixed agonists, has been used with varying results. These agents continue to play an uncertain role in the primary treatment of cocaine dependence. Pharmacologic treatments may be necessary to target secondary (cocaine-induced) or coexistent psychiatric disorders, both of which can complicate treatment if not addressed.
“Sensitization” to cocaine may add to the occurrence of psychiatric symptoms, as a person will have greater hyperactivity when rechallenged with cocaine. “Kindling,” a phenomenon in which lower doses over time produce the same or larger undesired effect (such as seizures or hallucinations), is also associated with cocaine usage. Kindling might also be responsible for worsening of psychiatric symptoms, especially psychosis and suspiciousness.
The incidence of hallucinations appears to be increasing secondary to an increase in cocaine dependence, mainly crack, as evidenced by a reported incidence of hallucinations associated with cocaine dependence of 18% in 1978 compared with 96% in 1991. This increase would also be consistent with a kindling model. Pharmacologic agents that decrease kindling, such as valproic acid and carbamazepine, may potentially be useful in treatment. All psychiatric symptoms need to be treated aggressively to prevent them from getting worse as well as more frequent. If suspiciousness, paranoia, and hallucinations continue after the person stops using cocaine, a dopamine blocker, such as haloperidol, should be considered.
The reinforcing properties of cocaine leave a positive memory of the cocaine experience, which usually overrides any negative memory produced by the drug. Extinguishing these positive memories of pleasure and ecstasy occurs over years through continued abstinence and intensive treatment. Behavioural “cues” that stimulate intense craving for cocaine must be learned and avoided.
Successful treatment usually involves 12-step programs, behavioural and supportive psychotherapy, as well as family therapy, as this illness affects everyone in a family. Neurotransmitter levels must be allowed to normalize. Recovering addicts may require initial and/or long-term treatment with nonaddictive medications to help normalize brain chemistry. All substances with potential for abuse need to be stopped. Learning and practicing alternative, safe activities that produce pleasure and “reinforcement” are essential in treatment and recovery.
Comorbidity of substance use disorders and psychiatric disorders is highly likely. In the National Institute of Mental Health Epidemiologic Catchment Area (ECA) study, 53% of patients with a nonalcohol drug disorder were also found to have a comorbid psychiatric disorder. Pharmacologic treatments are often useful to deal with secondary (cocaine-induced) or coexistent psychiatric disorders, both of which can complicate treatment and recovery if not addressed.
Treatment for a person with cocaine abuse or dependence requires considerable preplanning before initiation. Practitioners need to be prepared to discuss the psychological and physical consequences of continued use. Having a referral network of practitioners or programs that specialize in the treatment of cocaine use disorders is important. Equally important is understanding the components of the treatment program so one can adequately explain the program and prepare the patient. Practitioners and patients should expect the use of nonaddictive, psychopharmacologic treatments for comorbid and secondary psychiatric disorders. Practitioners' familiarity with current behavioural interventions and support groups can be beneficial in patients' long-term treatment programs.
The Have I Got A Problem website is a free online resource to help people better understand any issues or concerns they may have about mental health or addiction. The website includes resources specifically focused to; general Mental Health, Depression, Stress, Anxiety, Insecurities, Self-harm Schizophrenia, Bipolar, Anger Management, Eating Disorders, Coping, general Addiction, Alcohol, Smoking, Gambling, Drugs, Cocaine, Heroin, Marijuana (Cannabis) Ecstasy, PCP, Mephedrone, Ketamine & Crystal Meth.
The site was created to give the public information to help them understand mental health and addiction issues and to assist people in making better informed decisions about their life and personal choices.
www.haveigotaproblem.com was created and is run by 'Advising Communities’, which is a UK registered charity (Charity No. 1061055)
Downloads
Quotes
"Because of cocaine, I am the girl who sells dreams in a gentlemen's club, where you never actually meet 'gentleman' just bunch of horny guys. I am that girl who I never wanted to become."
Scarlett
MoreSend us your QuotesTips & Hints
Drugs Decide to make a change
For many people struggling with addiction, the biggest and toughest step toward recovery is deciding to make a change. It’s normal to...MoreReach out for support
Don’t try to go it alone. Whatever treatment approach you choose, having a solid support system is essential. The more positive influ...MoreKeep triggers and cravings in check
While getting sober from drugs is an important first step, it’s only the beginning of the recovery process. Once sober, the brain nee...MoreLook for help
There are many groups and organizations available to help you overcome your addiction. Once you have set your mind to beating your addi...MoreMake a life change
The first step to fighting addiction is to make a decision that it is time to make a life change. That life change will reflect your de...More More Tips & Hints
