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Medications to Treat Cocaine Addiction

Cocaine addiction is a far more widespread issue than many people realize. The National Institute on Drug Addiction (NIDA) reports that more than 1 in 10 admissions to rehab are for cocaine addiction. Even more alarming is that cocaine is responsible for 3 in 10 emergency room visits.1

Cocaine directly affects the central nervous system, which is one of the reasons why it is so addictive. Relapse is very common among cocaine users. Almost 25% of people relapse within a year of treatment.2


Cocaine and the Brain

The reason that cocaine addiction is so difficult to beat lies in how this drug interacts with the neurons in the brain. Inside the brain is a pathway called the mesolimbic dopamine system. This pathway is stimulated by rewarding stimuli, like food, sex, and drugs that interacts with dopamine. The pathway starts in the midbrain section and also helps regulate emotions and motivation. When dopamine is released after something pleasurable (like food or sex) it binds to specialized proteins called dopamine receptors. This makes dopamine into a sort of chemical messenger.3

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Using cocaine interferes with the normal communication of dopamine in the brain. Cocaine binds to dopamine transporters and blocks the removal of dopamine from the synapse. The result is that dopamine accumulates at the synapse site and produces an amplified signal to the surrounding neurons. That’s why most users experience a feeling of euphoria and pleasure after using cocaine.3

The release of dopamine acts as a reward for the brain, sending signals for both upbeat energy and feelings of intense pleasure. With continued use, the brain’s reward system cannot function with cocaine as its stimulus. People need to take more and more of the drug to feel the sensations first experienced.

The loss of pleasure is a condition called anhedonia. It’s one of the most challenging aspects of cocaine withdrawal for many addicts. Most research suggests that anhedonia is the driving force for relapse, as recovering addicts may feel there is little joy in life.4


Side Effects of Cocaine Withdrawal

The National Institutes of Health reports that people almost immediately suffer an emotional crash after a cocaine binge.5 Cravings can last for months after giving up the drug. There are some side effects that make it hard to tackle a cocaine addiction. These include the following:

  • Headaches
  • Muscle tremors
  • Lack of energy—both mental and physical
  • Nervousness and agitation
  • Inability to handle stressful situations
  • Increased appetite

Hope on the Horizon

The goal of medication therapy to treat cocaine addiction isn’t what people might think. Medication isn’t used to make cravings go away or eliminate withdrawal symptoms. Instead, medication will help patients get through the most challenging aspects of withdrawal to begin rebuilding the addict’s life.

When trying to overcome cocaine addiction, a multi-tiered approach increases the chances of success. There’s no one approach that will help successfully overcome an addiction. Because cocaine withdrawal can cause intense emotional and physical discomfort, detoxing under the care and supervision of trained medical staff is usually the least painful approach.

Currently, there are no FDA approved medications to treat cocaine addiction, but there are some medications that are useful in offsetting the symptoms of cocaine withdrawal. Of course, these medications come with some side effects, and should always be used in combination with therapy.


Types of Medication Prescribed

Medically supervised recovery programs take into account the patient’s health history, age, and physical condition. Additionally, an intake specialist will consider any life stressors that might make it difficult to overcome cocaine addiction.

Many of the medications used in top cocaine inpatient addiction treatment rehabs help to calm the central nervous system. Using cocaine over a long period of time can affect the brain’s natural production of neurotransmitters—the chemical messengers that generate certain feelings or responses. If you’re having trouble with anxiety and agitation, a doctor may prescribe medication that triggers the release of neurotransmitters that make you feel relaxed, like GABA and dopamine.

Some medications may be prescribed only during the detoxification period, when the body is adjusting to the absence of cocaine. Other medications may be recommended on a long-term basis to help avoid a relapse in the months ahead. Many of the medications that are currently prescribed for cocaine addiction are also used to treat other conditions. These include the following:

  • Modafinil: May prevent the fatigue and drowsiness associated with cocaine withdrawal by promoting healthy nighttime sleep and encouraging dopamine production.
  • Topiramate: An anticonvulsant drug that may ease agitation during recovery by reducing activity in the central nervous system
  • Vigabatrin: An anti-epileptic medication that may reduce cocaine cravings by increasing production of GABA.
  • Gabapentin: This drug helps to restore feelings of wellbeing by promoting the release of the neurotransmitter GABA.
  • Baclofen: In cocaine recovery, Baclofen may be used to increase the release of GABA.

