Treatment of Cocaine & Related Drug Abuse

Cocaine overdose is a medical emergency and should be managed in an intensive care unit. Cocaine toxicity causes hypertension (high blood pressure), tachycardia (high heart rate), tonic clonic seizures, dyspnea (breathlessness), and ventricular arrhythmias (change in rhythm of heart). Intravenous diazepam in doses up to 0.5 mg/kg administered over an 8-h period to control seizure. 0.5 to 1.0 mg of propranolol intravenously is given to control ventricular arrhythmias.

Treatment of chronic cocaine abuse requires the combined efforts of physicians, psychiatrists, and psychosocial worker. Symptoms are depression, guilt, insomnia, and anorexia, which may be severe. Individual and group psychotherapy, peer group assistance programs, and family therapy are useful for inducing prolonged remission from drug use. To reduce the duration and severity of cocaine abuse and dependence a number of medications used for the treatment of various medical and psychiatric disorders have been tried. But no available medication is both safe and highly effective. Psychotherapeutic interventions can be effective, no specific form of psychotherapy or behavioral modification is uniquely beneficial.

Cocaine abuse is usually involved with abuse of other drugs and it becomes much more difficult to treat a case of multi drug abuse. Adequate treatment of multi drug abuse requires innovative programs of intervention. The first step in successful treatment is detoxification, this may be difficult because of the abuse of several drugs with different pharmacologic actions e.g., alcohol, opiates, and cocaine. Another problem is that the patient may deny that he takes other drugs along with cocaine or he may not remember of multi drug abuse. That is why diagnostic evaluation should always include urine analysis for qualitative detection of psychoactive substances and their metabolites. Treatment of multi drug abuse requires hospitalization or inpatient residential care during detoxification and the initial phase of drug abstinence. Outpatient detoxification of multi drug abuse patients is ineffective and may be dangerous.

These patients generally respond well to the treatment. The physician should continue to assist patients during relapse and recognize that occasional recurrent drug use is not unusual in this complex behavioral disorder. Episodes of relapse can occur unpredictably and doctor should be prepared for that.

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