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Substance Use Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
There are currently no FDA-approved pharmacologic therapies available for detoxification or maintenance of cocaine dependence. Interventions for cocaine dependence primarily involve psychosocial therapies (e.g., cognitive behavioral therapy, motivational interviewing). Very few interventions have been specifically studied in pregnancy. Treatment programs for cocaine have a favorable impact on pregnancy outcome; rates of PTB and LBW were decreased by 67% and 84% [128]. Motivational enhancement therapy was compared to “usual” counseling for pregnant patients abusing cocaine in a randomized trial that found no difference in treatment utilization. The use of motivational incentives, also known as voucher-based contingency management, was studied in a small, RCT of pregnant patients abusing cocaine. Treatment retention and abstinence from cocaine was high in both groups and there was a trend toward increased attendance at prenatal care visits (p = 0.077) [147]. In a separate study, motivational interviewing was associated with a significant reduction in neonatal intensive care unit admission (NICU) and length of stay and cost savings amounted to $5000 per mother/infant pair above the cost of the program [148]. A recent pilot study demonstrated that progesterone may have some promise as a treatment for cocaine use disorder in postpartum patients [149].
Stimulants and psychedelics
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Cocaine dependence develops from regular cocaine use and produces a withdrawal state upon cessation of use. The route of administration is important, with smoking having higher reinforcing and dependence-producing effects (Volkow et al., 2000). Withdrawal symptoms may include depression, fatigue, anxiety, itching, irritability, insomnia, intense craving, formication, and, in some cases, nausea and vomiting. Symptoms can last for weeks and, in some cases, for months. Many users relapse back to cocaine use, especially at times of stress, or use alcohol or other substances.
The Mesocorticolimbic Circuit in Drug Dependence and Reward — a Role for the Extended Amygdala?
Published in Peter W. Kalivas, Charles D. Barnes, Limbic Motor Circuits and Neuropsychiatry, 2019
George F. Koob, Patricia Robledo, Athina Markou, S. Barak Caine
Evidence shows that after a cocaine “binge,” abstinence is characterized by severe mood disturbances including depressive symptoms combined with irritability and anxiety.46 These symptoms last several hours to several days and characterize the “crash” associated with the cocaine dependence cycle. However, cocaine dependence is not characterized by physical signs of withdrawal during abstinence like those observed with opiates or sedative-hypnotics.
Childhood trauma and the severity of past suicide attempts in outpatients with cocaine use disorders
Published in Substance Abuse, 2022
Romain Icick, Emily Karsinti, Georges Brousse, Clara Chrétienneau, Jean-Baptiste Trabut, Beatriz Belforte, Philippe Coeuru, Delphine Moisan, Alice Deschenau, Olivier Cottencin, Aurélia Gay, Philippe Lack, Anne-Laure Pelissier-Alicot, Gaël Dupuy, Maeva Fortias, Bruno Etain, Jean-Pierre Lépine, Jean-Louis Laplanche, Frank Bellivier, Florence Vorspan, Vanessa Bloch
Outpatients seeking treatment for past-year problems with cocaine/crack-cocaine use were consecutively recruited through a multicentric protocol between April 2012 and April 2016 aimed at measuring the interindividual susceptibility to cocaine-induced psychotic symptoms (NCT01569347). The protocol was approved by the relevant ethics committee (CPP Ile de France IV), in line with the 1975 Helsinki declaration as revised 2008. For the current study, patients aged ≥18 had to master the French language, sign written informed consent, and be diagnosed with cocaine dependence according to the Diagnostic and Statistical Manual of mental disorders, 4th edition—text revised (DSM-IV-TR).31 Of note, cocaine dependence was hereafter termed “cocaine use disorder” (CocUD). Patients were excluded if they showed any severe unstable condition (including psychiatric symptoms) requiring immediate care or severe cognitive impairment, if they were under compulsory treatment or wardship, or if they had no health insurance whatsoever. Study records were continuously monitored by the hospital research administration to ensure their conformity to the original protocol.
Factors associated with the absence of cocaine craving in treatment-seeking individuals during inpatient cocaine detoxification
Published in The American Journal of Drug and Alcohol Abuse, 2021
Jose Pérez de los Cobos, Saul Alcaraz, Antonio Verdejo-García, Laura Muñoz, Núria Siñol, Maria José Fernández-Serrano, Pilar Fernández, Ana Martínez, Santiago Duran-Sindreu, Francesca Batlle, Joan Trujols
Improving our understanding of consistent absence of spontaneous cocaine craving (from this point forward: absence of craving) can contribute to reduce the substantial disease burden associated with cocaine dependence (13). In patients with cocaine use disorder, precarious abstinence in the patients’ natural environment requires treatment to prevent relapse. In this situation, an important aim of treatment is to reduce cocaine craving, which is mainly withdrawal-related but also may be cue- and stress-elicited. Indeed, spontaneous cocaine craving is a risk factor for relapse at outpatient facilities (14). Furthermore, spontaneous cocaine craving has also been identified as a risk factor for relapse after discharge from controlled environments in some studies (15) but not in others (16).
Plasma pro- and anti-inflammatory cytokines may relate to cocaine use, cognitive functioning, and depressive symptoms in cocaine use disorder
Published in The American Journal of Drug and Alcohol Abuse, 2021
Sydney N. Stamatovich, Paula Lopez-Gamundi, Robert Suchting, Gabriela D. Colpo, Consuelo Walss-Bass, Scott D. Lane, Joy M. Schmitz, Margaret C. Wardle
Data from 85 individuals with CUD were included in the present analysis. Individuals had to be between ages 18–65, meet DSM-IV criteria for current cocaine dependence or DSM-V criteria for CUD of at least moderate severity, with ≥4 symptoms (diagnosis used the SCID interview, and bridged the transition from DSM-IV to DSM-V; American Psychiatric Association 1994, 2014 [44,45]), and be able to provide written consent. Exclusion criteria included the inability to read, write, or speak English, being pregnant or breastfeeding, having a psychotic disorder (these have been previously related to both cognition and inflammation), having a current or previous chronic or severe inflammatory disease such as rheumatoid arthritis, lupus, inflammatory bowel disease, tuberculosis, severe kidney damage/kidney failure, HIV, or hepatitis C, or regular anti-inflammatory use (these could produce outlying values). For the cognitive analysis only, exclusion criteria included a current or previous cognitive or neurological disorder such as epilepsy or stroke (these could impact cognitive abilities). Common but less severe medical disorders with some inflammatory contributions (e.g., hypertension, diabetes, osteoarthritis) and other substance use disorders (SUDs; e.g., nicotine, alcohol, marijuana) were included as the high comorbidity of these conditions with CUD made it impractical to exclude them. This is reflective of the typical CUD phenotype. The presence of other conditions was controlled for in analyses (see Data Analytic Strategy).