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Auricular acupuncture for cocaine dependence

There are no effective drugs for the treatment of cocaine dependence, and doctors do not agree on a best method of treatment. More than 400 substance abuse clinics in the USA and Europe offer a treatment for cocaine dependence called auricular acupuncture. In this treatment, needles are usually inserted into five specific points in the ear, but some clinics use only four or three of the points. In this Cochrane review the authors set out to discover whether auricular acupuncture is effective in treating cocaine dependence and whether the number of points used makes a difference. The authors searched the medical literature for studies called randomized controlled trials, in which one group of patients receives a treatment (such as acupuncture) and is compared with a similar group who receives a different treatment or no treatment (the control group). The authors found seven studies with a total of 1433 people. Most of the studies compared acupuncture with 'sham' acupuncture in which needles were inserted into random places in the ear but not into the specific points required for treatment. The studies used a variety of acupuncture techniques, using three, four, or five of the treatment points. The studies had a number of problems with the way their results were reported. The authors conclude that there is no evidence that any form of auricular acupuncture is effective for treating cocaine dependence. They recommend that better research be done, since it was difficult for them to draw conclusions from the few available studies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Efficacy of Psychostimulant Drugs for Cocaine Dependence

Cocaine dependence is a frequent disorder for which no medication has clearly proved to be efficacious. Substitution therapy involves the replacement of abused drug, which is often illegal, used several times a day, by a legal, orally administered one. A substitutive drug has similar effects to the abused one, but with a lower addictive potential therefore leading to drug abstinence and involving patients to follow medical and psychological assistance. This strategy has proved to be efficacious for heroin and nicotine dependence. In this review we investigated if psychostimulant substitution was efficacious for cocaine dependence. We found that sixteen studies that had enrolled 1,345 patients investigated the efficacy of psychostimulants against placebo for cocaine dependence. Seven drugs with psychostimulant effect or metabolized to a psychostimulant have been investigated: bupropion, dexamphetamine, methylphenidate, modafinil, mazindol, methamphetamine and selegiline. Psychotherapy was provided in all clinical trials. Study length ranged from 6 to 24 weeks. Psychostimulants did not improve cocaine use, had an unclear beneficial effect over sustained cocaine abstinence and were not associated with higher retention in treatment. Psychostimulants did not increase risk of serious adverse events. It was found that psychostimulants could be efficacious for some groups of patients, such as methadone maintained dual heroin‐cocaine addicts. Therefore, psychostimulants, though have not proved yet their efficacy for cocaine dependence, deserve further investigation.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Anticonvulsants for cocaine dependence

Cocaine is an illicit drug available as a powder for intranasal or intravenous use or smoked as crack. Short‐ and long‐term use of this drug results in the spread of infectious diseases (for example, AIDS, hepatitis, tuberculosis), crime, violence and prenatal drug exposure. Cocaine dependence is associated with medical and psychosocial complications and is a major public health problem. No proven pharmacological treatment for cocaine dependence is known. Antidepressant, anticonvulsant and dopaminergic medications have all been studied. The present review looked at the efficacy and safety of anticonvulsant drugs for treating cocaine dependence, both as a class and individually.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antidepressants for cocaine abuse and dependence

A pharmacological agent with proven efficacy does not exist for treatment of cocaine dependence. Cocaine is an alkaloid derived from the erythroxylon coca leaf that is used as powder for intranasal or intravenous use or as crack, a free‐base form which is smoked. Cocaine dependence is a major public health problem because its use can be associated with medical and psychosocial complications including the spread of infectious diseases (such as AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure. This review looked at the evidence on the efficacy and acceptability of antidepressants alone or in combination with a psychosocial intervention for the treatment of cocaine abuse and dependence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Dopamine agonists for the treatment of people who misuse cocaine

A pharmacological agent with proven efficacy does not exist for treatment of cocaine misuse. Cocaine is an alkaloid derived from the erythroxylon coca leaf that is used as powder for intranasal or intravenous use or as crack, a free‐base form which is smoked. Cocaine misuse is a major public health problem because its use can be associated with medical and psychosocial complications including the spread of infectious diseases (such as AIDS, hepatitis and tuberculosis), crime, violence and neonatal drug exposure. In this Cochrane Review we looked at the evidence on the efficacy and acceptability of dopamine agonists as a treatment, used either alone or in combination with any psychosocial intervention, for people addicted to cocaine.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Disulfiram as a medication for the treatment of cocaine dependence

