Treatment, for cocaine addiction

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. 

Preliminary Drug Design, Synthesis, and Preclinical Evaluation of a Series of Novel Slow-Onset, Long-Acting DA Substitution Medications as Potential Treatments for Cocaine Addiction... 

The medicinal use of ayahuasca, a plant beverage with psychotropic effects, has been proposed as a possible treatment for cocaine addiction. Proponents of this approach argue that DMT and other hallucinogens allow the substance abuser to modify his state of consciousness. In this altered state, the substance abuser looks for a meaning in his life. 

An attempt will be made here to distill down the essence of the SAR of cocaine as it relates to its stimulant properties. In many cases, compounds have been reported that have not been tested in vivo, but have only been compared for affinity at the monoamine transporters or in an in vivo assay. Some of these data will be summarized if they are reported in the context of the stimulant effects of cocaine. Similarly, there have been numerous attempts to develop cocaine analogs that may bind to the dopamine transporter and actually block the stimulant or reinforcing effects of cocaine itself, in efforts to develop treatments for cocaine addiction. This chapter largely ignores many of those studies unless they contain in vivo data suggestingthey are relevant to a discussion of stimulant effects. Nevertheless, because stimulant properties have been associated with bindingto the DAT, a good deal of the SAR discussion here must be discussed in the context of in vitro DAT affinity. 

Shorter D, Kosten TR (2011) Novel pharma-cotherapeutic treatments for cocaine addiction. BMC Med 9 119... 

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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... 

Buprenorphine is only recommended in the rehabilitation and continuing care stages of treatment for cocaine dependence if the patient is also addicted to an opioid. 

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Catalytic antibodies generally do not approach the catalytic efficiency of enzymes, but medical and industrial uses for them are nevertheless emerging. For example, catalytic antibodies designed to degrade cocaine are being investigated as a potential aid in the treatment of cocaine addiction. 

Approximately 50% of all people entering treatment for cocaine abuse or addiction to painkillers also report abusing a benzodiazepine. As with Rohypnol users with a simultaneous alcohol addiction, those with an addiction to other drugs in addition to Rohypnol must undergo a more complex withdrawal treatment than those who are addicted to Rohypnol alone. 

An alternative strategy for the treatment of cocaine addiction involves the use of an anticocaine vaccine. Experiments in rats have demonstrated reduced desire for the drug as well as reduced uptake of cocaine into the brain. The vaccine consists of a synthetic cocaine derivative attached to proteins that trigger immune responses to cocaine. The cocaine derivative is not addictive and brain levels of free cocaine were reduced by 40-60 percent in the study. There are approximately 400,000 cocaine abusers in drug-treatment programs in the United States. 

An advantage of the hedonic allostasis hypothesis is that it provides a basis for the strong comorbidity of drug addiction and depression. However, this relationship with depression is also the limit of the hypothesis. Thus, anhedonia induced by cocaine withdrawal has been proposed as a model of depression also on the basis of the observation that antidepressants reverse withdrawal-induced anhedonia yet, antidepressants do not provide a treatment for drug addiction. Therefore it would appear that anhedonia is a condition associated to drug addiction but is not the factor that sustains its maintenance or its resumption after a long period of abstinence. 

Disulfiram (Table 1) was tested in a cohort of cocaine and opioid codependent individuals as a pharmacotherapy for cocaine addiction in a placebo controlled clinical trial [52], Patients were stabilized on methadone and the treatment group received 250 mg of disulfiram daily. Disulfiram pharmacotherapy decreased cocaine use as measured by urine cocaine metabolites, with no concomitant... 

Haile CN, Kosten TR, Kosten TA (2009) Pharmacogenetic treatments for drug addiction cocaine, amphetamine and methamphet-amine. Am J Drug Alcohol Abuse 35 161-177... 

Petrakis IF, Carroll KM, Nich C, Gordon FT, McCance-Katz EF, Frankforter T, Rounsaville BJ (2000) Disulfiram treatment for cocaine dependence in methadone-maintained opioid addicts. Addiction 95 219-228... 

Metabolism also plays a critical role in the pharmacology of cocaine. The rapid hydrolysis of cocaine via two different pathways leads to its rapid inactivation/detoxification. This rapid metabolism has been a major determinant in the methods and modes of cocaine abuse. Identification and characterization of these hydrolytic enzymes would be useful in that selective induction of these enzymes offers a potential treatment strategy for dealing with cocaine overdose. It is conceivable that long-term elevation of the enzyme or enzymatic activity could be used in conjunction with maintenance therapy for cocaine addicts. Hydrolases or esterases are also responsible for the transesterfication of cocaine. The pharmacological effect of cocaine is prolonged and enhanced when cocaine is used in conjunction with ethanol. A carboxylesterase catalyzes an ethyl transeterification of cocaine to cocaethylene, which is biologically active. 

Abuse of psychoactive chemicals can result in neurotoxic effects that are difficult to treat medically. Successful therapy is often hindered by the lack of useful antagonists for many of these chemicals and by the extensive distribution of these chemicals out of the bloodstream. Although there are treatments for opiate addiction and an antagonist for opiate overdose, there are no such medical treatments for most drugs of abuse such as phencyclidine (PCP) and cocaine. Therefore, this chapter focuses on recent advances in immunotherapy which suggest this novel approach could be beneficial in the treatment of drug abuse. 

Dewey SL, Morgan AE, Ashby CR Jr, et al. A novel strategy for the treatment of cocaine addiction. Synapse 1998 30 119-129. 

The following reaction was performed as part of a research program sponsored by the National Institutes of Health to develop therapeutic agents for the treatment of cocaine addiction. Using what you have seen about the reactions of halogens with alkenes, propose a mechanism for this process. 

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