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1. Management of Cocaine Intoxication and Withdrawal

Intoxication

  • Cocaine intoxication is usually self-limited and typically requires only supportive care.

  • Intoxication can produce hypertension, tachycardia, seizures, and persecutory delusions in some patients that may require symptom-specific treatment.

  • Acutely agitated patients may benefit from sedation with benzodiazepines.

Withdrawal

  • Following cessation of cocaine use, anhedonia and craving are common.

  • Currently available pharmacotherapy provides no clear benefit.

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2. Management of Cocaine Dependence

Focus on abstinence.

Encourage regular participation in treatment, which has been shown to enhance effectiveness.

  • Intensive (i.e., more than twice a week) outpatient treatment is most effective.

  • Self-help group effectiveness is also greatest with regular participation.

Consider the following specific approaches:

  • Cognitive-behavioral therapies

  • Behavioral therapies, including contingency management

  • 12-step-oriented individual drug counseling

  • Self-help groups, including 12-step-oriented programs (e.g., Narcotics Anonymous)

For patients who have more severe dependence or have not responded to psychosocial treatment, consider adding pharmacological treatment.

Medications have had limited effectiveness, but topiramate, disulfiram, and modafinil currently show promising results in conjunction with psychosocial therapies.

References

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