Cocaine is used as powder for intranasal or intravenous use, or smoked as crack. Dependence on cocaine can cause major public health problems because of its psychological, social and medical impacts, including the spread of infectious diseases such as AIDS, hepatitis and tuberculosis. No proven pharmacological treatment of cocaine dependency exists as yet. Disulfiram is marketed for the treatment of alcoholism and interferes with the metabolism of alcohol. It may also be useful in treating cocaine dependence. Evidence from randomised controlled trials to support the clinical use of disulfiram in people with cocaine dependence is limited. The review authors identified seven controlled studies that randomised a total of 492 participants to receive disulfiram, a placebo, no pharmacological treatment or naltrexone in addition to psychosocial treatment. Their mean age was 38 years and the studies took place in an outpatient setting over a mean time of 12 weeks. All trials but one were conducted in the USA. Five studies enrolled patients with cocaine dependence and alcohol abuse or dependence. Two enrolled people with concurrent opioid addiction who were undergoing treatment with buprenorphine or methadone.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Antipsychotic medications for cocaine dependence

Cocaine dependence is often associated with medical, psychological and social problems for individual and public health, generating problems for the community. Users play a role in the spread of infectious diseases such as AIDS, hepatitis and tuberculosis, as well as in crime, violence and neonatal drug exposure. Use of drugs such as antidepressants, anticonvulsants and dopamine agonists to treat cocaine abuse or dependence is not supported by evidence from Cochrane reviews. The use of antipsychotic agents has also been considered, particularly because cocaine can induce hallucinations and paranoia that mimic psychosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

A systematic review comparing cognitive-behavioral therapy and contingency management for cocaine dependence

The main objective of this review was to compare the effectiveness of cognitive-behavioral therapy and contingency management for cocaine dependence. Contingency management alone reliably reduced cocaine use during active treatment in all cited trials, whereas the positive effect of cognitive-behavioral therapy emerged after treatment in 3 of 5 trials. Synergistic effects of the combination of contingency management plus cognitive-behavioral therapy are shown in 2 trials, but another 3 trials found no additive effects. Positive, rapid, and enduring effects on cocaine use are reliably seen with contingency management interventions, whereas measurable effects of cognitive-behavioral therapy emerge after treatment and are not as reliable as effects with contingency management.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Antipsychotic drugs in cocaine dependence: a systematic review and meta-analysis

A systematic review and meta-analysis to evaluate the efficacy of antipsychotic drugs in subjects with cocaine dependence is presented. Twelve randomized, double-blind, placebo-controlled clinical trials involving 681 patients were included. Five outcome measures were evaluated: number of dropouts, cocaine use assessed by means of urine benzoylecgonine tests, self-reported cocaine use, craving and Addiction Severity Index. On average, 48% of the enrolled participants were lost to follow-up. In comparison to placebo, antipsychotics did not significantly reduce cocaine use (WMD=0.01, 95%CI=-0.12 to 0.13) or improve retention in treatment (RR 0.91, 95%CI=0.82-1.02). Risperidone reduced slightly dropouts in comparison to placebo (RR=0.87; 95%CI=0.79-0.97). To date there is insufficient evidence to justify the use of antipsychotic drugs for cocaine dependence.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

The effectiveness of treatments for cocaine dependence in schizophrenic patients: a systematic review

OBJECTIVES: To evaluate and compare the effectiveness of available treatments for cocaine dependence in schizophrenic patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Disulfiram as a treatment for cocaine dependency

BACKGROUND: Cocaine abuse and dependency have a considerable impact on society and health issues. Current treatment of cocaine dependency consists primarily of psychosocial and therapeutic interventions. There is a marked need for effective pharmacological treatments in addition to the currently available treatment options. Recently, there is some evidence that disulfiram (DSF) might reduce use of cocaine in patients presenting with cocaine dependency.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Local anaesthesia (numbing medicine) that is directly applied to the skin may be used to provide pain control for repair of lacerations

