Weddington W W
Department of Psychiatry, Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
Psychiatr Clin North Am. 1993 Mar;16(1):87-95.
Significant advances in our understanding the phenomenology of cocaine addiction have occurred in the past 12 years such that we now recognize addiction to cocaine as a major public health problem. We now can diagnose cocaine addiction more accurately. Furthermore, cocaine addiction has stimulated creation and testing of novel treatment efforts because standard addiction treatment, although efficacious, is not as effective for cocaine addiction as compared with other addictions. Much remains to be learned. We need to clarify symptoms and syndromes associated with cocaine addiction to more precisely delineate true "comorbidity." Special attention is needed to understand the course and response to treatment in women addicted to cocaine. Also, work is needed to clarify the interaction of HIV, cocaine, and pharmacotherapy used to treat HIV. Regarding treatment, effort is needed to better understand the interactions among educational, group, cognitive-behavioral, and pharmacologic interventions. Specific attention is needed regarding use of 12-step recovery programs adapted for cocaine addicts with comorbid psychiatric disorders, such as schizophrenia, mood, and anxiety disorders. Finally, we need to better understand ways of attracting and holding cocaine addicts in treatment earlier in the course of their disorder. To that end, "nontraditional" interventions, such as acupuncture, deserve systematic examination as alternative methods of recruitment and intervention for certain populations of cocaine addicts.
在过去12年里，我们对可卡因成瘾现象学的理解取得了重大进展，以至于我们现在认识到可卡因成瘾是一个主要的公共卫生问题。我们现在能够更准确地诊断可卡因成瘾。此外，可卡因成瘾促使了新型治疗方法的创建和测试，因为标准的成瘾治疗虽然有效，但与其他成瘾相比，对可卡因成瘾的效果并不那么显著。仍有许多有待了解的地方。我们需要明确与可卡因成瘾相关的症状和综合征，以更精确地界定真正的“共病”。需要特别关注了解可卡因成瘾女性的病程和对治疗的反应。此外，还需要开展工作来阐明艾滋病毒、可卡因和用于治疗艾滋病毒的药物治疗之间的相互作用。关于治疗，需要努力更好地理解教育、团体、认知行为和药物干预之间的相互作用。对于为患有共病精神疾病（如精神分裂症、情绪和焦虑症）的可卡因成瘾者改编的12步康复计划的使用，需要给予特别关注。最后，我们需要更好地理解在疾病过程早期吸引和留住可卡因成瘾者接受治疗的方法。为此，像针灸这样的“非传统”干预措施，值得作为某些可卡因成瘾人群的替代招募和干预方法进行系统研究。
