Angres D H, Benson W H
Parkside Recovery Center, Lombard, Illinois.
Psychiatr Med. 1985;3(4):369-88.
Presented here is a model for the diagnosis and treatment of cocaine dependence. Intrinsic in the understanding of this model is the use of the disease concept of chemical dependence. Within the construct of this model we regard cocaine dependence or "cocainism" as a disease process and part of the spectrum of the disease of chemical dependence. We note that "pure" cocainism is rare and cocaine is usually just another chemical used in the polyaddicted patient. We call cocaine the "Great Precipitator" as it often brings the polyaddicted chemically-dependent person into a crisis that requires a treatment intervention. Cocainism, with its overwhelming compulsion and destruction, often precipitates a crisis in a matter of months from first use. As psychiatrists practicing addictionology, we understand the need to deal with cocainism as a primary disease process rather than a symptom of an underlying psychiatric illness. We deal with cocainism as we deal with alcoholism. While the DSM-III requires withdrawal and tolerance changes to be an essential feature for dependence, we more easily identify the disease of cocainism by its production of intense psychological addiction. Thereby the diagnosis of the disease of cocainism, as with other drugs (including alcohol) in the spectrum of chemical dependence, is characterized by the persistent, uncontrolled, compulsive use of cocaine. This illogical, irrational compulsion with continued, repeated use of cocaine as it destroys the individual's life, is the primary symptom of this disease. In regards to specific considerations, the psychiatric complications of cocainism, which can include cocaine induced psychosis, can persist beyond the intoxication period. We also note the depression that can accompany abstinence from cocaine and often has a protracted course following initial abstinence as well. We advocate the very cautious use of any psychotropic medications after an alloted period of time since we find that many of these additional symptoms seem to dissipate during the treatment process when involved in our suggested setting. In the cases of where it is determined that additional psychiatric illness co-exist with cocaine and chemical dependence such as in "dual diagnosis" patients, we have had that success by treating both illnesses concomitantly and aggressively. The "contract" with the dual diagnosis patient has afforded excellent results in this instance. The treatment modalities most effective in this model include a treatment team with its multidisciplinary and recovering and non-recovering characteristics, and the use of the group process and peer group therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
本文介绍了一种可卡因依赖的诊断和治疗模型。理解该模型的内在要点是运用化学依赖的疾病概念。在这个模型的框架内，我们将可卡因依赖或“可卡因中毒”视为一种疾病过程，是化学依赖疾病谱的一部分。我们注意到“单纯”的可卡因中毒很少见，可卡因通常只是多药成瘾患者使用的另一种化学物质。我们称可卡因是“重大诱因”，因为它常常使多药成瘾的化学依赖者陷入需要治疗干预的危机。可卡因中毒，因其压倒性的强迫性和破坏性，往往在首次使用后的几个月内就引发危机。作为从事成瘾学的精神科医生，我们明白需要将可卡因中毒作为一种原发性疾病过程来处理，而不是潜在精神疾病的症状。我们处理可卡因中毒的方式与处理酒精中毒一样。虽然《精神疾病诊断与统计手册》第三版要求戒断和耐受性改变是依赖的基本特征，但我们通过其产生的强烈心理成瘾更容易识别可卡因中毒这一疾病。因此，与化学依赖谱中的其他药物（包括酒精）一样，可卡因中毒疾病的诊断特征是持续、不受控制、强迫性地使用可卡因。这种不合逻辑、不理性的强迫行为，随着可卡因的持续、反复使用，摧毁着个体的生活，是这种疾病的主要症状。关于具体考量，可卡因中毒的精神科并发症，包括可卡因所致精神病，可能在中毒期过后仍持续存在。我们还注意到，戒断可卡因时可能伴随抑郁，而且在最初戒断后往往病程迁延。我们主张在一段规定时间后非常谨慎地使用任何精神药物，因为我们发现，在参与我们建议的治疗环境中，许多这些额外症状在治疗过程中似乎会消散。在确定存在与可卡因和化学依赖并存的其他精神疾病的情况下，比如“双重诊断”患者，我们通过同时积极治疗两种疾病取得了成功。在这种情况下，与双重诊断患者的“契约”产生了极好的效果。在这个模型中最有效的治疗方式包括一个具有多学科性质、有康复者和未康复者参与的治疗团队，以及运用团体治疗流程和同伴群体治疗。（摘要截选至400词）
