Cocaine abuse in methadone maintenance programs: integrating pharmacotherapy with psychosocial interventions

FRANÇAIS :
La consommation de cocaïne par des patients sous méthadone menace d'ébranler le succès des programmes méthadone tant à cause de la promotion de ce style de vie qu'en favorisant l'extension du sida. La recherche pharmacologique pour le traitement de la cocaïnomanie a passablement échoué. Les résultats les plus prometteurs concernent l'emploi de la desipramine pour des patients dépressifs ou à personnalité antisociale. Pour certains patients, l'abstinence de cocaïne doit s'accompagner d'une prise en charge psychosociale adaptée à leur milieu de vie. Cet article pose la question de savoir dans quelle direction doit s'orienter la recherche: approche psychosociale ou pharmacologique...
ENGLISH :
Cocaine abuse by methadone-maintained patients threatens to undermine the success of methadone programs by sustaining a drug-abusing lifestyle as well as contributing to the spread of HIV. The search for a pharmacotherapeutic agent for the treatment of cocaine abuse has met with limited success. The most promising results emerge when specific agents, such as desipramine, are matched appropriately to specific patient characteristics, such as depression or antisocial personality disorder. For some patients, abstinence from cocaine may also require the addition of intensive psychosocial treatments that target the considerable problems faced by inner-city opioid-addicted individuals. This article discusses ways in which future research could be directed toward investigating the interaction between psychosocial services and pharmacologic treatments, while at the same time developing and testing hypotheses concerning appropriate patient-treatment matching variables. (Authors' abstract)