One of the most promising medications available is disulfiram. This medication has been used for years to treat alcohol addiction. Emerging research suggests it might help prevent cocaine relapse in the same way it prevents alcohol relapse through the processing of dopamine in the brain.6


What Are the Drawbacks of Medication Therapy for Cocaine?

Because there isn’t one specific medication that can be used to treat cocaine addiction, some medications come with side effects. Generally these side effects are mildly unpleasant but, in some instances, can be life threatening.

Some medications can cause dizziness, nausea, and drowsiness. However, everyone responds to medications differently. One of the reasons it’s so important to have an assisted detox from cocaine is so your particular situation can be monitored and evaluated.

One of the most important things to do is to follow the orders of the treatment team. For many who enter addiction recovery, life is chaotic and unorganized. Beginning on a medication regimen is taking the first step toward restructuring a person’s life. Medication can make recovery easier to tolerate, but don’t confuse that with a false sense of security.

It’s important not to assume that pharmacological treatment is the only therapy needed to beat cocaine addiction. While pharmacotherapy may make it easier for to deal with detox, medication is only one aspect of a comprehensive recovery plan.


The Future of Cocaine Treatment

Research into the field of cocaine treatment is progressive and ongoing. There are many areas of research that the scientific community is exploring. Some of that research includes:7,8

  • Medications that reduce cocaine cravings and lower relapse risk by modifying the brain’s production and utilization of neurotransmitters.
  • Pharmaceutical therapies to help people in cocaine recovery respond to stress and other emotional factors that can trigger a relapse.
  • Vaccines that block the passage of cocaine from the bloodstream to the brain.
  • New emergency medical interventions for cocaine overdose.

Through careful research, it’s possible that the scientific community might eventually discover a medication that will help offset the many challenges of cocaine addiction.


What Else Can Be Done to Succeed at Recovery?

A patient is at a greater risk for relapse if he/she is not receiving a combination of medication with intensive counseling. Along with that, treatment should include behavior modification to help address the causes of the cocaine use. Understanding personal triggers will make success more likely.

The reality is that an addict going to have to face some hard truths—namely, the state of  relationships not just with family and friends but colleagues as well. That means a lot of support will be needed from many different sources to help aid and assist in recovery.

Medication to help treat addiction is just one part of the puzzle. Addiction is a multi-pronged issue, so it’s important to develop a network of trusted professions and peers. Medication might help curb cravings, but until root behavior patterns are dealt with, treatment might not be successful.  However, recovery can be an amazingly rewarding experience if all the necessary components of treatment are in place.

When you’re ready to begin the next chapter in your life, contact us. We know that addiction and the road to recovery looks different for each person. We’re here to help.


Sources

  1. National Institute on Drug Abuse. (n.d.). Cocaine.
  2. Nestler, E.J. (2005). The Neurobiology of Cocaine Addiction. Sci Pract Perspect, 3(1), 4-10.
  3. Baik, J.H. (2013). Dopamine Signaling in Reward-Related Behaviors. Front Neural Circuits.
  4. Fries, G.R., Khan, S., Stamatovich, S., Dyukova, E., Walss-Bass, C., Lane, S.D., Schmitz, J.M., Wardle, M.C. (2018). Anhedonia in cocaine use disorder is associated with inflammatory gene expression. PLOS ONE, 13(11), e0207231.
  5. National Institutes of Health. (2010). Uncovering the Mechanism of Cocaine Addiction.
  6. Gaval-Cruz, M., Weinshenker, D. (2009). mechanisms of disulfiram-induced cocaine abstinence: antabuse and cocaine relapse. Mol Interv, 9(4), 175-187.
  7. Kampman, K.M., (2005). New Medications for the Treatment of Cocaine Dependence. Psychiatry (Edgmont), 2(12), 44-48.
  8. Shorter, D., Kosten, T.R. Novel pharmacotherapeutic treatments for cocaine addiction. BMC Med, 9(119).

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