Overcoming Stimulant Drug Addiction

Harvard Mental Health Letter
Mar 3, 2009

Two million Americans are addicted to cocaine or other types of stimulants. Breaking free from this kind of addiction is a formidable task. The March 2009 issue of the Harvard Mental Health Letter outlines current treatment options for stimulant addiction and looks at how a vaccine might offer some aid.

Psychotherapy remains a mainstay of treatment. Various techniques can help individuals "unlearn" an addiction, resist cravings, and build a drug-free life. Options include cognitive behavioral therapy, contingency management, and a multi-pronged method called the Matrix Model.

No medication is currently approved by the FDA for treating cocaine or stimulant addiction. Drugs approved for other uses may be of use, but require further research. Drugs currently under study include:

  • Disulfiram. Six studies show that this medication, which is approved for treating alcohol dependence, may also help reduce cocaine use. It is generally safe, but shouldn't be used by people with cardiovascular or liver problems or those with multiple mental disorders.
  • Baclofen. In one study, the muscle relaxant Baclofen, combined with drug abuse counseling, reduced cocaine use.
  • Topiramate. Two preliminary studies reported that this anticonvulsant helped volunteers avoid cocaine use or reduced cravings for it.
  • Modafinil. Preliminary research suggested that modafinil, a stimulant, reduced cravings for amphetamines or cocaine. Other research suggests that the drug may help delay the type of impulsive reaction that underlies addiction.

Drug vaccines are designed to reduce the pleasurable effects of drug abuse and the cravings that accompany it. One anti-cocaine vaccine has reached clinical trials, and others are in development. Given the pace of drug discovery, it is unlikely any of these vaccines will reach the market soon, notes Dr. Michael Miller, editor in chief of the Harvard Mental Health Letter. In the meantime, behavioral therapies combined with medication trials offer the best hope of recovery.