0
0

Chapter 11. Clinical Management: Cocaine

Thomas R. Kosten, M.D.; Mehmet Sofuoglu, M.D., Ph.D.; Tracie J. Gardner, Ph.D.
DOI: 10.1176/appi.books.9781585623440.346875

Sections

Excerpt

Cocaine and amphetamine are psychoactive agents that increase central nervous system (CNS) activity and produce powerful reinforcing effects (e.g., euphoria, elevated mood, high) that contribute to their high abuse liability. Since the peak of the cocaine epidemic in the mid-1980s, addiction to this stimulant has been a major public health concern. Recently, localized epidemics of amphetamine abuse have developed, particularly in the Western United States. In addition, misuse of prescription stimulants has increased exponentially in the past several years, particularly among adolescents and young adults. The dangers associated with stimulant use are enormous and include increased risk of HIV infection, detrimental effects on the unborn and newborn, and increased crime and violence as well as medical, financial, and psychological problems. Because of these consequences, the task of identifying, characterizing, and developing treatments is more important than ever.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Table Reference Number
TABLE 11–1. Pharmacological targets for cocaine dependence
Table Reference Number

The rewarding effects of stimulants are mediated through the mesocorticolimbic dopamine system.

The reinforcing properties of cocaine and amphetamine are associated with their ability to increase synaptic dopamine levels.

Stimulants can produce a constellation of neurochemical, physiological, and neuropsychological impairments following chronic use.

Despite advances in pharmacotherapy research, to date there are no U.S. Food and Drug Administration–approved medications for the treatment of stimulant abuse.

Combined pharmacotherapy and behavioral interventions may improve treatment outcomes.

Pharmacotherapies that target both drug-related reinforcement and stress- and cue-related aspects of drug seeking could be beneficial in relapse prevention.

Polydrug use is common and therefore must be taken into consideration when assessing treatment options.

References

Aharonovich E, Nunes E, Hasin D: Cognitive impairment, retention and abstinence among cocaine abusers in cognitive-behavioral treatment. Drug Alcohol Depend 71:207–211, 2003
[PubMed]
 
Aharonovich E, Hasin DS, Brooks AC, et al: Cognitive deficits predict low treatment retention in cocaine dependent patients. Drug Alcohol Depend 81:313–322, 2006
[PubMed]
 
Ahmad K: Asia grapples with spreading amphetamine abuse. Lancet 361:1878–1879, 2003
[PubMed]
 
Alterman AI, Droba M, Antelo RE, et al: Amantadine may facilitate detoxification of cocaine addicts. Drug Alcohol Depend 31:19–29, 1992
[PubMed]
 
Bartzokis G, Beckson M, Newton T, et al: Selegiline effects on cocaine-induced changes in medial temporal lobe metabolism and subjective ratings of euphoria. Neuropsychopharmacology 20:582–590, 1999
[PubMed]
 
Ballon JS, Feifel D: A systematic review of modafinil: potential clinical uses and mechanisms of action. J Clin Psychiatry 67:554–566, 2006
[PubMed]
 
Beatty WW, Katzung VM, Moreland VJ, et al: Neuropsychological performance of recently abstinent alcoholics and cocaine abusers. Drug Alcohol Depend 37:247–253, 1995
[PubMed]
 
Bolla KI, Cadet JL, London ED: The neuropsychiatry of chronic cocaine abuse. J Neuropsychiatry Clin Neurosci 10:280–289, 1998
[PubMed]
 
Brodie JD, Figueroa E, Laska EM, et al: Safety and efficacy of gamma-vinyl GABA (GVG) for the treatment of methamphetamine and/or cocaine addiction. Synapse 55:122–125, 2005
[PubMed]
 
Carroll KM: Relapse prevention as a psychosocial treatment approach: a review of controlled clinical trials. Exp Clin Psychopharmacol 4:46–54, 1996
 
Carroll KM: Manual-guided psychosocial treatment: a new virtual requirement for pharmacotherapy trials? Arch Gen Psychiatry 54:923–928, 1997
[PubMed]
 
Carroll KM, Nich C, Ball SA, et al: Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction 93:713–727, 1998
[PubMed]
 
