The Self-Medication Hypothesis and Psychostimulant Treatment of Cocaine Dependence: An Update

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Background:Stimulant medications have shown promise as a treatment for cocaine dependence (CD) for several decades, yet these treatments have not been widely studied and substantial barriers to clinical implementation remain. The “Self-Medication Hypothesis,” posits that an individual's choice to use a particular substance is to some degree based on the substance's effect on subjective painful affects or unpleasant emotional states which may or may not be associated with a psychiatric disorder.Objectives:The Self-Medication Hypothesis remains relevant, particularly when considering the scenario of cocaine dependence, both with and without and co-occurring attention-deficit/hyperactivity disorder (ADHD).Methods:Two case studies (N = 2) and a review of the relevant literature are provided in this clinical update on psychostimulant treatment of cocaine dependence.Results:Two case studies are presented in which psychostimulant treatment of cocaine dependence was associated with a good clinical outcome.Discussion:While the use of psychostimulant medication for the treatment of cocaine dependence is controversial, emerging evidence suggests potential utility for this approach.Conclusions:Cocaine use in individuals with CD may represent self-medication, and prescribed psychostimulants may have benefit in restoring dopaminergic function.Scientific Significance:Psychostimulant treatment of cocaine dependence is consistent with the Self-Meidcation Hypothesis and is deserving of further study. (Am J Addict 2014;23:189–193)

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