Current Psychiatry Reports

, Volume 10, Issue 5, pp 385–391 | Cite as

Use of stimulants to treat cocaine and methamphetamine abuse

  • F. Gerard Moeller
  • Joy M. Schmitz
  • David Herin
  • Kimberly L. Kjome


The concept of using stimulants to treat cocaine and methamphetamine dependence is largely based on the “replacement” therapy model that has shown efficacy for treating nicotine and opiate dependence. Although results have been mixed, some evidence supports using stimulant medication to reduce cocaine use. There are not enough data to date to determine the efficacy of stimulants for methamphetamine dependence. Drawbacks of stimulants as treatments include the potential for abuse of the treatment, which necessitates careful screening and monitoring of patients. Possible reasons for efficacy of stimulants include enhancement of monoamine function dysregulated by chronic cocaine or methamphetamine use. Newer medications that enhance dopamine function but lack the abuse potential of older stimulants are being studied. It is hoped that these medications will provide safe, effective treatment for cocaine and methamphetamine dependence, but more research on this topic is needed.


Cocaine Amphetamine Methylphenidate Methamphetamine Cocaine Dependence 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Grabowski J, Shearer J, Merrill J, Negus SS: Agonist-like, replacement pharmacotherapy for stimulant abuse and dependence. Addict Behav 2004, 29: 1439–1464.PubMedCrossRefGoogle Scholar
  2. 2.
    Castells X, Casas M, Vidal X, et al.: Efficacy of central nervous system stimulant treatment for cocaine dependence: a systematic review and meta-analysis of randomized controlled clinical trials. Addiction 2007, 102: 1871–1887.PubMedCrossRefGoogle Scholar
  3. 3.
    Ritz MC, Cone EJ, Kuhar MJ: Cocaine inhibition of ligand binding at dopamine, norepinephrine and serotonin transporters: a structure-activity study. Life Sci 1990, 46: 635–645.PubMedCrossRefGoogle Scholar
  4. 4.
    Vocci FJ, Appel NM: Approaches to the development of medications for the treatment of methamphetamine dependence. Addiction 2007, 102(Suppl 1): 96–106.PubMedCrossRefGoogle Scholar
  5. 5.
    Buydens-Branchey L, Branchey M, Hudson J, et al.: Serotonergic function in cocaine addicts: prolactin responses to sequential D,L-fenfluramine challenges. Biol Psychiatry 1999, 45: 1300–1306.PubMedCrossRefGoogle Scholar
  6. 6.
    Volkow ND, Fowler JS, Wolf AP, et al.: Effects of chronic cocaine abuse on postsynaptic dopamine receptors. Am J Psychiatry 1990, 147: 719–724.PubMedGoogle Scholar
  7. 7.
    Martinez D, Broft A, Foltin RW, et al.: Cocaine dependence and d2 receptor availability in the functional subdivisions of the striatum: relationship with cocaine-seeking behavior. Neuropsychopharmacology 2004, 29: 1190–1202.PubMedCrossRefGoogle Scholar
  8. 8.
    Martinez D, Narendran R, Foltin RW, et al.: Amphetamine-induced dopamine release: markedly blunted in cocaine dependence and predictive of the choice to self-administer cocaine. Am J Psychiatry 2007, 164: 622–629.PubMedCrossRefGoogle Scholar
  9. 9.
    Volkow ND, Fowler JS, Wang GJ, et al.: Decreased dopamine D2 receptor availability is associated with reduced frontal metabolism in cocaine abusers. Synapse 1993, 14: 169–177.PubMedCrossRefGoogle Scholar
  10. 10.
    Volkow ND, Chang L, Wang GJ, et al.: Low level of brain dopamine D2 receptors in methamphetamine abusers: association with metabolism in the orbitofrontal cortex. Am J Psychiatry 2001, 158: 2015–2021.PubMedCrossRefGoogle Scholar
  11. 11.
    McCann UD, Wong DF, Yokoi F, et al.: Reduced striatal dopamine transporter density in abstinent methamphetamine and methcathinone users: evidence from positron emission tomography studies with [11C]WIN-35,428. J Neurosci 1998, 18: 8417–8422.PubMedGoogle Scholar
  12. 12.
    Sevy S, Hassoun Y, Bechara A, et al.: Emotion-based decision-making in healthy subjects: short-term effects of reducing dopamine levels. Psychopharmacology 2006, 188: 228–235.PubMedCrossRefGoogle Scholar
  13. 13.
    Stout JC, Busemeyer JR, Lin A, et al.: Cognitive modeling analysis of decision-making processes in cocaine abusers. Psychon Bull Rev 2004, 11: 742–747.PubMedGoogle Scholar
