Treating cocaine dependence: A promising new pharmacotherapy

November 28, 2012

Medication development efforts for cocaine dependence have yet to result in an FDA approved treatment. The powerful rewarding effects of cocaine, the profound disruptive impact of cocaine dependence on one's lifestyle, and the tendency of cocaine to attract people who make poor life choices and then exacerbate impulsive behavior all make cocaine a vexing clinical condition.

In this battle, many candidate pharmacotherapies have been tested, but none have succeeded sufficiently to be adopted widely. Perhaps like cancer, heart disease, and AIDS, is a disorder that requires combinations of medications for effective treatment.

In this issue of , researchers from Columbia University and New York State Psychiatric Institute report a step forward in this effort. They tested a medication approach that unites two themes in – amphetamine and topiramate.

There are clues that stimulants, like amphetamine, methylphenidate, and , reduce reward dysfunction and deficits in executive cognitive associated with addiction. This approach fits with the "self-medication" hypothesis of addiction, which suggests that some people use drugs to treat symptoms that lead them to addiction or that emerge as a consequence of addiction.

There is also evidence that topiramate may be the most effective current pharmacotherapy for alcoholism. There are gaps in our understanding of exactly how topiramate works to combat addiction, but it shows signs of efficacy in animal models of stimulant addiction. In a recent large study of methamphetamine addiction, it appeared to reduce the intensity of methamphetamine use.

Using this knowledge as building blocks, Mariani and colleagues set out to test a combination of mixed amphetamine salts and topiramate for the treatment of cocaine dependence. They recruited cocaine-dependent treatment-seeking adults who were randomized to receive either the combination treatment or a placebo for twelve weeks. It was conducted as a double-blind study, using matching capsules, so that neither participants nor the research staff knew which treatment each individual was receiving.

They found that the participants receiving the combination treatment achieved three weeks of continuous abstinence from cocaine at a rate twice that of placebo (33% versus 17%). There was a significant moderating effect of the total number of cocaine use days, which suggests that the combination treatment was most effective for participants with a high baseline frequency of cocaine use.

"The combination of mixed amphetamine salts and topiramate appears promising as a treatment for cocaine dependence," said the authors. "The positive results observed in this study need to be replicated in a larger, multicenter clinical trial. The findings also provide encouragement for the strategy of testing medication combinations, rather than single agents, for cocaine dependence."

Biological Psychiatry Editor Dr. John Krystal agreed, adding that "the challenge of developing pharmacotherapies for cocaine is daunting. Yet, this combination therapy approach is a promising new strategy."

Explore further: Abnormal brain structure linked to chronic cocaine abuse

More information: The article is "Extended-Release Mixed Amphetamine Salts and Topiramate for Cocaine Dependence: A Randomized Controlled Trial" by John J. Mariani, Martina Pavlicova, Adam Bisaga, Edward V. Nunes, Daniel J. Brooks, and Frances R. Levin (doi: 10.1016/j.biopsych.2012.05.032). The article appears in Biological Psychiatry, Volume 72, Issue 11 (December 1, 2012)

Related Stories

Abnormal brain structure linked to chronic cocaine abuse

June 21, 2011
Researchers at the University of Cambridge have identified abnormal brain structures in the frontal lobe of cocaine users' brains which are linked to their compulsive cocaine-using behaviour. Their findings were published ...

Addicts' cravings have different roots in men and women

January 30, 2012
When it comes to addiction, sex matters.

Cocaine decreases activity of a protein necessary for normal functioning of the brain's reward system

April 22, 2012
New research from Mount Sinai Medical Center in New York reveals that repeated exposure to cocaine decreases the activity of a protein necessary for normal functioning of the brain's reward system, thus enhancing the reward ...

Recommended for you

Probing how Americans think about mental life

October 20, 2017
When Stanford researchers asked people to think about the sensations and emotions of inanimate or non-human entities, they got a glimpse into how those people think about mental life.

Itsy bitsy spider: Fear of spiders and snakes is deeply embedded in us

October 19, 2017
Snakes and spiders evoke fear and disgust in many people, even in developed countries where hardly anybody comes into contact with them. Until now, there has been debate about whether this aversion is innate or learnt. Scientists ...

Inflamed support cells appear to contribute to some kinds of autism

October 18, 2017
Modeling the interplay between neurons and astrocytes derived from children with Autism Spectrum Disorder (ASD), researchers at University of California San Diego School of Medicine, with colleagues in Brazil, say innate ...

Study suggests psychedelic drugs could reduce criminal behavior

October 18, 2017
Classic psychedelics such as psilocybin (often called magic mushrooms), LSD and mescaline (found in peyote) are associated with a decreased likelihood of antisocial criminal behavior, according to new research from investigators ...

Taking probiotics may reduce postnatal depression

October 18, 2017
Researchers from the University of Auckland and Otago have found evidence that a probiotic given in pregnancy can help prevent or treat symptoms of postnatal depression and anxiety.

Schizophrenia disrupts the brain's entire communication system, researchers say

October 17, 2017
Some 40 years since CT scans first revealed abnormalities in the brains of schizophrenia patients, international scientists say the disorder is a systemic disruption to the brain's entire communication system.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.