Curing Cocaine Addiction: Moving Forward by Looking Behind

Cocaine addiction is a serious mental health issue that affects both individuals and their communities. For the individual, chronic cocaine use often causes irritability, restlessness, anxiousness, paranoia, and psychosis. Additional peripheral health problems may also develop such as heart attack or stroke, which may result in sudden death.[1] Societies also suffer from an individual’s addiction. Diverse studies have affirmed an association between cocaine use and crime. Comprehensive research covering a 21 year timeline from 1986 to 2006 has shown a high proportion of violent acts occur when cocaine is used by aggressors, its victims or both.[2] Hence, finding more effective methods for treating cocaine dependency is important and heavily sought out. Current treatment options fall into three main categories: punitive treatment (imprisonment), pharmacotherapy, and psychotherapy (of which group therapy and cognitive behavioral therapy are most widely practiced). By evaluating the efficacy of each treatment, one can gain further insight for developing better programs.

The punitive approach towards treating cocaine dependence involves imprisonment upon drug abuse. The rationale behind this treatment is that individuals will be swayed from abusing drugs by negative reinforcement (jail time). In addition, the punitive treatment allows the community to gain a sense of retribution for one’s breaking of the law. In fact, most of the policy makers, who support punitive treatment, do so because “they believe that the public wants offenders punished.”[3]

Regarding the efficacy punitive treatment in rehabilitating cocaine dependent individuals, many studies indicate that there is much inefficacy. Cocaine dependent individuals who underwent prison-based treatment programs were found to have the same relapse rate as individuals who underwent no such treatment.[4] While the punitive approach could potentially serve as deterrence against starting cocaine use, much evidence suggests that this method does not help the already addicted. In a former prisoner’s own words, ““You know, it’s easy to analyze yourself and all your mistakes when you are in jail because you don’t have anything else to do but that…. But when you come out and you have no one to go to and nothing to go to, you don’t have the support that you need.”[5] As indicated by the former inmate, treatment programs need to provide participants with someone to go to, somewhere to go, and support. Prison-based treatment fails to provide such resources. While the punitive treatment may possibly be useful in creating deterrence against using cocaine, it has shown to be useless in curing addiction.

Pharmacotherapy has shown to be more effective than punitive treatment. This treatment provides support for one’s withdrawal with drug agonist medication. Drug agonists counter the rewarding effect of cocaine and/or relieve withdrawal symptoms. Since there are currently no such medications that are approved by the food and drug administration, all pharmacotherapy treatments are performed within contexts of clinical trials. The basis for pharmacotherapy is that cocaine addiction stems from biochemical pathways in the brain. By targeting such pathways, one can help cure one’s addiction.

Several reports from clinical trials suggest that drug agonist treatment is rather effective. In one such trial, subjects took oxcarbazepine, which is effective in reducing cocaine cravings, for twelve weeks. All of the subjects who remained compliant throughout the twelve weeks remained abstinent.[6] Despite reports of success, there are valid criticisms to the pharmacotherapy approach. Drug agonists do not cure but rather replace cocaine dependency. Furthermore, pharmacotherapy programs ignore the underlying causes of drug dependence and only focus on blocking cocaine-induced reward or alleviating withdrawal symptoms. Drug agonists have no effect on other problems, which are closely linked with drug abuse such as antisocial traits.[7] Such critical attitudes have become prevalent regarding general pharmacotherapy approaches towards mental illnesses: “A great deal of American culture is based on instant gratification… Drugs are easily administered and require little extra effort on the part of both doctors and patients. And best of all, if you take a pill- poof! You're cured.”[8] The sarcasm in the previous statement shows criticism for how pharmacotherapy focuses only on ridding addiction and fails to provide proper help for the larger issues which underlie one’s drug dependence.

Psychotherapy aims to explore and resolve such larger issues. This approach is broken down into to two subcategories: group therapy and cognitive behavioral therapy. The basis behind group therapy is that problematic social forces underlie the development and continuation one’s drug addiction.[9] By immersing themselves into new, drug-free, support groups, drug dependent individuals can beneficially influence each other out of addiction.

While group therapy “is valuable in an educational context (like our course), that the spontaneous sharing of diverse stories can be quite productive in encouraging revision of individual ones [for some individuals],”[10] group therapy may not be so effective for others. Studies have reported that half of the average cocaine anonymous participants remain abstinent.[11] The difficulty in remaining sober for a group therapy participant is understandable: “although an addict may be fine while in the [group therapy] program, when he goes home… he is again alone in the world which bred his addiction and he goes back to the narcotic habit.”[12] While group therapy is very effective for some, it fails to provide individual and group-independent empowerment against addiction for others.

Cognitive behavioral treatment is a short-term, focused approach to helping cocaine-dependent individuals become abstinent from cocaine. The basis of this approach is that learning processes play an important role in the development of cocaine addiction, and these same learning processes can be used to help individuals cease their drug use.[13] Cognitive behavioral therapy has been shown to be effective for decreasing cocaine use and preventing relapse;[14] more so than group therapy.[15] Still, not all participants who undergo cognitive behavioral therapy remain abstinent. The most reasonable explanation for this is that the biological drive of cocaine addiction overrides the cognitive restraint for some participants.

As shown above, there is no full-proof strategy for treating cocaine addiction. However, evaluating the current variety of approaches towards treating cocaine addiction has revealed several lessons, which may help in developing better ways to treat cocaine addiction. First, while imprisonment may create a sense of deterrence against first using cocaine, it is ineffective in treating an already established addiction. Furthermore, imprisonment contributes to stigmatization. One of the biggest obstacles in treating mental health issues is overcoming stigmatization. Labeling cocaine addiction as a character flaw or a crime, for which one must be punished, is not productive in treating one’s problem. Instead, communities must conceive addiction as a mental health issue, which requires compassion rather than condemnation. Such perception of addiction will be the only way in which effective treatments can be developed and employed in our society.

Another important lesson is that addiction is not usually a problem in and of itself. Rather, it is often a symptom of a larger problem pertaining to one’s mental state. An addict’s mental state derives more satisfaction from cocaine than from life: “There is a tendency to use [drugs] in order to manage such emotions as rage, shame, jealousy, and anxiety; to use stimulants to alleviate depression and weakness…”[16] This understanding of addiction explains why the most effective treatment is a combination of some form of pharmacotherapy and psychotherapy.[17] Pharmacotherapy enables one to enter into a healthy, less drug-obsessing mental state so that s/he can explore the larger problem and reveal the story via psychotherapy. Rather than only focusing on the biological basis of addiction, mental health providers must also shed light on the larger problems that drives one to addiction.

The last lesson learned is that treatment must be individualized. As observed, some treatment options work well for some but not for others. For example, group therapy requires members to learn how to be open with their thoughts and feelings as well as develop social support networks. This requirement is difficult for many, and therefore we see that only half of the group therapy participants successfully conquer their addiction. Those who were unable to quit with group therapy may be more successful with cognitive behavioral therapy. Likewise, those who were unable to stop cocaine use with cognitive behavioral therapy may be more successful with group therapy. Addressing the specific needs and characters of cocaine dependent individuals is necessary so that they can be fitted with appropriate treatment. Such a system would make their current drug treatment system much more effective.