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Cocaine Abuse and Dependence TreatmentThe principles of cocaine rehabilitation are similar to treatment of alcoholism or sedativism. Detoxification is a prerequisite in the treatment of this disorder.Antianxiety DrugsSevere cocaine induced agitation can be treated with diazepam (Valium) 5 to 10 mg every 3 hours IM or PO. Tachyarrhythmias can be treated with propranolol (Inderol) 10 to 20 mg PO every 4 hours.Antidepressant DrugsIn preliminary tests, imipramine and desipramine reduced cocaine euphoria and craving.LithiumLithium has been reported to block cocaine euphoric effects, though recent evidence suggests lithium is effective only in bipolar or cyclothymic patients.Other DrugsVitamin C (0.5 g PO every 6 hours) may increase urinary excretion by acidifying urine.Treatment outcome is affected more by such factors as employment status, family support, and degree of antisocial features than by initial motivation for treatment.It is likely that some heavy cocaine users, like other heavy drug users, suffer from chronic anxiety, depression, or feelings of inadequacy. In these cases, the drug abuse is a symptom rather than the central problem. These cases can benefit from psychotherapy.Psychotherapy is useful when it focuses on the reasons for the patient drug abuse. The drug abuse itself past, present, and future consequences must be given firm emphasis. Involving an interested and cooperative parent or spouse in conjoint therapy is often very beneficial.The therapist must be watchful for return of cocaine related activities, attitudes, friendships, and paraphernalia. Alcohol and other mood altering drugs should be avoided, since they may disinhibit behavior and lead to relapse. Concurrent psychiatric or personality disorders should be treated with attention to the interaction with cocaine disorder.Treatment of clearly defined attention deficit disorder or bipolar or unipolar depression should proceed along with attention to the addiction.Cannabis Abuse and Dependence TreatmentUsually adverse effects of marijuana intoxication do not lead to professional attention. There is no adequately documented case of a fatality in a human being. Pure marijuana abuse rarely requires inpatient or pharmacological treatment, and detoxification is not necessary.Since marijuana may be one of many drugs abused, total abstinence from all psychoactive substances should be the goal of therapy.Periodic urine testing should be used to monitor abstinence.Cannabinoids can be detected in the urine up to 21 days after abstinence in chronic abusers due to fat redistribution; however, one to five days is the normal urine positive period. Thus, beginning drug monitoring needs to be interpreted accordingly.Antianxiety DrugsAntianxiety drugs are occasionally needed to treat severe cannabis induced anxiety or panic.
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