The HPA axis in cocaine use: implications for pharmacotherapy

The role of the hypothalamic-pituitary-adrenal (HPA) axis in cocaine use is reviewed within the context of two approaches to developing pharmacological treatments in humans: (1) reducing the reinforcing effects of cocaine and (2) reducing cocaine addict's susceptibility to stress-induced relapse. This review suggests that HPA-axis-suppressing medications are unlikely to block cocaine's reinforcing effects completely but may be useful in decreasing the frequency of use by increasing the addicted individual's resistance to stress-induced relapse. Implications for designing inpatient studies to test the safety and efficacy of candidate pharmacological agents are discussed.