Despite huge advances in the neuroscience of
substance abuse and dependence in the past 20 years, no approved pharmacological treatment exists for
cocaine abuse. The available drugs for the treatment of
cocaine abuse are poorly effective, hence the need for new compounds to be screened and tested for efficacy: targeting symptoms might improve the effectiveness of the treatment of
cocaine abuse and dependence. On the basis of the known neurochemistry of
cocaine, some target compounds have been studied: among others,
BP-897, a D3 partial agonist;
vanoxerine, a highly selective inhibitor of
dopamine uptake;
aripiprazole, a partial mixed-action agonist approved for the treatment of
schizophrenia. Recently
modafinil, approved for the treatment of
narcolepsy, proved effective in favouring
cocaine abstinence in
cocaine-abusing people. Some placebo-controlled studies also reported the effectiveness of
topiramate, a licensed
antiepileptic drug, and of
tiagabine, a
gamma-aminobutyric acid (
GABA) re-uptake inhibitor also approved as an
anticonvulsant; both compounds increased
cocaine abstinence with no serious adverse events. Promising results came from two more compounds acting on the
GABA circuits,
baclofen and
valproic acid. Finally
disulfiram, prescribed with active psychosocial
therapy, was found to favour higher retention rates and longer abstinence periods from both alcohol and
cocaine in polydrug-abusing patients. An alternative approach rests on the use of
vaccines, to date in the experimental stage still. Psychosocial treatments are a useful companion in the
pharmacotherapy of
cocaine abuse, with group therapy and contingency management
therapies improving motivation and social functioning, particularly in patients abusing alcohol as well.