Cocaine and cocaine addiction: State-of-the-art learning and current strategies

Until the late 1970s, cocaine use was not considered a public health problem. With the arrival of free base cocaine in the mid-1970s and crack cocaine in the early 1980s, the number of cocaine users has been steadily increasing in America and Europe, resulting in a significant increase in the number of cocaine users, but also a worrying increase in the number and severity of cocaine-related intoxications. However, there is still no pharmacological treatment that has proved its effectiveness. Psychotherapeutic approach remains the mainstay of care, which must be multidisciplinary and multimodal. Our purpose is to present a focus on state-of-the-art learning from literature review on psychotherapy and pharmacotherapy of cocaine addiction. We first describe a short history of cocaine and crack use and describe epidemiological and clinical issues relative to cocaine addiction. We then discuss current pharmacological treatments (agonist and antagonist therapies; anti-craving agents; clinical trials in humans and animal models), including strategies for cocaine use during maintenance therapy for opiate use disorders. Finally, we present neurostimulation techniques as a novel therapeutic tool to inhibit drug cue-associated behaviors and reduce cocaine craving. (C) 2018 Elsevier Masson SAS. All rights reserved.