Pain control for suturing of torn skin is conventionally achieved by injecting medication into the skin, which may itself cause pain. Topical anaesthetics are directly applied to the skin and are painless to administer. Cocaine was one of the first anaesthetics to be successfully applied topically. Concerns over adverse effects with cocaine and the administrative burdens of dispensing a controlled substance led to the development of cocaine‐free anaesthetics. There are numerous cocaine‐free topical anaesthetics and these were found to be effective for enabling repair of dermal lacerations. We included 23 randomized controlled trials involving 3128 patients in this review. The small number of trials in each comparison group and the heterogeneity of outcome measures precluded quantitative analysis of data in all but one outcome, pain scores using a visual analogue scale. Additional studies are necessary to directly compare the effectiveness of different formulations of topical anaesthetics. No serious side effects were reported in the studies included in the review following use of cocaine‐containing or cocaine‐free topical anaesthetics.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Psychological treatments for people with antisocial personality disorder

We considered 11 studies, but were unable to draw any firm conclusions from the evidence available. Although several studies looked at treatments to reduce drug or alcohol misuse in people with antisocial personality disorder, few studies focused on treating the disorder itself. Only three studies reported outcome measures that were originally defined in the review protocol as being of particular importance in this disorder (reconviction and aggression). Nonetheless, there was some evidence that a type of treatment known as contingency management (which provides rewards for progress in treatment) could help people with antisocial personality disorder to reduce their misuse of drugs or alcohol.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Efficacy of central nervous system stimulant treatment for cocaine dependence: a systematic review and meta-analysis of randomized controlled clinical trials

AIMS: To evaluate the efficacy of central nervous system (CNS) stimulants compared with placebo for the treatment of cocaine dependence.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

Which talking therapies (counselling) work for drug users with alcohol problems?

We wanted to determine whether talking therapies have an impact on alcohol problems in adult users of illicit drugs (mainly opiates and stimulants) and whether one type of therapy is more effective than another.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Antipsychotics for cocaine or psychostimulant dependence: systematic review and meta-analysis of randomized, placebo-controlled trials

OBJECTIVE: Since cocaine and psychostimulant dependence are related to increased dopamine release, antipsychotics have been tried to reduce their reinforcing properties. A meta-analysis was undertaken to assess the efficacy and tolerability of antipsychotics in cocaine- or stimulant-dependent patients.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Auricular acupuncture in the treatment of cocaine/crack abuse: a review of the efficacy, the use of the National Acupuncture Detoxification Association protocol, and the selection of sham points

This review concluded that the efficacy of auricular acupuncture for the treatment of cocaine abuse could not be confirmed. This reflects the evidence presented. However, limitations in the review process suggest that studies might have been missed and that subjective decisions were made; this may mean that the conclusions do not reflect the available literature.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

Anticonvulsant drugs in cocaine dependence: a systematic review and meta-analysis

The review evaluated efficacy of anticonvulsant medications compared with placebos in patients with cocaine dependence and found no evidence of any advantageous effect on retention in treatment or cocaine use. The authors' cautious conclusions appeared justified on the basis of the evidence provided and may be reliable, but limited reporting of quality assessment results should be borne in mind.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Efficacy of acupuncture for cocaine dependence: a systematic review and meta-analysis

This review assessed the impact of acupuncture on cocaine dependence. A comprehensive search was conducted for published and unpublished literature in all languages. Trials with biochemical confirmation of cocaine abstinence were pooled and no treatment effect was found. The findings appear reliable, although the authors noted that the high drop-out rate might have hampered the results.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

Efficacy of opiate maintenance therapy and adjunctive interventions for opioid dependence with comorbid cocaine use disorders: a systematic review and meta-analysis of controlled clinical trials

This review concluded that dual opioid and cocaine dependence could be effectively treated with opiate maintenance therapy combined with other interventions. Higher opiate therapy doses were better than lower doses and methadone was better than buprenorphine. There was potential for bias in the review and small samples in the included trials, which limit the reliability of the authors' conclusions.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

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