Carroll KM, Fenton LR, Ball SA, et al: Efficacy of disulfiram and cognitive-behavioral therapy in cocaine-dependent outpatients: a randomized placebo-controlled trial. Arch Gen Psychiatry 61:264–272, 2004
[PubMed]
 
Cornish JW, Maany I, Fudala PJ, et al: Carbamazepine treatment for cocaine dependence. Drug Alcohol Depend 38:221–227, 1995
[PubMed]
 
Crits-Christoph P, Siqueland L, Blaine J, et al: Psychosocial treatments for cocaine dependence: National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Arch Gen Psychiatry 56:493–502, 1999
[PubMed]
 
Dackis CA, Lynch KG, Yu E, et al: Modafinil and cocaine: a double-blind placebo-controlled drug interaction study. Drug Alcohol Depend 70:29–37, 2003
[PubMed]
 
Dackis CA, Kampman KM, Lynch KG, et al: A double-blind, placebo-controlled trial of modafinil for cocaine dependence. Neuropsychopharmacology 30: 205–211, 2005
[PubMed]
 
Di Sclafani V, Tolou-Shams M, Price LJ, et al: Neuropsychological performance of individuals dependent on crack-cocaine, or crack-cocaine and alcohol, at 6 weeks and 6 months of abstinence. Drug Alcohol Depend 66:161–171, 2002
 
Ebadi M, Sharma S, Shavali S, et al: Neuroprotective actions of selegiline. J Neurosci Res 67:285–289, 2002
[PubMed]
 
Erb S, Hichcott PK, Rajabi H, et al: Alpha-2 adrenergic receptor agonists block stress-induced reinstatement of cocaine seeking. Neuropsychopharmacology 23:138–150, 2000
[PubMed]
 
Fischman MW, Schuster CR, Resnekov L, et al: Cardiovascular and subjective effects of intravenous cocaine administration in humans. Arch Gen Psychiatry 33:983–989, 1976
[PubMed]
 
Gawin FH, Ellinwood EH: Cocaine and other stimulants: actions, abuse, and treatment. N Engl J Med 318:1173–1182, 1988
[PubMed]
 
George TP, Chawarski MC, Pakes J, et al: Disulfiram versus placebo for cocaine dependence in buprenorphine-maintained subjects: a preliminary trial. Biol Psychiatry 47:1080–1086, 2000
[PubMed]
 
Goldsmith RJ: The elements of contemporary treatment, in The Principles and Practice of Addictions in Psychiatry. Edited by Miller NS. Philadelphia, PA, WB Saunders, 1996, pp 392–399
 
Gonzalez G, Sevarino K, Sofuoglu M, et al: Tiagabine increases cocaine-free urines in cocaine-dependent methadone-treated patients: results of a randomized pilot study. Addiction 98:1625–1632, 2003
[PubMed]
 
Gonzalez G, Desai R, Sofuoglu M, et al: Clinical efficacy of gabapentin versus tiagabine for reducing cocaine use among cocaine dependent methadone-treated patients. Drug Alcohol Depend 87:1–9, 2007
[PubMed]
 
Gottschalk C, Beauvais J, Hart R, et al: Cognitive function and cerebral perfusion during cocaine abstinence. Am J Psychiatry 158:540–545, 2001
[PubMed]
 
Grabowski J, Rhoades H, Elk R, et al: Fluoxetine is ineffective for treatment of cocaine dependence or concurrent opiate and cocaine dependence: two placebo-controlled double-blind trials. J Clin Psychopharmacol 15:163–174, 1995
[PubMed]
 
Grabowski J, Roache JD, Schmitz JM, et al: Replacement medication for cocaine dependence: methylphenidate. J Clin Psychopharmacol 17:485–488, 1997
[PubMed]
 
Grabowski J, Rhoades H, Schmitz J, et al: Dextroamphetamine for cocaine-dependence treatment: a double-blind randomized clinical trial. J Clin Psychopharmacol 21:522–526, 2001
[PubMed]
 
Grassi MC, Cioce AM, Giudici FD, et al: Short-term efficacy of disulfiram or naltrexone in reducing positive urinalysis for both cocaine and coaethylene in cocaine abusers: a pilot study. Pharmacol Res 55:117–121, 2007
[PubMed]
 
