Cocaine Abuse and Dependence Treatment
The principles of cocaine rehabilitation are similar to treatment of alcoholism or sedativism. Detoxification is a prerequisite in the treatment of this disorder.
Severe cocaine-induced agitation can be treated with diazepam (Valium) 5 to 10 mg every 3 hours IM or PO. Tachyarrhythmias can be treated with propranolol (Inderol) 10 to 20 mg PO every 4 hours.
In preliminary tests, imipramine and desipramine reduced cocaine euphoria and craving.
Lithium has been reported to block cocaine euphoric effects, though recent evidence suggests lithium is effective only in bipolar or cyclothymic patients.
Vitamin C (0.5 g PO every 6 hours) may increase urinary excretion by acidifying urine.
Methylphenidate has not been found to be useful in those cocaine abusers who do not have preexisting attention deficit disorder.
Usually cocaine-dependent patients are best treated as outpatients. Inpatient hospitalization may be needed for severe crash symptoms, suicide ideation, psychotic symptoms, or failure in outpatient treatment.
If a user is to remain drug-free, follow-up treatment, usually with psychiatric help and resort to community resources, is vital.
Lifestyle changes such as avoiding people, places, and things related to cocaine use should be encouraged.
Initial psychosocial treatment should focus on confronting denial, teaching the disease concept of addictions, fostering an identification as a recovering person, recognizing the negative consequences of cocaine abuse, avoiding situational and intrapsychic cues that stimulate craving, and formulating support plans.
Drug urine tests should be used to ensure compliance.
Treatment outcome is affected more by such factors as employment status, family support, and degree of antisocial features than by initial motivation for treatment.
It is likely that some heavy cocaine users, like other heavy drug users, suffer from chronic anxiety, depression, or feelings of inadequacy. In these cases, the drug abuse is a symptom rather than the central problem. These cases can benefit from psychotherapy.
Psychotherapy is useful when it focuses on the reasons for the patient’s drug abuse. The drug abuse itself – past, present, and future consequences – must be given firm emphasis. Involving an interested and cooperative parent or spouse in conjoint therapy is often very beneficial.
The therapist must be watchful for return of cocaine-related activities, attitudes, friendships, and paraphernalia. Alcohol and other mood-altering drugs should be avoided, since they may disinhibit behavior and lead to relapse. Concurrent psychiatric or personality disorders should be treated with attention to the interaction with cocaine disorder.
Treatment of clearly-defined attention deficit disorder or bipolar or unipolar depression should proceed along with attention to the addiction.
Cannabis Abuse and Dependence Treatment
Usually adverse effects of marijuana intoxication do not lead to professional attention. There is no adequately documented case of a fatality in a human being. Pure marijuana abuse rarely requires inpatient or pharmacological treatment, and detoxification is not necessary.
Since marijuana may be one of many drugs abused, total abstinence from all psychoactive substances should be the goal of therapy.
Periodic urine testing should be used to monitor abstinence.
Cannabinoids can be detected in the urine up to 21 days after abstinence in chronic abusers due to fat redistribution; however, one to five days is the normal urine-positive period. Thus, beginning drug monitoring needs to be interpreted accordingly.
Antianxiety drugs are occasionally needed to treat severe cannabis-induced anxiety or panic.
If the patient was using cannabis for anxiety reduction, an antianxiety drug should be considered as substitution therapy.
Antipsychotic drugs are occasionally needed to treat protracted, cannabis-induced psychosis.
If the patient was using cannabis to alleviate depression, an antidepressant should be considered as substitution therapy.