Cocaine abuse treatment

Pollack M, Brotman A Rosenbaum J (1989). Cocaine abuse treatment. Comprehensive Psychiatry, 30, 31-44... 

Gorelick, D. A. (1998) The rate hypothesis and agonist substitution approaches to cocaine abuse treatment Adv. Pharmacol. 42, 995-997. 

Kim DI, Deutsch HM, Ye XC, Schweti MM. Synthesis and pharmacology of site-specific cocaine abuse treatment agents Restricted rotation analogues of methylphenidate. / Med Chem. 2007 50 2718-2731. 

The development of effective pharmacotherapy has lagged behind progress in understanding the reward mechanisms and chronic impairments underlying stimulant abuse. Pharmacological and behavioral treatment approaches that have been used for cocaine abuse have not been as widely tested for the treatment of amphetamine abuse, limiting what can be offered for treatment of this disorder. No treatment agents are approved by the FDA for treatment of cocaine or amphetamine dependence. 

Because chronic cocaine use appears to reduce the efficiency of central dopamine neurotransmission, a number of dopaminergic compounds, including amantadine, bromocriptine, mazindol, and methylphenidate, have been examined as treatments for cocaine abuse. It is thought that these relatively slow-onset dopaminergic agents, with low or relatively low abuse potential, would correct the dopamine dysregulation and alleviate withdrawal symptoms following chronic stimulant use. 

Chermack ST, Blow FC Violence among individuals in substance abuse treatment the role of alcohol and cocaine consumption. Drug Alcohol Depend 66 29—37, 2002... 

Kosten TR, Kleber HD Rapid death during cocaine abuse a variant of the neuroleptic malignant syndrome Am J Drug Alcohol Abuse 14 335-346, 1988 Kosten TR, Kleber HD, Morgan C Treatment of cocaine abuse with buprenorphine. Biol Psychiatry 26 637—639, 1989... 

Schmitz JM, Averill P, Stotts AL, et al Fluoxetine treatment of cocaine-dependent patients with major depressive disorder. Drug Alcohol Depend 63 207-214,2001 Schottenfeld RS, Pakes JR, Oliveto A, et al Buprenorphine vs methadone maintenance treatment for concurrent opioid dependence and cocaine abuse. Arch Gen Psychiatry 54 713-720, 1997... 

In other substance use disorders, the use of 12-step interventions is also popular, and participation in 12-step groups is correlated with better outcomes in cocaine abusers (e.g., McKay et al. 1994). However, a smdy of 128 cocaine abusers found that cognitive-behavioral therapy was more efficacious than 12-step facilitation in engendering cocaine abstinence (Maude-Griffm et al. 1998). Thus, the relative efficacy of 12-step approaches for drug use disorders requires further investigation. No known studies have systematically evaluated the efficacy of 12-step treatments in opioid-dependent patients, either alone or in conjunction with pharmacotherapies. 

Rawson RA, Huber A, McCann M, et al A comparison of contingency management and cognitive-behavioral approaches during methadone maintenance treatment for cocaine dependence. Arch Gen Psychiatry 59 817—824, 2002 Rohsenow DJ, Monti PM, Martin RA, et al Motivational enhancement and coping skills training for cocaine abusers effect on substance use outcomes. Addiction... 

Zhan C-G (2006) Modeling Reaction Mechanism of Cocaine Hydrolysis and Rational Drug Design for Therapeutic Treatment of Cocaine Abuse. 4 107-159 Zuccato C, see Gambari R (2007) 9 265-276... 

Outpatient group members were very similar to the inpatient PCP abusers in most sociodemographic and drug-use characteristics. Their mean age was 29 years, educational level 12.6 years, and number of prior arrests 1.5. The majority of outpatients were black (83 percent), unmarried (67 percent), and unemployed (67 percent). Their mean duration of PCP use was almost 8 years, with, usually, no prior or recent substance abuse treatment. Thirty-seven percent used PCP at least daily, always by smoking. Like the inpatient PCP abusers, outpatients frequently (87 percent) reported abuse of other drugs alcohol (46 percent), marijuana (46 percent), and cocaine (37 percent). Several outpatients for whom cocaine was the preferred drug of abuse used PCP as a "cheaper high" when cocaine was not affordable. 

The treatment goals for withdrawal from ethanol, cocaine/ amphetamines, and opioids include (1) a determination if pharmacologic treatment of withdrawal symptoms is necessary, (2) management of medical manifestations of withdrawal such as hypertension, seizures, arthralgias, and nausea, and (3) referral to the appropriate program for substance abuse treatment. 

Pollack M., Rosenbaum J. Fluoxetine treatment of cocaine abuse in heroin addicts. J. Clin. Psychiatry. 52 31, 1991. 

A series of DAT selective 3-phenyltropanes have been reported to have potential for treatment of cocaine abuse [33,36,37]. RTI-336,15 (reuptake IC50 — 4.1 nM) was the most potent among these tropane derivatives in locomotor activity and drug discrimination it was less stimulatory than cocaine, and had the slowest onset and longest duration of action. It also reduced self-administration of cocaine in rats and rhesus monkeys. Interestingly, in rhesus monkeys trained to self-administer cocaine, when coadministrated with either citalopram or sertraline, 15 produced significantly more robust reductions in cocaine self-administration compared with 15 alone [38]. 

Rogers PJ, Dernoncourt C. (1998). Regular caffeine consumption a balance of adverse and beneficial effects for mood and psychomotor performance. Pharmacol Biochem Behav. 59(4) 1039-45. Rounsaville BJ, Anton SF, Carroll K, Budde D, Prusoff BA, Gawin F. (1991). Psychiatric diagnoses of treatment-seeking cocaine abusers. Arch Gen Psychiatry. 48(1) 43-51. 

Immunopharmacotherapy has recently appeared as a viable treatment strategy for cocaine abuse using an animal model for relapse. Larsen et al were the first to construct a monoclonal antibody, GNC92H2, that was raised against hapten GNC (Figure 27(a)), and that was found to bind selectively to cocaine with respect to its metabolites with a of 10 mol 1 (Figure 27(b)). 

When diagnosing a substance use disorder, it is named in accordance with the substance that is being misused. Patients can be said to have alcohol abuse or dependence, cocaine abuse or dependence, opiate abuse or dependence, and so forth. In severe cases when the patient is misusing several substances, (s)he is diagnosed with polysubstance dependence. The complete list of DSM-IV substance use disorders is shown in Table 6.3. Although the diagnostic criteria for the specific substance use disorders are uniform from substance to substance, certain features of the addiction are specihc to the substance being misused. The typical age of onset, the course of the disorder, and the treatment of the disorder vary by substance. Nevertheless, many features of substance abuse and substance dependence are similar across substances. 

Goodman, C., et. al. (1997). Market Barriers to the Development of Pharmacotherapies for the Treatment of Cocaine Abuse and Addiction Final Report The Lewin Group, http //aspe.hhs.gov/health/reports/ cocaine/final.htm (for full report)... 

Carroll, F. L, Howell, L. L. and Kuhar, M. J. 1999. Pharmacotherapies for treatment of cocaine abuse Preclinical aspects. Journal of Medical Chemistry, 42 299-302. 

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