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Heroin Addiction and Related Clinical Problems: 2023, 25, N3 (pages: 37 - 46)

Cocaine Use in Opioid and Alcohol Substance Use Disorders

Pacini M., Della Rocca F., Maremmani A.G.I., and Maremmani I.

Summary: Cocaine use is a significant complication in the history of other-SUD patients, particularly in patients with alcohol or opiate addiction, and is a source of more significant mental discomfort, a higher level of functional impairment and a worse global prognosis. In particular, the evolution of cocaine-related behaviours and dysfunctions depends on one side on the ability to assess the cocaine-related condition within the context and concerning the primary SUD: on the other, on the response to the treatment of the primary SUD. In general, the concurrence of CUD and a primary SUD is expected to predict a worse treatment outcome for the primary SUD. A specific treatment which grants the prevention or early control of cocaine use at any stage is not yet available. Therefore, clinicians must be skilled in the diagnosis of CUD to identify cocaine use as a risk factor from the very beginning. The assessment of predictive factors for cocaine use and CUD during OAT may be a way to predict the spontaneous extinction of cocaine during the early phases of treatment. For instance, higher severity of opiate addiction, injective use and polysubstance use are predictive of an unfavourable course of cocaine use during OAT. On diagnostic grounds, the ability to assess for the psychiatric disorder may make a difference. In cocaine abusers, stabilization of OAT may require higher dosages, whereas concurrent alcohol abuse may counterbalance such a difference. Waiting for specific treatments for cocaine addiction to be developed, such hints may at least help clinicians to contrast the complications of cocaine use and allow early recognition of CUD at a pre-addictive stage.