Psychostimulant abuse: the case for combined behavioral and pharmacological treatments

Behavioral and pharmacological therapies have been used alone and in combination for the treatment of substance abuse; however, to date, no single treatment approach for psychostimulant abuse has demonstrated widespread efficacy. This paper describes the various functions that are served by both behavioral therapies and pharmacotherapies and their respective mechanisms of action. It is argued that combined treatments can be expected to produce additive effects because the two approaches operate through different and potentially complementary mechanisms. Illustrations of these underlying principles and experimental support for the use of combined treatments are drawn from smoking cessation research, which has broadly applied combined behavioral and pharmacological therapies for treating abuse of nicotine, a mild stimulant. In addition, the results of recent studies that have evaluated the efficacy of behavioral techniques and/or potential pharmacotherapies for treating cocaine abuse are reviewed. Finally, methodological strategies are recommended for future evaluations of combined therapy approaches to conclusively evaluate separate and combined efficacy of treatments for psychostimulant abuse.