From the Guidelines
Treatment for cocaine use disorder should prioritize a comprehensive approach combining behavioral therapies, such as cognitive-behavioral therapy (CBT), contingency management, and motivational interviewing, alongside supportive medications, as evidenced by the most recent and highest quality study 1. The primary treatment for cocaine use disorder typically involves delivering these therapies in outpatient settings over 12-16 weeks. While no FDA-approved medications exist specifically for cocaine addiction, certain medications may help manage symptoms:
- Disulfiram (250-500 mg daily) can reduce cocaine use
- Modafinil (200-400 mg daily) may decrease cravings
- Topiramate (titrated to 200-300 mg daily) shows promise in reducing use
- Antidepressants like bupropion (300 mg daily) may benefit those with co-occurring depression Treatment should address common co-occurring conditions such as anxiety, depression, and other substance use disorders. Recovery support services, including 12-step programs and peer support groups, provide crucial ongoing support. The neurobiological basis of cocaine addiction involves dopamine system dysregulation, which explains the intense cravings and difficulty achieving abstinence. Key considerations in treating cocaine use disorder include:
- Viewing it as a chronic condition requiring ongoing management rather than a short-term intervention
- The importance of longer duration of engagement in treatment for improved effectiveness
- The need for a comprehensive approach that combines behavioral therapies with supportive medications
- Addressing co-occurring conditions to provide holistic care The most recent and highest quality evidence supports the use of psychosocial interventions, such as CBT and contingency management, as effective treatments for cocaine and amphetamine addiction 1.
From the Research
Treatment Options for Cocaine Use Disorder
- There are currently no FDA-approved pharmacotherapies for cocaine use disorder, as stated in studies 2, 3, 4, 5.
- Various medications have been tested in clinical trials, including antidepressants, bupropion, topiramate, and psychostimulants, with some showing promise in improving abstinence and treatment retention 2, 4, 5.
- Behavioral interventions, such as contingency management and cognitive-behavioral therapy, have demonstrated efficacy in treating cocaine use disorder, but barriers remain in delivering these treatments to patients 3, 6.
Pharmacological Treatments
- Antidepressants have been widely studied, but appear to have no effect on cocaine use or treatment retention 2.
- Bupropion, topiramate, and psychostimulants have shown increased abstinence in some studies, although the strength of evidence is low 2, 4, 5.
- Antipsychotics may improve treatment retention, with moderate strength of evidence 2.
Behavioral Interventions
- Contingency management and cognitive-behavioral therapy have demonstrated efficacy in treating cocaine use disorder 3, 6.
- Combination of behavioral interventions and pharmacotherapy may be more effective than either alone, but further research is needed 5, 6.