Sarah Coscas

New treatments for cocaine dependence: a focused review.

Cocaine, already a significant drug problem in North and South America, has become a more prominent part of the European drug scene. Cocaine dependence has major somatic, psychological, psychiatric, socio-economic, and legal implications. No specific effective pharmacological treatment exists for cocaine dependence. Recent advances in neurobiology have identified various neuronal mechanisms implicated in cocaine addiction and suggested several promising pharmacological approaches. Data were obtained from Medline, EMBASE, and PsycINFO searches of English-language articles published between 1985 and June 2007 using the key words: cocaine, addiction, cocaine dependence, clinical trials, pharmacotherapy(ies) singly and in combination. Large well-controlled studies with appropriate statistical methods were preferred. Pharmacological agents such as GABA agents (topiramate, tiagabine, baclofen and vigabatrin) and agonist replacement agents (modafinil, disulfiram, methylphenidate) seem to be the most promising in treatment of cocaine dependence. The results from trials of first- and second-generation neuroleptics are largely negative. Aripiprazole, a partial dopaminergic agonist that may modulate the serotonergic system, shows some promise. Preliminary results of human studies with anti-cocaine vaccine, N-acetylcysteine, and ondansetron, are promising, as are several compounds in preclinical development. While no medication has received regulatory approval for the treatment of cocaine dependence, several medications marketed for other indications have shown efficacy in clinical trials. An anti-cocaine vaccine and several compounds in preclinical development have also shown promise. Findings from early clinical trials must be confirmed in larger, less selective patient populations.

Consommation de tabac et trouble lié à l’usage de substances illicites : que devrions-nous faire ?

UNLABELLED Tobacco use is a commonplace phenomenon in our society. Its use is responsible for more death and disease than any other noninfectious cause. More deaths are caused each year by tobacco use than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. Tobacco remains responsible for greater morbidity than alcohol and all other drugs combined. Tobacco dependence is highly prevalent among drug-dependent patients. Substance abuse patients smoke more and are more vulnerable to the effects of smoking than general populations. Traditional substance abuse therapeutic programs too frequently focus only on treatment of alcohol or other drugs rather than including treatment for tobacco dependence. Currently, there are no official medical recommendations for the treatment of tobacco addiction in illicit polysubstance users. METHODS A comprehensive literature search from a range of electronic databases (PubMed, Embase, PsycInfo, Google Scholar) was conducted for the period from 1988 to September 2012, using the following keywords alone or in combination: tobacco, nicotine, cocaine, cannabis, amphetamines, opiates, substance abuse, substance dependence, addiction, treatment. There were no restrictions on the identification or inclusion of studies in terms of publication status, language and design type. RESULTS Our literature review will focus on epidemiological, neurobiological, clinical interactions between tobacco, alcohol and other illicit drugs. It will also focus on therapeutic programs in this dual addictive disorder. The aim of this literature review is to make proposals for the treatment of tobacco addiction in polysubstance users entering in specific therapeutic programs.

Mise au pointAddiction à la cocaïne : un facteur de risque de suicide ?Addiction to cocaine: A risk factor for suicide?

Cocaine is an illicit substance which is the greatest suicide-induced potential. Studies show a link between cocaine dependence and suicide. The prevalence of its use, in the days leading up to a suicide, may vary as between 9.4 and 20% according to the chosen method. The number of suicides is important. The acting out may be present at all stages of the addictive cycle associated with cocaine. On the 12th National Day on Suicide Prevention devoted to addictions and suicide, it was recommended that addictive phenomena should be taken more into account by experts in the subject, and that the risk of suicide should be evaluated by specialists in addiction in order that people presenting a risk be placed in appropriate preventative care in time.

Le cannabis : addiction. Conséquences aiguës et chroniques

Le cannabis reste la drogue la plus experimentee au cours de la vie et la plus consommee en France notamment chez les adolescents, les jeunes adultes et les populations souffrant de troubles psychiatriques (schizophrenie, trouble anxieux, trouble depressif, trouble bipolaire...). Cette substance se consomme essentiellement par voie inhalee mais peut etre ingeree ou vapotee dans des cigarettes electroniques. Outre les effets psychoactifs d’une intoxication aigue, le cannabis peut etre a l’origine de consequences psychiatriques aigues propres (pharmacopsychose, anxiete, hallucinations, troubles cognitifs...), d’un trouble de l’usage ou addiction, d’un syndrome de sevrage, de consequences psychiatriques chroniques (depersonalisation, syndrome amotivationnel, troubles cognitifs..).