The principles of cocaine rehabilitation are similar to treatment of alcoholism or sedativism. Detoxification is a prerequisite in the treatment of this disorder. In preliminary tests, imipramine and desipramine attenuated cocaine euphoria and craving. Lithium Lithium has been reported to block cocaine euphoric effects, though recent evidence suggests lithium is effective only in bipolar or cyclothymic patients. Methylphenidate has not been found to be useful in those cocaine abusers who do not have preexisting attention deficit disorder.
Hospitalization Usually cocaine dependent patients are best treated as outpatients.
Inpatient hospitalization may be needed for severe crash symptoms, suicide ideation, psychotic symptoms, or failure in outpatient treatment. Life-style changes such as avoiding people, places, and things related to cocaine use should be encouraged. Initial psychosocial treatment should focus on confronting denial, teaching the disease concept of addictions, fostering an identification as a recovering person, recognition of the negative consequences of cocaine abuse, avoiding situational and intrapsychic cues that stimulate craving, and formulation of support plans. Drug urine tests should be used to ensure compliance. Treatment outcome is affected more by such factors as employment status, family support, and degree of antisocial features than by initial motivation for treatment.