[Cocaine and crack addiction: a growing public health problem]

Cocaine addiction is an important public health problem worldwide, and use of this drug is growing in France. Cocaine produces its psychoactive and addictive effects primarily by acting on the brain's reward system--a set of interconnected regions that regulate pleasure and motivation. An initial short-term effect due to a build-up of the neurochemical dopamine gives rise to euphoria and to a desire to take the drug again. Cocaine's many longer-term effects include addiction, persistent craving and a high risk of relapse. Dysregulation of brain reward pathways is associated with a drastic escalation of drug-seeking behaviors and intake. Cocaine addiction is rapidly progressive and can have severe medical, psychiatric and psychosocial consequences. There are no proven pharmacotherapies for cocaine addiction. However, cocaine addiction being due to a pharmacologically induced reduction in the neuroplasticity of brain circuits mediating normal reward learning, novel pharmacotherapies directly targeting the biological pathology of addiction should be feasible. Progress in the neurobiology of cocaine dependence has enabled researchers to identify medications that might help patients initiate abstinence and avoid relapse. Several such medications, and a vaccine, have given encouraging results in controlled clinical trials with cocaine-dependent patients. Major behavioral therapies have also proven to be effective on cocaine addiction. Treatment approaches combining medication and behavioral intervention are likely to produce the best results.