Addictions cocaine

A series of papers dealing with the investigation of cocaine addiction may also be noted. 

Gawin FH Cocaine addiction psychology and neurophysiology. Science 251 1580-1586, 1991... 

Kranzler HR, Bauer LO, Hersh D, et al Carbamazepine treatment of cocaine dependence a placebo-controlled trial. Drug Alcohol Depend 38 203-211, 1995 Levin FR, Lehman AF Meta-analysis of desipramine an adjunct in the treatment of cocaine addiction. J Clin Pharmacol 11 374-378, 1991 Lima MS, Reisser AA, Soares BG, et al Antidepressants for cocaine dependence. Cochrane Database Syst Rev 4 CD002950, 2001 Ling W, Shoptaw S, Majewska D Baclofen as a cocaine anti-craving medication a preliminary clinical study 0etter). Neuropsychopharmacology 18 403 04, 1998... 

Bohn MJ, Kranzler HR, Beazoglou D, et al Naltrexone and brief counseling to reduce heavy drinking results of a small clinical trial. Am J Addict 3 91—99, 1994 Budney AJ, Higgins ST A Community Reinforcement Plus Vouchers Approach Treating Cocaine Addiction. (NIDA Puhl No 98 309). Rockville, MD, National Institute on Drug Abuse, 1998... 

In the vertebrate CNS monoamines have been associated with a number of physiological functions (reviewed in Kandel et al., 1991). Serotonin has functions associated with mood, pain, sleep, learning, and memory. Dopamine has functions associated with schizophrenia, Parkinson s disease, and cocaine addiction. In vertebrates, dopamine is further metabolized into two additional neurotransmitters, norepinephrine and epinephrine. Norepinephrine increases the excitability of cells in response to sudden sensory input such as fear. Epinephrine has been identified in specific neurons of the brain, but the function of these cells is unknown. In addition, AADC has also been found in a class of neurons that do not have any of the four neurotransmitters discussed above (Jaeger et al., 1983). These neurons may use one of the trace amines, tyramine, tryptamine, or phenylethylamine, as a neurotransmitter. 

Kreek, M.J., Bart, G., Lilly, C., LaForge, K.S., and Nielsen, D.A., Pharmacogenetic and human molecular genetics of opiate and cocaine addictions and their treatments, Pharmacol. Rev., 57, 1, 2005. 

Weddington, W.W., Brown, B.S., Haertzen, C.A. et al. Changes in mood, craving, and sleep during short-term abstinence reported by male cocaine addicts. A controlled, residential study. Arch. Gen. Psychiatry. 47 861, 1990. 

Maurice, T., Martin-Fardon, R., Romieu, P., Matsumoto, R.R. Sigma(l) (sigma(l)) receptor antagonists represent a new strategy against cocaine addiction and toxicity. Neurosci. Biobehav. Rev. 26 499, 2002. 

Nestler, E.J. Historical review Molecular and cellular mechanisms of opiate and cocaine addiction. Trends Pharmacol. Sci. 25 210, 2004. 

Hurd Y., Herkenham M. Molecular alterations in the neostriatum of human cocaine addicts. Synapse. 13 357, 1993. 

Satel S. Craving for and fear of cocaine A phenomenologic update on cocaine craving and paranoia. In Kosten T., Kleber H., Eds. Clinician s Guide to Cocaine Addiction. Guilford Press, New York, 1992, 172. 

Roberts D.C. Preclinical evidence for GABA(B) agonists as a pharmacotherapy for cocaine addiction. Physiol. Behav. 86 18, 2005. 

In the epidemiological tracking of agitated delirium victims in Metropolitan Dade County, men with preterminal delirium comprised approximately 10% of the annual number of cocaine overdose deaths. The demographic trends show that the proportion of these cases remains consistent throughout the epidemic of cocaine abuse and tends to track the annual frequency of cocaine-related sudden deaths. This observation suggests that a certain percentage of cocaine addicts may be at risk for cocaine delirium with chronic abuse. 

Carroll KM (1998). A Cognitive-Behavioral Approach Treating Cocaine Addiction (NIH Publication No. 98-4308). National Institute on Drug Abuse, Rockville, MD. 

Gawin FH (1991). Cocaine addiction Psychology and neuropsychology. Science, 251, 1580-1586. 

Ziedonis DM and Kosten TR (1991). Pharmacotherapy improves treatment outcome in depressed cocaine addicts. Journal of Psychoactive Drugs, 23, 417-425. 

Antidepressants. The tricyclic antidepressant desipramine has shown some small success in reducing cocaine craving, but the results are not overly impressive, and desipramine has many well-documented side effects and is dangerous in overdose (see Chapter 3 for more information). Cocaine-abusing patients who are not highly motivated will usually not remain adherent to the desipramine prescription. We do not recommend desipramine for the nondepressed cocaine addict. 

Dopamine-Stimulating Medications. A variety of drugs that increase the availability of dopamine have been studied in cocaine addicts including L-DOPA, bupropion, amantadine, and methylphenidate. In small uncontrolled trials, these have shown some benefit, but definitive studies have yet to be performed. In addition, some dopamine-stimulating medications (in particular, the stimulants like methylphenidate or the amphetamines) are themselves subject to abuse, though, of note, this is typically not a problem when they are prescribed to patients who do not have a history of substance abuse such as, for example, in the treatment of attention deficit-hyperactivity disorder. 

The cocaine addict most often presents during withdrawal after a binge of cocaine use. Cocaine withdrawal is not life threatening and does not require medical intervention in the same sense as alcohol or opiate withdrawal. It is, however, associated with a profound depression that can render the addict suicidal for 24-48 hours. The crashing cocaine addict should be assessed for suicide risk and, if indicated, the patient should be monitored in an emergency psychiatric setting or may require a brief 1-2 day inpatient psychiatric admission until the withdrawal resolves and the suicide risk is relieved. 

Once the crash has abated, the patient should be reassessed and treatment recommendations made. Psychosocial treatments are the mainstay of treatment for cocaine addicts. Intensive outpatient programs and partial hospitalization programs are most effective during the initial phase of treatment. Psychotherapy and self-help treatment can help the patient devise means to manage craving and sustain sobriety. 

Psychiatric medications do not currently play a prominent role in the treatment of cocaine-dependent patients (see Table 6.4). Although researchers have labored to find medications to treat cocaine addiction, there have not been any notable breakthroughs. As with other substance use disorders, the presence of a psychiatric disorder for which medication is indicated (i.e., depression, anxiety disorders, bipolar affective disorder, or schizophrenia) should prompt appropriate treatment. Similar to the presence of alcohol intoxication, deferring a diagnosis for a day or two in a new patient with no past history is often the more prudent course. 

Unlabeled Uses Treatment of cocaine addiction, hyperprolactinemia associated with pituitary adenomas, neuroleptic malignant syndrome... 

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