Cocaine Rehab and Treatment

What treatments are effective for cocaine abusers?
There has been an enormous increase in the number of people seeking treatment for cocaine addiction during the 1980’s and 1990’s. Treatment providers in most areas of the country, except in the West and Southwest, report that cocaine is the most commonly cited drug of abuse among their clients. The majority of individuals seeking treatment smoke crack, and are likely to be users of more than one substance. The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse. Cocaine addiction and use is a complex problem involving biological changes in the brain as well as a myriad of social, familial, and environmental factors. Therefore, treatment of cocaine addiction is complex, and must address a variety of issues. Like any good treatment plan, cocaine treatment strategies need to assess the psychobiological, social, and pharmacological aspects of the patient’s drug abuse.

Pharmacological Approaches
There are no medications currently available to treat cocaine addiction specifically. Consequently, NIDA is aggressively pursuing the identification and testing of new cocaine treatment medications. Several newly emerging compounds are being investigated to assess their safety and efficacy in treating cocaine addiction. Topiramate and modafanil, two marketed medications, have shown promising signals as potential cocaine treatment agents. Additionally, baclofen, a GABA-B agonist, showed promise in a subgroup of cocaine addicts with heavy use patterns. Because of mood changes experienced during the early stages of cocaine abstinence, antidepressant drugs have been shown to be of some benefit. In addition to the problems of treating addiction, cocaine overdose results in many deaths every year, and medical treatments are being developed to deal with the acute emergencies resulting from excessive cocaine abuse.

Behavioral Interventions
Many behavioral treatments have been found to be effective for cocaine addiction, including both residential and outpatient approaches. Indeed, behavioral therapies are often the only available, effective treatment approaches to many drug problems, including cocaine addiction, for which there is, as yet, no viable medication. However, integration of both types of treatments may ultimately prove to be the most effective approach for treating addiction. Disulfiram (a medication that has been used to treat alcoholism), in combination with behavioral treatment, has been shown, in clinical studies, to be effective in reducing cocaine abuse. It is important that patients receive services that match all of their treatment needs.

For example, if a patient is unemployed, it may be helpful to provide vocational rehabilitation or career counseling. Similarly, if a patient has marital problems, it may be important to offer couples counseling. A behavioral therapy component that is showing positive results in many cocaine-addicted populations is contingency management. Contingency management may be particularly useful for helping patients achieve initial abstinence from cocaine. Some contingency management programs use a voucher-based system to give positive rewards for staying in treatment and remaining cocaine free. Based on drug-free urine tests, the patients earn points, which can be exchanged for items that encourage healthy living, such as joining a gym, or going to a movie and dinner.

Cognitive-behavioral therapy, or Relapse Prevention, is another approach. Cognitive-behavioral treatment, for example, is a focused approach to helping cocaine-addicted individuals abstain,and remain abstinent,from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and dependence. The same learning processes can be employed to help individuals reduce drug use and successfully cope with relapse. This approach attempts to help patients recognize, avoid, and cope; i.e., recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviors associated with drug abuse. This therapy is also noteworthy because of its compatibility with a range of other treatments patients may receive, such as pharmacotherapy.

Therapeutic communities (TCs), or residential programs with planned lengths of stay of 6 to 12 months, offer another alternative to those in need of treatment for cocaine addiction. TCs focus on resocialization of the individual to society, and can include on-site vocational rehabilitation and other supportive services. Of course, there is variation in the types of therapeutic processes offered in TCs.

Source: National Institute on Drug Abuse (NIDA) Research Report – Cocaine Abuse and Addiction