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Background

Stimulant medications have shown promise as a treatment for cocaine dependence (CD) for several decades, yet these treatments have not been widely studied and substantial barriers to clinical implementation remain. The “Self-Medication Hypothesis,” posits that an individual's choice to use a particular substance is to some degree based on the substance's effect on subjective painful affects or unpleasant emotional states which may or may not be associated with a psychiatric disorder.

Objectives

The Self-Medication Hypothesis remains relevant, particularly when considering the scenario of cocaine dependence, both with and without and co-occurring attention-deficit/hyperactivity disorder (ADHD).

Methods

Two case studies (N = 2) and a review of the relevant literature are provided in this clinical update on psychostimulant treatment of cocaine dependence.

Results

Two case studies are presented in which psychostimulant treatment of cocaine dependence was associated with a good clinical outcome.

Discussion

While the use of psychostimulant medication for the treatment of cocaine dependence is controversial, emerging evidence suggests potential utility for this approach.

Conclusions

Cocaine use in individuals with CD may represent self-medication, and prescribed psychostimulants may have benefit in restoring dopaminergic function.

Scientific Significance

Psychostimulant treatment of cocaine dependence is consistent with the Self-Meidcation Hypothesis and is deserving of further study. (Am J Addict 2014;23:189–193)