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Alcohol and Substance Abuse - Stimulant Specific Concerns

Mark Dombeck, Ph.D.

Cocaine and CNS Stimulants

  • Detoxification should take place under medical supervision.

  • Psychiatric medicines (anti-depressants) may be helpful in keeping cravings down.

  • If a user is to remain drug-free, follow-up treatment, usually with the aid of psychiatric help and access to community resources, is vital. Life-style 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, recognition of the negative consequences of cocaine abuse, avoiding situational and intrapsychic cues that stimulate craving, and formulation of 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.

  • Heavy cocaine users, like other heavy drug users, often 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 and psychiatric medication.

  • 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.

  • Patients should routinely be introduced and asked to participate in Cocaine Anonymous, or Narcotics Anonymous.