Pharmacotherapies for Cocaine Use
The development of pharmacological treatments for cocaine abuse has been based on the premise that an altered neurochemi-cal substrate underlies the chronic, high-intensity (binge) use and acute abstinence/withdrawal that follows binge use. This neuroadaptation model has also served as a basis for a number of studies that have evaluated the clinical utility of psychotropic agents that, based on their pharmacological profile, might pos-sess anticraving properties, block euphoria, or decrease cocaine abstinence symptoms. To date, no medication has emerged as an accepted effective pharmacotherapy.
Several common problems are encountered in the
treatment of patients with cocaine use disorders. These include: 1) relapse to
cocaine use, 2) comorbid psychiatric disorders, 3) comorbid sub-stance use
disorders, 4) premature treatment termination and 5) treatment refractoriness.