Cocaine Treatment
Two types of treatment interventions for cocaine-related problems are described in the following section: pharmacotherapy and behavioural treatment. These interventions pursue a variety of goals.
The focus of pharmacotherapy research has been on finding a medication that will block or substantially reduce the effects of cocaine, and also block the severe craving experienced by users. In addition, some studies have focussed on pharmacological treatment for the depression that is associated with withdrawal from cocaine.
Such medications may address both the management of withdrawal, as well as longer-term maintenance. Behavioural interventions address the reduction or elimination of attitudes, feelings or behaviours that support or contribute to substance use, and help the individual to develop healthier behaviours and a corresponding healthier lifestyle.
For the evaluation of medications, all articles that used double-blind randomized control procedures were selected as the basis for making best practice statements. In addition, some information is provided on drugs that show potential, but have not yet demonstrated effectiveness in rigorous scientific trials. For the evaluation of behavioural treatment, studies that used random assignment and a credible control or comparison treatment procedure were included.
For each study that was evaluated, the following information (when available) was obtained: a) retention in the treatment program, b) reduction of cocaine usage, c) reduction of cocaine cravings, and d) improvement in medical or psychological status. These categories are consistent with those recommended by the Treatment Protocol Effectiveness Study (Treatment Outcome Working Group, 1996). Most of the pharmacotherapy studies provided information for some or all of these variables. However, the studies evaluating behavioural treatment procedures provided less information.
Some studies involved interventions with subjects who were dependent on other drugs besides cocaine, particularly opioids and alcohol. There is some evidence that people with addictions to more than one drug may not respond as well to treatment compared to those abusing only one substance (e.g. Brown, Seraganian and Tremblay, 1994). This is consistent with the treatment of other disorders.
