Cocaine. Diagnosis and treatment.

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.