19 - Treatment of stimulant dependence  pp. 369-380

Treatment of stimulant dependence

By Mehmet Sofuoglu, Kostas Agath and Thomas R. Kosten

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Editor's note

Cocaine, amphetamine and methamphetamine are the stimulants considered in this chapter. Yet most of the treatments discussed primarily deal with issues related to cocaine. Despite a growing knowledge base as to the underlying action of stimulants, we have not found psychopharmacologic treatments that consistently can be counted upon to be effective in the treatment of the misuse of substances within this class. There are single randomized control trials that show effectiveness for fluoxetine, imipramine, disulfiram, some dopamine agents and adrenergic blocking agents, but there are few RCT replications of the effectiveness of these agents. The treatment of stimulant abuse remains primarily psychosocial, especially treatments that use a cognitive-behavioral approach, an approach whose effectiveness can be further enhanced with contingency management and the use of vouchers. There is some growing interest and studies of combined cognitive behavioral approaches with pharmacotherapy, but even here no single pharmacotherapeutic agent or class of agents stands out. The measures of effectiveness are usually (a) the presence of drug-free urines and (b) the continued involvement in the treatment program which is referred to as treatment retention.

Introduction

Cocaine and amphetamine addictions have become major public health concerns for over 20 years worldwide. The estimated annual prevalence of cocaine abusers in the population over 15 years of age is 0.3% globally, 0.4% in Europe and 1.7% in the Americas, while the relevant figures for amphetamine abusers are 0.6% globally, 0.7% in Europe and 0.7% in the Americas (United Nations Office for Drug Control and Crime Prevention, 2000).

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