Haberny KA, Walsk SL, Ginn DH, et al: Absence of acute cocaine interactions with the MAO-B inhibitor selegiline. Drug Alcohol Depend 39:55–62, 1995
[PubMed]
 
Higgins ST, Budney AJ, Bickel WK: Applying behavioral concepts and principles to the treatment of cocaine dependence. Drug Alcohol Depend 34:87–97, 1994a
 
Higgins ST, Budney AJ, Bickel WK, et al: Incentives improve outcome in outpatient behavioral treatment of cocaine dependence. Arch Gen Psychiatry 51:568–576, 1994b
 
Higgins ST, Badger GJ, Budney AJ: Initial abstinence and success in achieving longer term cocaine abstinence. Exp Clin Psychopharmacol 8:377–386, 2000a
 
Higgins ST, Wong CJ, Badger GJ, et al: Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up. J Consult Clin Psychol 68:64–72, 2000b
 
Highfield D, Yap J, Grimm JW: Repeated lofexidine treatment attenuates stress-induced, but not drug cues-induced reinstatement of a heroin-cocaine mixture (speedball) seeking in rats. Neuropsychopharmacology 25:320–331, 2001
[PubMed]
 
Holman BL, Carvalho PA, Mendelson J, et al: Brain perfusion is abnormal in cocaine-dependent polydrug users: a study using technetium-99m-HMPAO and ASPECT. J Nucl Med 32:1206–1210, 1991
[PubMed]
 
Holman BL, Mendelson J, Garada B, et al: Regional cerebral blood flow improves with treatment in chronic cocaine polydrug users. J Nucl Med 34:723–727, 1993
[PubMed]
 
Johanson CE, Fischman MW: The pharmacology of cocaine related to its abuse. Pharmacol Rev 41:3–52, 1989
[PubMed]
 
Kampman K, Volpicelli JR, Alterman A, et al: Amantadine in the early treatment of cocaine dependence: a double-blind, placebo-controlled trial. Drug Alcohol Depend 41:25–33, 1996
[PubMed]
 
Kampman KM, Volpicelli JR, Alterman AI, et al: Amantadine in the treatment of cocaine-dependent patients with severe withdrawal symptoms. Am J Psychiatry 157:2052–2054, 2000
[PubMed]
 
Kampman KM, Pettinati H, Linch KG, et al: A pilot trial of topiramate for the treatment of cocaine dependence. Drug Alcohol Depend 75:233–240, 2004
[PubMed]
 
Khantzian EJ, Gawin F, Kleber HD, et al: Methylphenidate (Ritalin) treatment of cocaine dependence: a preliminary report. J Subst Abuse Treat 1:107–112, 1984
[PubMed]
 
King GR, Ellinwood EH: Amphetamines and other stimulants, in Substance Abuse: A Comprehensive Textbook, 3rd Edition. Edited by Lowinson JH, Ruiz P, Millman RB, et al. Baltimore, MD, Lippincott Williams & Wilkins, 1997, pp 207–233
 
Kosten TR: Pathophysiology and treatment of cocaine dependence, in Neuropsychopharmacology: The Fifth Generation of Progress. Edited by Davis KL, Charney D, Coyle JT, et al. Baltimore, MD, Lippincott Williams & Wilkins, 2002, pp 1461–1473
 
Kosten TR, Biegel D: Therapeutic vaccines for substance dependence. Expert Rev Vaccines 1:363–367, 2002
[PubMed]
 
Kosten TR, Kleber HD: Rapid death during cocaine abuse: a variant of the neuroleptic malignant syndrome? Am J Drug Alcohol Abuse 14:335–346, 1988
[PubMed]
 
Kosten TR, Kleber HD, Morgan C: Treatment of cocaine abuse with buprenorphine. Biol Psychiatry 26:637–639, 1989
[PubMed]
 
Kosten TR, Gawin FH, Silverman DG, et al: Intravenous cocaine challenges during desipramine maintenance. Neuropsychopharmacology 7:169–176, 1992
[PubMed]
 
Kosten TR, Schottenfeld RS, Ziedonis D, et al: Buprenorphine versus methadone maintenance for opioid dependence. J Nerv Ment Dis 181:358–364, 1993
[PubMed]
 
Kosten TR, Cheeves C, Palumbo J, et al: Regional cerebral blood flow during acute and chronic abstinence from combined cocaine-alcohol abuse. Drug Alcohol Depend 50:187–195, 1998
[PubMed]
 
