While there are no medications approved by the FDA specifically to treat crack cocaine addiction, many are used to help patients combat withdrawal. Others find use in treating underlying psychological disorders.
Drugs used in crack cocaine withdrawal
Physical withdrawal from crack cocaine addiction is well known to cause paranoia, insomnia and depression. These symptoms can be reduced by prescribing anti-depressants and sleep aids. Caution is warranted. Physicians and psychiatrists have to consider what symptoms are short-term and due to withdrawal and which symptoms might be indicative of deeper issues.
SSRIs (Selective Serotonin Reuptake Inhibitors) such as Prozac or Zoloft are used in the treatment of depression. They have not been shown to reduce cocaine cravings or produce improved abstinence.
Benzodiazepines can help patients who have trouble sleeping when insomnia is driven by anxiety. Xanax and Ativan are two in this class.
Hypnotics like Ambien find use in those who cannot get to sleep in the short withdrawal period. Both this medication and the benzodiazepines have addiction risks and are usually not considered long-term solutions for insomnia in addicts.
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Research into medical treatment for drug addiction
- Dopamine system alternation
- Cocaine (and other drugs of abuse) have been shown to act on the dopamine system in the brain1 and this suggests drugs which affect this system might be useful to stop the cravings associated with relapse. Unfortunately, while the dopamine neurotransmitter is definitely involved in cocaine abuse and cravings,2 drugs that alter this system have not been shown to help in cocaine addiction.
- Tegretol (generic, Carbamazepine)
- Tegretol is an anti-seizure medication that has shown promise in reducing cocaine cravings. Research done on rats showed a lowering in self-administered doses, but the effect is unreliable in humans.3
- Kappa Opioid Antagonists
- Although cocaine is not an opioid, the pathways to addictive behavior seem to revolve around opioid receptors in the brain. The current picture is one where these receptors are involved in stress-activated cravings. This is currently under investigation for cocaine addiction (as well as other addictions).4
- Vaccines
- It is possible, in principle to create an antibody response to cocaine.5 This would block the drug from getting into the brain and block its effects. If this strategy works, patients might be immunized against cocaine and although they might still crave it, the drug wouldn’t have the desired effect. Much depends on whether or not a vaccine can be found that is both safe to administer and induces a long-term immunity to cocaine.
- Adjunct treatments
- Some treatment programs use vitamin therapy with exercise as an attempt to alter patient response to cocaine cravings. This has not been shown, so far, to decrease relapse significantly.
The larger picture
While the medical research community continues to look for new and more reliable therapies for crack cocaine addiction, the addiction treatment community continues to modify and use therapy as the mainstay of treatment. Cognitive and group therapy, in combination, remains the best option for treatment of crack cocaine addiction.6
photo by Anton Malan
References
- "Dopamine in Drug Abuse and Addiction," Nora D. Volkow, MD et al, Archives of Neurology, 2007;64(11):1575-1579.
- "Can’t Get Enough of That Dopamine," Am J Psychiatry 164:543-546, April 2007, Bruce M. Cohen, M.D., PH.D., and William A. Carlezon Jr., PH.D.
- "Effects of carbamazepine on self-administration of intravenously delivered cocaine in rats," Marilyn E. Carrolla et al, University of Minnesota
- "Kappa Opioid Antagonists: Past Successes and Future Prospects," AAPS Journal, October 27, 2005, Matthew D. Metcalf and Andrew Coop, University of Maryland School of Pharmacy [PDF file]
- "Development of a therapeutic vaccine for the treatment of cocaine addiction," Drug Alcohol Dependency, 1997 Dec 15;48(3):153-8, Fox BS, ImmuLogic Pharmaceutical Corporation
- "Psychosocial Treatments for Cocaine Dependence," NIDA Collaborative Cocaine Treatment Study, Paul Crits-Christoph, PhD et al, Archives of General Psychiatry, 1999;56:493-502.
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