  14. 14.
    Gonzalez R, Bechara A, Martin EM: Executive functions among individuals with methamphetamine or alcohol as drugs of choice: preliminary observations. J Clin Exp Neuropsychol 2007, 29: 155–159.PubMedCrossRefGoogle Scholar
  15. 15.
    Patkar AA, Gottheil E, Berrettini WH, et al.: Relationship between platelet serotonin uptake sites and measures of impulsivity, aggression, and craving among African-American cocaine abusers. Am J Addict 2003, 12: 432–447.PubMedCrossRefGoogle Scholar
  16. 16.
    Moeller FG, Barratt ES, Dougherty DM, et al.: Psychiatric aspects of impulsivity. Am J Psychiatry 2001, 158: 1783–1793.PubMedCrossRefGoogle Scholar
  17. 17.
    Elkashef A, Vocci F: Biological markers of cocaine addiction: implications for medications development. Addict Biol 2003, 8: 123–139.PubMedCrossRefGoogle Scholar
  18. 18.
    Volkow ND, Li TK: Drug addiction: the neurobiology of behaviour gone awry. Nat Rev Neurosci 2004, 5: 963–970.PubMedCrossRefGoogle Scholar
  19. 19.
    Schweri MM, Deutsch HM, Massey AT, Holtzman SG: Biochemical and behavioral characterization of novel methylphenidate analogs. J Pharmacol Exp Ther 2002, 301: 527–535.PubMedCrossRefGoogle Scholar
  20. 20.
    Thanos PK, Michaelides M, Benveniste H, et al.: Effects of chronic oral methylphenidate on cocaine self-administration and striatal dopamine D2 receptors in rodents. Pharmacol Biochem Behav 2007, 87: 426–433.PubMedCrossRefGoogle Scholar
  21. 21.
    Negus SS, Mello NK: Effects of chronic d-amphetamine treatment on cocaine-and food-maintained responding under a second-order schedule in rhesus monkeys. Drug Alcohol Depend 2003, 70: 39–52.PubMedCrossRefGoogle Scholar
  22. 22.
    Dackis C, O’Brien C: Glutamatergic agents for cocaine dependence. Ann N Y Acad Sci 2003, 1003: 328–345.PubMedCrossRefGoogle Scholar
  23. 23.
    Gold LH, Balster RL: Evaluation of the cocaine-like discriminative stimulus effects and reinforcing effects of modafinil. Psychopharmacology (Berl) 1996, 126: 286–292.CrossRefGoogle Scholar
  24. 24.
    de Wit H, Enggasser JL, Richards JB: Acute administration of d-amphetamine decreases impulsivity in healthy volunteers. Neuropsychopharmacology 2002, 27: 813–825.PubMedCrossRefGoogle Scholar
  25. 25.
    Faraone SV, Biederman J: Efficacy of Adderall for attention-deficit/hyperactivity disorder: a meta-analysis. J Atten Disord 2002, 6: 69–75.PubMedCrossRefGoogle Scholar
  26. 26.
    Fillmore MT, Rush CR, Marczinski CA: Effects of d-amphetamine on behavioral control in stimulant abusers: the role of prepotent response tendencies. Drug Alcohol Depend 2003, 71: 143–152.PubMedCrossRefGoogle Scholar
  27. 27.
    Levin FR, Evans SM, Kleber HD: Prevalence of adult attention-deficit hyperactivity disorder among cocaine abusers seeking treatment. Drug Alcohol Depend 1998, 52: 15–25.PubMedCrossRefGoogle Scholar
  28. 28.
    Carroll KM, Power ME, Bryant K, Rounsaville BJ: One-year follow-up status of treatment-seeking cocaine abusers. Psychopathology and dependence severity as predictors of outcome. J Nerv Ment Dis 1993, 181: 71–79.PubMedCrossRefGoogle Scholar
  29. 29.
    Faraone SV, Wilens TE: Effect of stimulant medications for attention-deficit/hyperactivity disorder on later substance use and the potential for stimulant misuse, abuse, and diversion. J Clin Psychiatry 2007, 68(Suppl 11): 15–22.PubMedGoogle Scholar
  30. 30.
    Levin FR, Evans SM, McDowell DM, Kleber HD: Methylphenidate treatment for cocaine abusers with adult attention-deficit/hyperactivity disorder: a pilot study. J Clin Psychiatry 1998, 59: 300–305.PubMedGoogle Scholar
  31. 31.
    Levin FR, Evans SM, Brooks DJ, Garawi F: Treatment of cocaine dependent treatment seekers with adult ADHD: double-blind comparison of methylphenidate and placebo. Drug Alcohol Depend 2007, 87: 20–29.PubMedCrossRefGoogle Scholar
  32. 32.
    Johnston LD, Bachman JG, Schulenberg JE: Monitoring the future national survey results on drug use, 1975–2005. Volume I: Secondary school students. Bethesda, MD: National Institute on Drug Abuse; 2006.Google Scholar
