Cognitive enhancement as a pharmacotherapy target for stimulant addiction
Article first published online: 14 DEC 2009
© 2010 The Author. Journal compilation © 2010 Society for the Study of Addiction
Volume 105, Issue 1, pages 38–48, January 2010
How to Cite
Sofuoglu, M. (2010), Cognitive enhancement as a pharmacotherapy target for stimulant addiction. Addiction, 105: 38–48. doi: 10.1111/j.1360-0443.2009.02791.x
- Issue published online: 14 DEC 2009
- Article first published online: 14 DEC 2009
- Submitted 24 April 2009; initial review completed 29 June 2009; final version accepted 25 August 2009
- cognitive enhancers;
Background No medications have been proven to be effective for cocaine and methamphetamine addiction. Attenuation of drug reward has been the main strategy for medications development, but this approach has not led to effective treatments. Thus, there is a need to identify novel treatment targets in addition to the brain reward system.
Aim To propose a novel treatment strategy for stimulant addiction that will focus on medications enhancing cognitive function and attenuating drug reward.
Methods Pre-clinical and clinical literature on potential use of cognitive enhancers for stimulant addiction pharmacotherapy was reviewed.
Results and conclusions Cocaine and methamphetamine users show significant cognitive impairments, especially in attention, working memory and response inhibition functions. The cognitive impairments seem to be predictive of poor treatment retention and outcome. Medications targeting acetylcholine and norepinephrine are particularly well suited for enhancing cognitive function in stimulant users. Many cholinergic and noradrenergic medications are on the market and have a good safety profile and low abuse potential. These include galantamine, donepezil and rivastigmine (cholinesterase inhibitors), varenicline (partial nicotine agonist), guanfacine (alpha2-adrenergic agonist) and atomoxetine (norepinephrine transporter inhibitor). Future clinical studies designed optimally to measure cognitive function as well as drug use behavior would be needed to test the efficacy of these cognitive enhancers for stimulant addiction.