ABSTRACT
New possibilities with medications for the treatment of cocaine dependence have begun to emerge. For example, in a randomised controlled study, disulfiram succeeded for the first time in significantly reducing cocaine consumption. In October 2003, a phase IIb study was started in the USA testing active immunisation against cocaine dependence. There is also an ongoing study in Switzerland testing methylphenidate treatment in combination with cognitive behavioural therapy. Pilot studies indicate that vigabatrin, selegiline, and topiramate are promising candidates for further clinical substance testing.
Subject(s)
Cocaine-Related Disorders/rehabilitation , Psychotropic Drugs/therapeutic use , Animals , Cocaine/immunology , Cocaine-Related Disorders/immunology , Humans , Immunization, Passive , Randomized Controlled Trials as Topic , VaccinationABSTRACT
Cocaine and the opiates are--together with alcohol--involved in the genesis of the "three great addictions". The medical conceptualisation of the dependence phenomenon has evolved on the grounds of a critical observation of different ways of use and treatment endeavours, mainly during the last three centuries. Whereas the prohibitionists favoured (and still favour) total abstinence from all psychotropic drugs, defect theoreticians emphasise analytically-oriented psychotherapeutic procedures aiming at healing a supposed underlying self-defect. Contrarily, proponents of the "Metabolic Theory" of the addictions suggest a mainly medication-based approach in order to normalise a--in their eyes causal--still in some aspects hypothetical metabolic defect. Based on a short survey of recently emerging trends of consumption patterns (speed-balling, chasing, multi-substance-use) in Europe, the most important newer treatment types and forms are presented. Finally, a multimodal, integrated, and individualized approach is recommended.
Subject(s)
Cocaine-Related Disorders/etiology , Cocaine-Related Disorders/rehabilitation , Cocaine/toxicity , Narcotics/toxicity , Opioid-Related Disorders/rehabilitation , Cocaine-Related Disorders/diagnosis , Drug and Narcotic Control/legislation & jurisprudence , Humans , Opioid-Related Disorders/diagnosis , Substance Withdrawal Syndrome/diagnosis , Substance Withdrawal Syndrome/etiology , Substance Withdrawal Syndrome/rehabilitation , SwitzerlandABSTRACT
To examine possible metabolic frontal lobe alterations in i.v. heroin-dependent patients with different histories of concomitant substance use, N-acetylaspartate (NAA), a putative marker of neuronal viability, was measured by (1)H-MRS. Compared with controls, NAA levels in patients were reduced by 7% in gray matter (p = 0.015) but not in white matter. To what extent comorbid conditions or substance use, including alcohol, contributed to these frontocortical metabolic changes remains to be elucidated.
