Cocaine Use Disorder (CUD): Current Clinical Perspectives

Abstract

Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD - contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular - however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.

Keywords: behavioral interventions; cocaine; cocaine use disorder; pharmacotherapy; treatment.

Figure 1

CUD: A Comprehensive Treatment Approach: After ruling out the need for acute medical or psychiatric care, a dynamic comprehensive treatment plan should be formulated for each patient based on an ongoing assessment of several critical domains. This assessment can also help to determine the appropriate level of care which may be lower or higher, depending on several different factors (such as the presence or severity of co-occurring disorders or co-occurring substance use, presence of immediate stressors, or different levels of social support).