Treatment of cocaine abuse: pharmacotherapy

Until recently the treatment of cocaine addicts was limited to non-pharmacological methods because cocaine abuse was viewed as a psychological addiction to the drug's euphoriant effects. Chronic stimulant abuse is now known to lead to neurophysiological adaptation. This physiological evidence, and the failure of many patients to respond adequately to psychological treatment, prompted clinicians and researchers to explore numerous pharmacological agents in the early 1980s. Promising medications that may affect the euphoria, the craving, withdrawal, or the toxic effects associated with cocaine are under development. Potential pharmacological agents being studied include tricyclic antidepressants, anticonvulsants, neurotransmitter precursors, stimulants and dopamine agonists, serotonin re-uptake blockers and agonists, neuroleptics and opioid agonists/antagonists. Most of the research to date is on anti-craving agents. While many positive clinical reports exist, most reports are anecdotal and uncontrolled. The available data are reviewed. Potential pharmacotherapies require further research to elucidate the differences between treatments, the target populations, the optimal dosages and duration, and the interaction with behavioural and psychotherapeutic approaches.