Kosten TR, George TP, Kosten TA: The potential of dopamine agonists in drug addiction. Expert Opin Investig Drugs 11:491–499, 2002a
 
Kosten TR, Rosen M, Bond J, et al: Human therapeutic cocaine vaccine: safety and immunogenicity. Vaccine 20:1196–1204, 2002b
 
Kosten T, Poling J, Oliveto A: Effects of reducing contingency management values on heroin and cocaine use for buprenorphine and desipramine treated patients. Addiction 98:665–671, 2003
[PubMed]
 
Kranzler HR, Bauer LO, Hersh D, et al: Carbamazepine treatment of cocaine dependence: a placebo-controlled trial. Drug Alcohol Depend 38:203–211, 1995
[PubMed]
 
Levin FR, Lehman AF: Meta-analysis of desipramine as an adjunct in the treatment of cocaine addiction. J Clin Psychopharmacol 11:374–378, 1991
[PubMed]
 
Lima MS, Reisser AA, Soares BG, et al: Antidepressants for cocaine dependence. Cochrane Database of Systematic Reviews, Issue 4, Article No: CD002950, 2001
 
Ling W, Shoptaw S, Majewska D: Baclofen as a cocaine anti-craving medication: a preliminary clinical study (letter). Neuropsychopharmacology 18:403–404, 1998
[PubMed]
 
London ED, Cascella NG, Wong DF, et al: Cocaine-induced reduction of glucose utilization in human brain: a study using positron emission tomography and [fluorine 18]-fluorodeoxyglucose. Arch Gen Psychiatry 47:567–574, 1990
[PubMed]
 
Maisonneuve IM, Archer S, Glick SD: U50, 488, a kappa opioid receptor agonist, attenuates cocaine-induced increases in extracellular dopamine in the nucleus accumbens of rats. Neurosci Lett 181:57–60, 1994
[PubMed]
 
Malcolm R, Kajdasz DK, Herron J, et al: A double-blind, placebo-controlled outpatient trial of pergolide for cocaine dependence. Drug Alcohol Depend 60:161–168, 2000
[PubMed]
 
Malison RT, Best SE, van Dyck CH, et al: Elevated striatal dopamine transporters during acute cocaine abstinence as measured by [123I] beta-CIT SPECT. Am J Psychiatry 155:832–834, 1998
[PubMed]
 
Margolin A, Kosten TR, Avants SK, et al: A multicenter trial of bupropion for cocaine dependence in methadone-maintained patients. Drug Alcohol Depend 40:125–131, 1995
[PubMed]
 
Martell BA, Mitchell E, Poling J, et al: Vaccine pharmacotherapy for the treatment of cocaine dependence. Biol Psychiatry 58:158–164, 2005
[PubMed]
 
Montoya ID, Levin FR, Fudala PJ, et al: Double-blind comparison of carbamazepine and placebo for treatment of cocaine dependence. Drug Alcohol Depend 38:213–219, 1995
[PubMed]
 
Nich C, McCance-Katz EF, Petrakis IL, et al: Sex differences in cocaine-dependent individuals' response to disulfiram treatment. Addict Behav 29:1123–1128, 2004
[PubMed]
 
Nunes EV, Quitkin FM, Brady R, et al: Imipramine treatment of methadone maintenance patients with affective disorder and illicit drug use. Am J Psychiatry 148:667–669, 1991
[PubMed]
 
Oliveto AH, Feingold A, Schottenfeld R, et al: Desipramine in opioid-dependent cocaine abusers maintained on buprenorphine vs methadone. Arch Gen Psychiatry 56:812–820, 1999
[PubMed]
 
Olmstead TA, Sindelar JL, Petry NM: Cost-effectiveness of prize-based incentives for stimulant abusers in outpatient psychosocial treatment programs. Drug Alcohol Depend 87:175–182, 2007
[PubMed]
 
Petrakis IL, Carroll KM, Nich C, et al: Disulfiram treatment for cocaine dependence in methadone-maintained opioid addicts. Addiction 95:219–228, 2000
[PubMed]
 