  33. 33.
    de Wit H, Stewart J: Reinstatement of cocaine-reinforced responding in the rat. Psychopharmacology (Berl) 1981, 75: 134–143.CrossRefGoogle Scholar
  34. 34.
    Volkow ND, Wang GJ, Telang F, et al.: Dopamine increases in striatum do not elicit craving in cocaine abusers unless they are coupled with cocaine cues. Neuroimage 2008, 39: 1266–1273.PubMedCrossRefGoogle Scholar
  35. 35.
    Grabowski J, Rhoades H, Schmitz J, et al.: Dextroamphetamine for cocaine-dependence treatment: a double-blind randomized clinical trial. J Clin Psychopharmacol 2001, 21: 522–526.PubMedCrossRefGoogle Scholar
  36. 36.
    Grabowski J, Rhoades H, Stotts A, et al.: Agonist-like or antagonist-like treatment for cocaine dependence with methadone for heroin dependence: two double-blind randomized clinical trials. Neuropsychopharmacology 2004, 29: 969–981.PubMedCrossRefGoogle Scholar
  37. 37.
    Shearer J, Wodak A, van Beek I, et al.: Pilot randomized double blind placebo-controlled study of dexamphetamine for cocaine dependence. Addiction 2003, 98: 1137–1141.PubMedCrossRefGoogle Scholar
  38. 38.
    Elkashef A, Fudala PJ, Gorgon L, et al.: Double-blind, placebo-controlled trial of selegiline transdermal system (STS) for the treatment of cocaine dependence. Drug Alcohol Depend 2006, 85: 191–197.PubMedCrossRefGoogle Scholar
  39. 39.
    Dackis CA, Kampman KM, Lynch KG, et al.: A double-blind, placebo-controlled trial of modafinil for cocaine dependence. Neuropsychopharmacology 2005, 30: 205–211.PubMedCrossRefGoogle Scholar
  40. 40.
    White R: Dexamphetamine substitution in the treatment of amphetamine abuse: an initial investigation. Addiction 2000, 95: 229–238.PubMedCrossRefGoogle Scholar
  41. 41.
    Carnwath T, Garvey T, Holland M: The prescription of dexamphetamine to patients with schizophrenia and amphetamine dependence. J Psychopharmacol 2002, 16: 373–377.PubMedCrossRefGoogle Scholar
  42. 42.
    Shearer J, Wodak A, Mattick RP, et al.: Pilot randomized controlled study of dexamphetamine substitution for amphetamine dependence. Addiction 2001, 96: 1289–1296.PubMedCrossRefGoogle Scholar
  43. 43.
    Laqueille X, Dervaux A, El Omari F, et al.: Methylphenidate effective in treating amphetamine abusers with no other psychiatric disorder. Eur Psychiatry 2005, 20: 456–457.PubMedCrossRefGoogle Scholar
  44. 44.
    Tiihonen J, Kuoppasalmi K, Fohr J, et al.: A comparison of aripiprazole, methylphenidate, and placebo for amphetamine dependence. Am J Psychiatry 2007, 164: 160–162.PubMedCrossRefGoogle Scholar
  45. 45.
    Ferre S, Diamond I, Goldberg SR, et al.: Adenosine A2A receptors in ventral striatum, hypothalamus and nociceptive circuitry implications for drug addiction, sleep and pain. Prog Neurobiol 2007, 83: 332–347.PubMedCrossRefGoogle Scholar
  46. 46.
    Ferre S: An update on the mechanisms of the psychostimulant effects of caffeine. J Neurochem 2008, 105: 1067–1079.PubMedCrossRefGoogle Scholar
  47. 47.
    Margolin A, Avants SK, Kosten TR: Mazindol for relapse prevention to cocaine abuse in methadone-maintained patients. Am J Drug Alcohol Abuse 1995, 21: 469–481.PubMedCrossRefGoogle Scholar
  48. 48.
    Stine SM, Krystal JH, Kosten TR, Charney DS: Mazindol treatment for cocaine dependence. Drug Alcohol Depend 1995, 39: 245–252.PubMedCrossRefGoogle Scholar
  49. 49.
    Grabowski J, Roache JD, Schmitz JM, et al.: Replacement medication for cocaine dependence: methylphenidate. J Clin Psychopharmacol 1997, 17: 485–488.PubMedCrossRefGoogle Scholar
  50. 50.
    Schubiner H, Saules KK, Arfken CL, et al.: Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Exp Clin Psychopharmacol 2002, 10: 286–294.PubMedCrossRefGoogle Scholar
  51. 51.
    Dackis CA, Kampman KM, Lynch KG, et al.: A double-blind, placebo-controlled trial of modafinil for cocaine dependence. Neuropsychopharmacology 2005, 30: 205–211.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  • F. Gerard Moeller
    • 1
  • Joy M. Schmitz
  • David Herin
  • Kimberly L. Kjome
  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of Texas Health Science Center at HoustonHoustonUSA

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