In the past several years Addiction Professionals and Sufferers have enjoyed major advances in the areas of alcohol and opiate dependence with the advent of treatments such as Revia, Cameral, Vivitrol and Suboxone. Vivitrol and Revia, in particular, have been invaluable for opiate and alcohol dependence in substantially decreasing the craving for these substances, which is the key factor that contributes to relapse.
The good news is that research is extending these advancements into the area of cocaine addiction.
In the pas year, there is increasing FDA approval for drugs that are catching up in terms of addressing cocaine cravings. The following agents have now emerged from clinical trials and are emerging into general practice to help patients, having shown substantial success in reducing cocaine cravings and are also deemed to be generally safe if then correctly.
Levodopa-Carbidopa which works by boosting dopamine, the crucial neurotransmitter in the addiction cycle — has been widely studied and can prove to be quite effective. The advantages are once a day dosing, and that unlike many other psychiatric medications, the rate of onset is relatively fast. Most patients can experience relief in a day or two. Doxazocin, which works more on adrenaline, has also been shown to be highly effective. It has a low side effect profile but is a bit slower in terms of taking effect, often requiring a two week period to begin to exert its effects.
Interestingly Disulfiram (also known as Antabuse, which has had a major impact on alcoholism) is also in the new regimen of treatments offered. As opposed to the treatment of alcoholism — where it produces nausea and vomiting if the patient drinks while taking this — in the case of cocaine dependence, it actually does reduce cravings, although the mechanism for this is not yet clearly understood.
Nepicastat, another agent which woks on noradrenaline functions more the way Antabuse would for an alcoholic. It blocks the high that people get from cocaine although it doesn’t appear as strong in reducing cravings. Modafanl (also known as Provigil) which works on a triad of neurotransmitters — dopamine, noradrenaline and glutamate — has shown powerful effects in terms of craving reduction and is usually easy to tolerate. It’s not clear yet whether it’s close cousins, Nuvigil will soon enter the picture.
And finally Vyvanse — has also been shown to be profoundly effective in curbing cravings. There is some controversy here — as because this is a modified form of amphetamine — there is clear concern that patients vulnerable to addiction may simply transfer one addiction to another. So my own strategy is to reserve this as the final option if other strategies fail.
It’s gratifying to see a bridge from the world of academic laboratories into the actual treatment arsenal of some new approaches that can help combat this complex disorder.