An enormous increase has occurred in the number of people seeking treatment for cocaine addiction during the 1980s and 1990s. Treatment providers report that cocaine is the most commonly cited drug of abuse among their clients. The majority of individuals seeking treatment smoke crack, and are likely to be multiple-drug users, or users of more than one substance. The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse.

Cocaine abuse and addiction is a complex problem involving biological changes in the brain, as well as myriad social, familial and environmental factors. Treatment of cocaine addiction, therefore, is complex and must address a variety of problems. Like any good treatment plan, cocaine treatment strategies need to assess the psychobiological, social and pharmacological aspects of the patient’s drug abuse.

It is important to match the best treatment regimen to the needs of the patient. This may include adding to or removing from an individual’s treatment regimen a number of different components or elements. For example, if an individual is prone to relapses, a relapse component should be added to the program.

Behavioral Interventions

Many behavioral treatments have been found to be effective for cocaine addiction, including both residential and outpatient approaches. Indeed, behavioral therapies are often the only available, effective treatment approaches to many drug problems, including cocaine addiction.

After stabilization, treatment can take place in an inpatient or outpatient program. Recovery begins with a learning process of breaking old habits, ties with cocaine-using friends and identifying “triggers” that increase desire to use cocaine.

Cognitive-behavioral therapy is another approach. Cognitive-behavioral coping skills treatment, for example, is a short-term, focused approach to helping cocaine-addicted individuals become abstinent from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and dependence.

The same learning processes can be employed to help individuals reduce drug use. This approach attempts to help patients to recognize, avoid and cope; for example, recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate and cope more effectively with a range of problems and behaviors associated with drug abuse.

Patients are encouraged to identify specific triggers and to restructure their lifestyles to avoid them. Many patients identify certain music or movies with cocaine and must learn to deal with these issues. There is an old Chinese proverb that speaks to the issue of craving cocaine and relapse. “You can’t help it if a bird lands on your head. But you don’t have to let him build a nest.” If you entertain the thought long enough it gains the power to impair your judgment and influence behavior. Cocaine abusers become experts at self-deception and therefore create reasons to use more cocaine.

Counseling on Spiritual and Emotional Issues

Perhaps the most difficult aspect of treatment and recovery from cocaine involves the guilt and intense shame felt by most users. It is true that all addicted individuals feel shame because drug-using behavior often is in conflict with a person’s values and morals. Inappropriately spending thousands of dollars or having an affair, lying and stealing are hard things to face. The guilt associated with these behaviors becomes a major reason to use more cocaine. Getting high is, in a sense, a short vacation from the intense guilt and shame associated with cocaine addiction.

Dealing with these painful issues takes time and trust. An experienced counselor, another recovering addict or trusted clergy can be of great help. Most good treatment programs have these people on staff.

Therapeutic communities, or residential programs with planned lengths of stay of six to 12 months, offer another alternative to those in need of treatment for cocaine addiction. Therapeutic communities are often comprehensive, in that they focus on the resocialization of the individual to society, and can include on-site vocational rehabilitation and other supportive services. Therapeutic communities typically are used to treat patients with more severe problems, such as co-occurring mental health problems and criminal involvement.

Self-Help Programs

Twelve-step programs offer support by helping cocaine abusers accept their problems by learning from, and helping other recovering addicts to realize that there is life after cocaine. These programs include:

  • Cocaine Anonymous
  • Narcotics Anonymous
  • Alcoholics Anonymous

Twelve-step programs emphasize taking responsibility for behavior, making amends to others and self-forgiveness. The first step of Cocaine Anonymous states that, “We are powerless over cocaine and our lives have become unmanageable.” Successful recovery programs strongly urge daily attendance at 12-step meetings for the first 90 days of sobriety.

Individuals who successfully abstain from cocaine attend a lot of 12-step meetings for support and accountability. They often report that a part of them still looks for a good reason to use cocaine. Twelve-step meetings are daily reminders of their powerlessness over drugs.

Medication Approaches

No medications currently are available specifically to treat cocaine addiction. Consequently, the National Institute of Drug Abuse (NIDA) is aggressively pursuing the identification and testing of new cocaine treatment medications. Attempts are even being made to develop a vaccine to cocaine so that cocaine users could conceivably be made immune to its effects.

Several newly emerging compounds are being investigated to assess their safety and efficacy in treating cocaine addiction. Because of mood changes experienced during the early stages of cocaine abstinence, antidepressant drugs have been shown to be of some benefit. In addition to the problems of treating addiction, cocaine overdose results in many deaths every year, and medical treatments are being developed to deal with the acute emergencies resulting from excessive cocaine abuse.

Mark S. Gold, M.D. contributed to this article.