Petry NM, Peirce JM, Stitzer ML, et al: Effect of prize-based incentives on outcomes in stimulant abusers in outpatient psychosocial treatment programs. Arch Gen Psychiatry 62:1148–1156, 2005
[PubMed]
 
Poling J, Oliveto A, Petry N, et al: Six-month trial of buproprion with contingency management for cocaine dependence in a methadone-maintained population. Arch Gen Psychiatry 63:219–228, 2006
[PubMed]
 
Rawson RA, McCann MJ, Fammino F, et al: A comparison of contingency management and cognitive-behavioral approaches for stimulant-dependent individuals. Addiction 101:267–274, 2006
[PubMed]
 
Rocha BA, Fumagalli F, Gainetdinov RR, et al: Cocaine self-administration in dopamine-transporter knockout mice. Nat Neurosci 1:132–137, 1998
[PubMed]
 
Rothman RB, Baumann MH: Balance between dopamine and serotonin release modulates behavioral effects of amphetamine-type drugs: Ann NY Acad Sci 1074:245–260, 2006a
 
Rothman RB, Baumann MH: Therapeutic potential of monoamine transporter substrates. Curr Top Med Chem 6:1845–1859, 2006b
 
Rothman RB, Partilla JS, Baumann MH, et al: Neurochemical neutralization of methamphetamine with high-affinity nonselective inhibitors of biogenic amine transporters: a pharmacological strategy for treating stimulant abuse. Synapse 35:222–227, 2000
[PubMed]
 
Rothman RB, Blough BE, Baumann MH: Dual dopamine-5-HT releasers: potential treatment agents for cocaine addiction. Trends Pharmacol Sci 27:612–618, 2006
[PubMed]
 
Rounsaville BJ, Anton SF, Carroll KM, et al: Psychiatric diagnosis of treatment seeking cocaine abusers. Arch Gen Psychiatry 18:43–51, 1991
 
Satel SL, Southwick SM, Gawin FH: Clinical features of cocaine-induced paranoia. Am J Psychiatry 148:495–498, 1991
[PubMed]
 
Schottenfeld RS, Pakes JR, Oliveto A, et al: Buprenorphine vs methadone maintenance treatment for concurrent opioid dependence and cocaine abuse. Arch Gen Psychiatry 54:713–720, 1997
[PubMed]
 
Schottenfeld RS, Chawarski MC, Pakes JR, et al: Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence. Am J Psychiatry 162:340–349, 2005
[PubMed]
 
Schubiner H, Saules KK, Arfken CL, et al: Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Exp Clin Psychopharmacol 10:286–294, 2002
[PubMed]
 
Sevarino KA, Oliveto A, Kosten TR: Neurobiological adaptations to psychostimulants and opiates as a basis of treatment development, Vol 909, in New Medications for Drug Abuse. Edited by Glick SD, Maisonneuve IM. New York, New York Academy of Sciences, 2000, pp 51–87
 
Shaham Y, Highfield D, Delfs J, et al: Clonidine blocks stress-induced reinstatement of heroin seeking in rats: an effect independent of locus coeruleus noradrenergic neurons. Eur J Neurosci 12:292–302, 2000
[PubMed]
 
Shoptaw S, Kintaudi PC, Charuvastra C, et al: A screening trial of amantadine as a medication for cocaine dependence. Drug Alcohol Depend 66:217–224, 2002
[PubMed]
 
Shoptaw S, Yang X, Rotheram-Fuller EJ, et al: Randomized placebo controlled trial of baclofen for cocaine dependence: preliminary effects for individuals with chronic patterns of cocaine use. J Clin Psychiatry 64:1440–1448, 2003
[PubMed]
 
Silverman K, Higgins ST, Brooner RK, et al: Sustained cocaine abstinence in methadone maintenance patients through voucher-based reinforcement therapy. Arch Gen Psychiatry 53:409–415, 1996
[PubMed]
 
Sinha R, Kimmerling A, Doebrick C, et al: Effects of lofexidine on stress-induced and cue-induced opioid craving and opioid abstinence rates: preliminary findings. Psychopharmacology (Berl) 190:569–574, 2007
[PubMed]
 
Sora I, Wichems C, Takahashi N, et al: Cocaine reward models: conditioned place preference can be established in dopamine- and in serotonin-transporter knockout mice. Proc Natl Acad Sci USA 95:7699–7704, 1998
[PubMed]
 
