8– 10 The increased euphoria experienced by patients with cocaine withdrawal syndrome may make it more difficult for them to give up cocaine. Several investigators have noted that cocaine-dependent patients who experience cocaine withdrawal symptoms report a greater high from experimentally administered cocaine. 2, 5– 7 Poor treatment outcomes may be due to the fact that cocaine-dependent patients who have cocaine withdrawal symptoms experience cocaine differently. In several studies, it has been demonstrated that patients who enter treatment with severe cocaine withdrawal symptoms are more likely to drop out of treatment prematurely and are less likely to attain abstinence from cocaine in outpatient treatment programs. Cocaine withdrawal symptoms include dysphoric mood, fatigue, sleep disturbance, appetite changes, and irritability. The presence of cocaine withdrawal symptoms may make it difficult for cocaine users to attain a period of initial abstinence. Medications for cocaine dependence are being developed to achieve both of these goals. In the treatment of addictions, there are two goals for medications: To help patients attain an initial period of abstinence and to assist patients avoid relapse. Finally, a vaccine capable of stimulating the production of cocaine specific antibodies has shown promise in preliminary studies for the prevention of relapse to cocaine use.Ĭocaine Withdrawal and Abstinence Initiation Surprisingly, an old treatment for alcohol dependence, disulfiram, may also have efficacy for cocaine relapse prevention. Potential relapse-prevention medications include GABAergic medications, such as baclofen, tiagabine, and topiramate, and the glutamatergic medication, modafinil. For the prevention of relapse, medications that block cocaine euphoria or reduce cocaine craving have shown promise. Among more severely addicted patients, propranolol may be helpful in promoting an initial period of stable abstinence.

Progress in the understanding of the neurobiology of cocaine dependence has led to the discovery of several promising medications that have already shown encouraging results in controlled clinical trials. However, despite many years of research, no medication has emerged as consistently effective for the treatment of cocaine dependence. Therefore, the development of an effective medication for the treatment of cocaine dependence is a research priority.

Although some cocaine- dependent patients will respond well to drug counseling, for many, standard psychosocial treatment is inadequate. Cocaine dependence continues to be a significant public health problem in the United States.

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