MEDICINES FOR PSYCHO-STIMULANT CRAVINGS

Return to Substance Abuse Articles 

As mentioned in other articles, the chronic use of the psycho-stimulant agents lead to a withdrawal syndrome when they are stopped.  This is characterized by depression with resultant anxiety, irritability and sleep disturbance.  There may also be intense cravings.  The former user will hunger for the drug as intensely as a starving person will hunger for food.  Most experts believe that this is due to alterations in dopamine metabolism.

All drugs of abuse (except LSD-like drugs) increase dopamine in the pleasure center of the brain.   However, the stimulants have the greatest effects in this regard.  Dopamine is lost with chronic use and this leads to withdrawal symptoms.  Perhaps, if we could replace the dopamine, we can ameliorate this  syndrome.

Dopamine is made in the body from amino acid precursors.  Years ago, people thought that the use of specific amino acids might help the body to replenish faster.  Unfortunately, studies never revealed this to be an effective treatment.

BROMOCRIPTINE

A lot of work has been done with a drug called bromocriptine.  This drug is otherwise known as Parlodel.  This drug mimics dopamine and is able to stimulate dopamine receptors; it becomes an artificial dopamine.  Perhaps this effect can help to reduce cravings for cocaine as well.

It is approved for treating Parkinson’s disease.  Woman use it for treating excessive secretion of milk.   In both cases, the drug works by imitating dopamine.

Initial studies with animals were encouraging.  Animals who were addicted to cocaine were less drug seeking after they were given bromocriptine.  However, the studies in people were mixed.  Some showed a mild decrease in craving while others did not.  Relapse was not significantly reduced.  The FDA would not give the drug an indication to be used for this purpose.

However, I began to use Bromocriptine in 1989 before the studies found it ineffective.  My own experience runs contrary to the published studies.  Over 75% of my patients describe significant reductions in drug cravings and I have continued to use it.  This reduction of craving is especially apparent in the first weeks of treatment.  Perhaps, it is a placebo effect.  Nevertheless, I will take whatever benefit I can get.

Side effects include fatigue, headache and nausea but the drug is well tolerated by most people.  Psychosis is caused by too much dopamine in the brain.   Bromocriptine can cause psychosis in susceptible people and I will not use it in any one with a history of hallucinations or schizophrenia.

Amantidine is a drug for treating the flu.  It has effects on dopamine and may cause an increase in dopamine levels.  Despite some reports showing a benefit, I have not seen it work yet.

BACLOFEN

One interesting phenomenon in addiction is the anticipation related cravings.  Some people seem to get high just by thinking about the drug.  It turns out that dopamine is released in the brain when we anticipate using drugs.  This release of dopamine is pleasurable and will cause an even greater desire to use the drug.  If we can reduce the dopamine release from anticipation, perhaps we can reduce cravings.

Research has recently focused on a medication called baclofen.  This is an old medication primarily used for muscle spasms.  It may be able to interfere with the anticipation-related release of dopamine and therefore it has anti-craving effects.

Some recent studies looking at baclofen have shown significant reduction of cravings; unfortunately, the amount of drug use was not significantly reduced.  However, it is still being studied.  My own personal experience is that more than 50% of my patients have fewer cravings.  It has become my first frug used 

ANTI-DEPRESSANTS

I have also used the anti-depressant buproprion (Wellbutrin, Zyban).  This anti-depreesant is the only one that is able to increase the amount of dopamine in the synapse It takes several weeks to kick in but it will significantly reduce cravings.  

Studies have found its benefits to be equivocal.  However, it is useful in treating nicotine cravings.  Since nicotine cravings and other stimulant cravings are similar mechanisms, I continue to use this
 drug.  Patients do find it quite helpful

CHANTIX

Chantix has been available for the past few years.  It is used to reduce nicotine cravings in smokers and help them stop smoking.  The nicotine from smoking leads to periodic increases in dopamine (which is why people smoke) followed by relative deficits in dopamine levels.  The low dopamine levels lead to nicotine cravings.  In those patients who also use other stimulants, these low dopamine levels may also cause increased cravings for those drugs as well.  

Chantix works by occupying and partially stimulating the nicotine receptors which leads to a modest increase in dopamine.  The partial increase in dopamine is enough to reduce the cravings caused by dopamine depletion; but not strong enough to lead to addiction to the chantix.  It is especially needed in patients who continue to smoke.

I have used this drug solely in patients who also smoked.  Many have noted a significant reduction in their overall stimulant cravings.
  
The use of medication for cocaine treatment is helpful but it is only a part of a more complete treatment approach.  It must be stressed that cocaine cravings and relapse are caused by multiple factors.  Many people will want to use drugs secondary to a variety of factors including stress.  For this reason, counseling is essential to understand how one copes with stress and to learn new coping behaviors
.  Psychiatric conditions should be treated when present.

Return to Substance Abuse Articles