Sora I, Hall FS, Andrews AM, et al: Molecular mechanisms of cocaine reward: combined dopamine and serotonin transporter knockouts eliminate cocaine place preference. Proc Natl Acad Sci USA 98:5300–5305, 2001
[PubMed]
 
Spear J, Alderton D: Psychosis associated with prescribed dexamphetamine use. Aust NZ J Psychiatry 37:383, 2003
[PubMed]
 
Turner DC, Robbins TW, Clark L, et al: Cognitive enhancing effects of modafinil in healthy volunteers. Psychopharmacology (Berl) 165:260–269, 2003
[PubMed]
 
Turner DC, Clark L, Dowson J, et al: Modafinil improves cognition and response inhibition in adult attention deficit/hyperactivity disorder. Biol Psychiatry 55:1031–1040, 2004
[PubMed]
 
Volkow ND, Mullani N, Gould KL, et al: Cerebral blood flow in chronic cocaine users: a study with positron emission tomography. Br J Psychiatry 152:641–648, 1988
[PubMed]
 
Volkow ND, Fowler JS, Wolf AP, et al: Changes in brain glucose metabolism in cocaine dependence and withdrawal (see comments). Am J Psychiatry 148:621–626, 1991
[PubMed]
 
Volkow ND, Hitzemann R, Wang GJ, et al: Long-term frontal brain metabolic changes in cocaine abusers. Synapse 11:184–190, 1992; erratum in Synapse 12:86, 1992
 
Volkow ND, Ding YS, Fowler JS, et al: Cocaine addiction: hypothesis derived from imaging studies with PET. J Addict Dis 15:55–71, 1996a
 
Volkow ND, Fowler JS, Gatley SJ, et al: PET evaluation of the dopamine system of the human brain. J Nucl Med 37:1242–1256, 1996b
 
Volkow ND, Wang GJ, Fischman MW, et al: Relationship between subjective effects of cocaine and dopamine transporter occupancy. Nature 386:827–830, 1997
[PubMed]
 
Volkow ND, Chang L, Wang GJ, et al: Association of dopamine transporter reduction with psychomotor impairment in methamphetamine abusers. Am J Psychiatry 158:377–382, 2001a
 
Volkow ND, Chang L, Wang GJ, et al: Low level of brain dopamine D2 receptors in methamphetamine abusers: association with metabolism in the orbitofrontal cortex. Am J Psychiatry 158:2015–2021, 2001b
 
Weinstock J, Alessi SM, Petry NM: Regardless of psychiatric severity the addition of contingency management to standard treatment improves retention and drug use outcomes. Drug Alcohol Depend 87:288–296, 2007
[PubMed]
 
Weiss RD, Mirin SM, Michael JL, et al: Psychopathology in chronic cocaine abusers. Am J Drug Alcohol Abuse 12:17–29, 1986
[PubMed]
 
White FJ, Kalivas PW: Neuroadaptations involved in amphetamine and cocaine addiction. Drug Alcohol Depend 51:141–153, 1998
[PubMed]
 
Woods SW, O'Malley SS, Martini BL, et al: SPECT regional cerebral blood flow and neuropsychological testing in non-demented HIV-positive drug abusers: preliminary results. Prog Neuropsychopharmacol Biol Psychiatry 15:649–662, 1991
[PubMed]
 
Ziedonis DM, Kosten TR: Depression as a prognostic factor for pharmacological treatment of cocaine dependence. Psychopharmacol Bull 27:337–343, 1991
[PubMed]
 
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Which of the following about the neurobiological effects of chronic stimulant abuse is false?
2.
What is not true of the phenomenon of stimulant delirium?
3.
Withdrawal from stimulants may result in a "crash." Which of the following symptoms is not characteristic of the crash?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 16.  >
The American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition > Chapter 10.  >
Manual of Clinical Psychopharmacology, 7th Edition > Chapter 8.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 4.  >
What Your Patients Need to Know About Psychiatric Medications, 2nd Edition > Chapter 64.  >
Topic Collections
Psychiatric News
PubMed Articles
Emerging drugs of abuse: current perspectives on substituted cathinones. Subst Abuse Rehabil 2014;5():37-52.doi:10.2147/SAR.S37257.
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation