Die Behandlung der Kokainabhängigkeit

U. W. Preuß; M. Bahlmann; G. Koller; M. Soyka

doi:10.1055/s-2000-11634

Fortschritte der Neurologie · Psychiatrie, Inhaltsverzeichnis

Fortschr Neurol Psychiatr 2000; 68(5): 224-238
DOI: 10.1055/s-2000-11634

ORIGINALARBEIT

Georg Thieme Verlag Stuttgart ·New York

Die Behandlung der Kokainabhängigkeit

Intoxikation, Entzug und RückfallprophylaxeTreatment of Cocaine-Dependence:U. W. Preuß, M. Bahlmann, G. Koller, M. Soyka

Psychiatrische Klinik und Poliklinik, Ludwig-Maximilians-Universität München (Direktor Prof. Dr. H.-J. Möller)

Abstract

Zusammenfassung:

Es wird ein Überblick über die Behandlung des Kokainentzuges, der Kokainintoxikation und der Rückfallprophylaxe der Kokainabhängigkeit gegeben. Derzeit nehmen in Deutschland rund 25 % der polizeilich auffälligen Erstkonsumenten von Drogen Kokain. Weit größere Ausmaße hat die Kokainabhängigkeit in den USA angenommen. Der Entzug von Kokain kann in drei Phasen eingeteilt werden, wobei die psychische Symptomatik im Vordergrund steht. Lebensgefahr kann bei einer Kokainintoxikation bestehen, häufig im Zusammenhang mit dem Beigebrauch anderer Substanzen. Im Langzeitverlauf besteht bei Kokainabhängigen eine hohe Rückfallgefahr. In Therapieevaluationsstudien wird im Zusammenhang mit Rückfällen häufig ein intensiver Drang nach Kokain (Craving) bei Abhängigen berichtet. Empfehlungen für die Behandlung der Kokainintoxikation, des Kokainentzuges und zur Rückfallprophylaxe der Kokainabhängigkeit werden gegeben. Verschiedene medikamentöse Strategien, die in klinischen Studien und Anwendungsbeobachtungen mit Antidepressiva, Antikonvulsiva, dopaminergen und serotonergen Substanzen gewonnen wurden sowie psychotherapeutische Ansätze zur Behandlung und zur Rückfallprophylaxe der Kokainabhängigkeit werden in diesem Artikel beschrieben und bewertet. Außerdem wird ein Überblick über neuartige, experimentelle Behandlungsformen gegeben.

The aim of this review article is to evaluate the treatment of cocaine-withdrawal, cocaine-intoxication and long-term relapse prevention of cocaine-addicts. Some 25 % of police recognized first time drug users in Germany consume cocaine. However, there is an increasing number of cocaine-abusers and -addicts in the USA. The withdrawal of cocaine can be divided into three phases dominated mainly by psychiatric symptoms. Lifethreatening condition can occur in cocaine-intoxication mainly in combination with other drug-use. A high risk of relapse is seen in follow-up trials of cocaine-addicts. Intensive craving, high cocaine- and substance-abuse is reported regularely in cocaine-addicts after detoxification therapy. Recommendations in the treatment of cocaine-intoxication, withdrawal and long-term relapse prevention are made. The use of antidepressives, anticonvulsants, dopaminergic and serotonergic medications as well as behavioural, psychoanalytical and combined therapies and their efficacy in clinical and trails is evaluated. A short review of new experimental therapies in the treatment of cocaine-dependence is shown.

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Literatur

1 Peterson R. Rauschgiftlage 1995. In: Deutsche Hauptstelle gegen Suchtgefahren (Hrsg.) Jahrbuch Sucht '97. Geesthacht; Neuland Verlag 1996: 55-72
2 Halikas J A, Crosby R D, Pearson V L, Graves N M. A randomized double-blind study of carbamazepine in the treatment of cocaine abuse. Clinical Pharmacology and Therapeutics. 1997; 62 (1) 89-105
3 Gawin F H, Kleber H D, Byck R, Rounsaville B J, Kosten T R, Jatlow P I, Morgan C. Desipramine facilitation of initial cocaine abstinence. Arch Gen Psychiatry. 1989; 46 117-121
4 Means L B, Small M, Capone D M, Capone T J, Condren R, Peterson M, Hayward B. Client demographics and outcome in outpatient cocaine treatment. Int J Addict. 1989; 24 (8) 765-783
5 Higgins S T, Delaney D D, Budney A J, Bickel W K, Hughes J R, Foerg F, Fenwick J W. A behavioral approach to achieving initial cocaine abstinence. Am-J-Psychiatry. 1991; 148 (9) 1218-1242
6 Carroll K M, Ziedonis D, O'Malley S, McCance-Katz E F, Gordon L, Rounsaville B. Pharmacologic interventions for abusers of alcohol and cocaine: a pilot study of disulfiram versus naltrexone. J Drug Addiction. 1993; 2 77-79
7 Soyka M. Drogen und Medikamentenabhängigkeit. Stuttgart; Wissenschaftliche Verlagsgesellschaft mbH 1998: 61-71
8 Killy J E, Lorang D, Amara S G. Cloning and expression of a cocaine-sensitive rat dopamine transporter. Science. 1991; 254 576-578
9 Woolverton W L, Johnson K M. Neurobiology of cocaine abuse. TIPS. 1992; 13 192-200
10 Voss H L. Patterns of drug use. Data from the 1985 National Household Survey. NIDA-Research-Monograph-Series. 1989; 91 33-46
11 Anthony J C, Petronis K R. Epidemiologic evidence on suspected associations between cocaine and psychiatric disturbances. In: Schober S, Schade C (eds.) The Epidemiology of Cocaine Use and Abuse. National Institute on Drug Abuse Research Monograph 110. Washington DC; DHHS Pub No (ADM); Supt of Docs, US Govt Print Off 1991: 91-1787; 71 - 94
12 Wagner-Echeagaray F A, Schutz C G, Chilcoat H D, Anthony J C. Degree of acculturation and the risk of crack cocaine smoking among Hispanic Americans. Am J Public Health. 1994; 84/11 1825-1827
13 Kleber H D. Pharmacotherapy, current and potential for the treatment of cocaine dependence. Clinical Neuropharmacology. 1995; 18 (Suppl 1) 96-106
14 Van-Etten M L, Anthony J C. Comparative epidemiology of initial drug opportunities and transitions to first use. Marijuana, cocaine, hallucinogens and heroin. Drug Alcohol Dependence. 1999; 54/2 117-125
15 Schweer T, Strasser H. Die Straßendroge Crack: Eine erste Bestandsaufnahme. Sucht. 1994; 40 (2) 121-126
16 Perkonigg A, Beloch E, Garzynski E, Nelson C B, Pfister H, Wittchen H U. Prävalenz von Drogenmissbrauch und -abhängigkeit bei Jugendlichen und jungen Erwachsenen. Gebrauch, Diagnosen und Auftreten erster Missbrauchs- und Abhängigkeitsmerkmale. Z Klin Psychologie. 1997; 26 (4) 247-257
17 Bührs R. Drogen - Entwicklungen - Trends. Analyse empirischer Daten von 781 suchtmittelabhängigen Jugendlichen und jungen Erwachsenen. Sucht. 1993; 39 35-44
18 Simon R, Wibilishauser P M. Ergebnisse der Repräsentativerhebung 1990 zum Konsum und Missbrauch von illegalen Drogen, alkoholischen Getränken, Medikamenten und Tabakwaren. Sucht. 1993; 39 177-180
19 Kraus L, Schumann J, Wiblishauser P U, Herbst K. Die Entwicklung des Konsums von legalen und illegalen Drogen in den neuen Bundesländern. Sucht. 1994; 40 (2) 107-120
20 Gawin F H, Kleber H D. Abstinence symptomatology and psychiatric diagnoses in cocaine abusers. Arch Gen Psychiatry. 1986; 43 107-113
21 Satel S L, Price L H, Palumbo J M, McDougle C J, Krystal J H, Gawin F, Charney D S, Heninger G R, Kleber H D. Clinical phenomenology and neurobiology of cocaine abstinence: a prospective inpatient study. Am J Psychiatry. 1991; 148 1712-1716
22 Jacobs I G, Roszler M H, Kelly J K, Klein M A, Kling G A. Cocaine abuse: neurovascular complications. Radiology. 1989; 170 223-227
23 Chow J M, Menchen S L, Paul B D, Stein R J. Vascular changes in the nasal submucosa of chronic cocaine addicts. Am J Forensic Med Pathol. 1990; 11 136-143
24 Rubin R B, Neugarten J. Cocaine rhabdomyolysis masquerading as myocardial ischemis. Am J Med. 1989; 86 551-553
25 Freye E. Maßnahmen bei der Akutintoxikation mit Kokain und Amphetaminabkömmlingen. Klinikarzt. 1997; 4 101-107
26 Julien R M. Drogen und Psychopharmaka. Heidelberg, Berlin, Oxford; Spektrum Akademischer Verlag 1996: 133-164
27 Caine S B, Koob G F. Modulation of cocaine self-administrations in the rat through D-3 dopamine receptors. Science. 1993; 260 1814-1816
28 Gawin F H. Neuroleptic reduction of cocaine-induced paranoia but not euphoria. Psychopharmacology (Berl). 1986; 90 142-143
29 Kuhar M J, Pilotte N S. Neurochemical changes in cocaine withdrawal. Trends Pharmacol Sci. 1996; 17 (7) 260-263
30 Leukefeld C G, Tims F M. Relapse and recovery in drug abuse. Int J Addict. 1989; 24 (3) 189-201
31 Gawin F H, Kleber H D, Byck R, Rounsaville B J, Kosten T R, Jatlow P I, Morgan C. Desipramine facilitation of initial cocaine abstinence. Arch Gen Psychiatry. 1989; 46 117-121
32 Gawin F H, Kleber H D. Cocaine abuse treatment with lithium and desipramine. Arch Gen Psychiatry. 1984; 41 903-909
33 Giannini A J, Malone D A, Giannini M C, Price W A, Loiselle F H. Treatment of depression in chronic cocaine and phenylcyclidine abuse with desipramine. J Clin Pharmacol. 1986; 26 211-214
34 Carroll K M, Rounsaville B J, Nich C, Gordon L T, Wirtz PW, Gawin F. One-year follow-up of psychotherapy and pharmacotherapy for cocaine dependence. Arch Gen Psychiatry. 1994; 51 989-997
35 Tennant F S, Tarver A L. Double-blind comparison of desipramine and placebo in withdrawal from cocaine dependence. NIDA Res Monogr. 1984; 55 (1) 159-163
36 Kosten T R, Morgan C M, Falcione J, Schottenfeld R S. Pharmacotherapy for cocaine abusing methadone-maintained patients using amantadine or desipramine. Arch Gen Psychiatry. 1992; 49 894-898
37 Weddington Jr W W, Brown B S, Haertzen C A, Hess J M, Makaffey J R, Kolar A F, Jaffe J H. Comparison of amantadine and desipramine combined with psychotherapy for treatment of cocaine dependence. Am J Drug Alcohol Abuse. 1991; 17 137-152
38 Gößling H W, Sjnkel S, Wegener U, Woiton V. Auswirkungen fraktionierter Methadongabe im klinischen Opiatentzug. Fortschr Neurol Psychiat. 1998; 6 278-285
39 Waldvogel D, Uehlinger C. Zur Häufigkeit der Injektion von Methadon-Trinklösungen an einem Behandlungszentrum für Opiatabhängige. Fortschr Neurol Psychiat. 1999; 67 281-283
40 Arndt I O, Dorozynsky L, Woody G E, McLellan A T, O'Brien C P. Desipramine treatment of cocaine dependence in methadone-maintained patients. Arch Gen Psychiatry. 1992; 49 (11) 888-893
41 Arndt I O, McLellan A T, Dorozynsky L, Woody G E, O'Brien C P. Desipramine treatment for cocaine dependence. Role of antisocial personality disorder. J Nerv Ment Dis. 1994; 182 (3) 151-156
42 Leal J, Ziedonis D, Kosten T. Antisocial personality disorder as a prognostic factor for pharmacotherapy of cocaine dependence. Drug Alcohol Dependence. 1994; 35 31-35
43 Levin F R, Lehman A F. Meta-analysis of desipramine as an adjunct in the treatment of cocaine addiction. J Clin Psychopharm. 1991; 11 374-378
44 Ziedonis D, Richardson T, Lee E, Petrakis I, Kosten T. Adjunctive desipramine in the treatment of cocaine abusing schizophrenics. Psychopharm Bulletin. 1992; 28 (3) 309-314
45 Nunes E V, McGrath P J, Quitkin F M, Ocepek Welikson K, Stewart J W, Koenig T, Wager S, Klein D F. Imipramine treatment of cocaine abuse: possible boundaries of efficacy. Drug Alcohol Depend. 1995; 39 (3) 185-195
46 Nunes E V, Quitkin F M, Donovan S J, Deliyannides D, Ocepek Welikson K, Koenig T, Brady R, McGrath P J, Woody G. Imipramine treatment of opiate-dependent patients with depressive disorders - A placebo-controlled trial. Arch Gen Psychiatry. 1998; 55 (2) 153-160
47 Galloway G P, Newmeyer J, Knapp T, Stalcup S A, Smith D. Imipramine for the treatment of cocaine and methamphetamine dependence. J Addict Dis. 1994; 13 (4) 201-216
48 Brotman A W, Witkie S M, Gelenberg A J, Falk W E, Wojcik J, Leahy L. An open trial of maprotiline for the treatment of cocaine abuse: a pilot study. J Clin Psychopharmacol. 1988; 8 125-127
49 Gold M S, Dackis C A. New insights and treatments: opiate withdrawal and cocaine addiction. Clin Ther. 1984; 7 6-21
50 Gawin F H, Allen D, Humblestone B. Outpatient treatment of ‚crack’ cocaine smoking with flupenthixol decanoate: a preliminary report. Arch Gen Psychiatry. 1989; 46 (4) 322-325
51 Kampman K, Volpicelli J R, Alterman A, Cornish J, Weinrieb R, Epperson L, Sparkman T, O'Brien C P. Amantadine in the early treatment of cocaine dependence: a double-blind, placebo-controlled trial. Drug and Alcohol Dependence. 1996; 41 25-33
52 Tennant Jr F S, Sagherian A A. Double-blind comparison of amantadine and bromocriptine for ambulatory withdrawal from cocaine dependence. Arch Intern Med. 1987; 147 (1) 109-112
53 Sitland-Marken P A, Well B G, Froemming J H, Chung Chou C, Brown C S. Psychiatric applications of bromocriptine therapy. J Clin Psychiatry. 1990; 51 (2) 68-82
54 Dackis C A, Gold M S. Bromocriptine as treatment of cocaine abuse. Lancet. 1985; 1 (8438) 1151-1152
55 Dackis C A, Gold M S, Sweeney D R, Byron Jr J P, Climko R. Single-dose bromocriptine reverses cocaine craving. Psychiatry Res. 1987; 20 (4) 261-264
56 Gutierrez-Esteinou R, Baldessarini R J, Cremens M C, Campbell A, Teicher M H. Interactions of bromocriptine with cocaine. Am J Psychiatry. 1988; 145 (9) 1173
57 Campbell A, Baldessarini R J, Cremens C, Teicher M H, Marsh E, Kula N S. Bromocriptine antagonizes behavioral effects of cocaine in the rat. Neuropsychopharmacology. 1989; 2 (3) 209-224
58 Kranzler H R, Bauer L O, Hersh D, Klinghoffer V. Carbamazepine treatment of cocaine dependence: a placebo-controlled trial. Drug Alcohol Dependence. 1995; 38 203-211
59 Jaffe J H, Cascella N G, Kumor K M, Sherer M A. Cocaine-induced cocaine craving. Psychopharmacology. 1989; 97 59-64
60 Giannini A J, Baumgartel P, DiMarzio L R. Bromocriptine therapy in cocaine withdrawal. J-Clin-Pharmacol. 1987; 27 (4) 267-270
61 Giannini A J, Folts D J, Feather J N, Sullivan B S. Bromocriptine and amantadine in cocaine detoxification. Psychiatry Res. 1989; 29 (1) 11-16
62 Handelsman L, Rosenblum A, Palij M, Magura S, Foote J, Lovejoy M, Stimmel B. Romocriptine for cocaine dependence. A controlled clinical trial. Am J Addict. 1997; 6 (1) 54-64
63 Eiler K, Schaefer M R, Salstrom D, Lowery R. Double-blind comparison of bromocriptine and placebo on cocaine withdrawal. Am J Drug Alcohol Abuse. 1995; 21 (1) 65-79
64 Alterman A I, Droba M, Antelo R E, Cornish J W, Sweeney K K, Parikh G A, O'Brien C P. Amantadine may facilitate detoxification of cocaine addicts. Drug and Alcohol Dependence. 1992; 31 (1) 19-29
65 Berger P, Gawin F, Kosten T R. Treatment of cocaine abuse with mazindol. Lancet 1. 1989; (8632) 283
66 Margolin A, Avants S K, Kosten T. Mazindol for relapse prevention to cocaine abuse in methadone maintained patients. Am J Drug Alcohol Abuse. 1995; 21 (4) 469-481
67 Berger S P, Hall S, Mickalian J D, Reid M S, Crawford C A, Delucchi K, Carr K, Hall S. Haloperidol antagonism of cue-elicited cocaine craving. Lancet. 1996; 347 504-508
68 Smelson D A, Roy A, Roy M. Risperidone and neuropsychological test performance in cocaine-withdrawn patients (letter). Can J Psychiatry. 1997; 42 (4) 431
69 Khantzian E J. An extreme case of cocaine dependence and marked improvement with methylphenidate treatment. Am J Psychiatry. 1983; 140 784-785
70 Khantzian E J, Gawin F H, Riodan C, Kleber H D. Methylphenidate treatment of cocaine dependence: a preliminary report. J Subst Abuse Treat. 1984; 1 107-112
71 Levin F, Kleber H. Attention-deficit hyperactivity disorder and substance abuse: relationships and implications for treatment. Hav Rev Psychiatry. 1995; 2 246-255
72 Grabowski J, Rhoades H, Elk R, Schmitz J, Davis C, Creson D, Kirby K. Fluoxetine is ineffective for treatment of cocaine dependence of concurrent opiat and cocaine dependence: two placebo-controlled double-blind trials. J Clin Psychopharmacology. 1995; 15 (3) 163-174
73 Gawin F H, Riordan C, Kleber H. Methylphenidate treatment of cocaine abusers without attention deficit disorder: a negative report. Am J Drug Alcohol Abuse. 1985; 11 193-197
74 Wolfsohn R, Sanfilipo M, Angrist B. A placebo-controlled trial of L-DOPA/Carbidopa in early cocaine abstinence. Neuropsychopharmacology. 1993; 9 49-53
75 Heßlinger B, Klose P, Normann C, Langosch J M, Berger M, Walden J. Zur adjuvanten Behandlung schizophrener Störungen mit Carbamazepin. Fortschr Neurol Psychiat. 1998; 66 145-150
76 Halikas J A, Kuhn K L. A possible neurophysiological basis of cocaine craving. Ann Clin Psychiatry. 1990; 2 79-83
77 Halikas J A, Kemp K, Kuhn K, Carlson G A, Crea F. Carbamazepine for cocaine addiction? (letter). Lancet. 1989; 1 623-624
78 Halikas J A, Crosby R D, Carlson G A, Gravea F, Graves N M, Bowers L D. Cocain reduction in unmotivated crack users using carbamazepine versus placebo in a short term, souble blind crossover design. Clin Pharmacol Ther. 1991; 50 81-95
79 Kranzler H R, Bauer L O. Bromocriptine and cocaine cue reactivity in cocaine-dependent patients. Br J Addiction. 1992; 87 1537-1548
80 Montoya I D, Levin F R, Fudala P J, Gorelick D A. Double-blind comparison of carbamazepine and placebo for treatment of cocaine dependence. Drug Alcohol Depend. 1995; 38 213-319
81 Cornish J W, Maany I, Fudala P J, Neal S, Poole S A, Volpicelli P, O'Brien C P. Carbamazepine treatment for cocaine dependence. Drug and Alcohol Dependence. 1995; 38 221-227
82 Halikas J A, Crosby R D, Pearson V L, Graves N M. A randomized double-blind study of carbamazepine in the treatment of cocaine abuse. Clinical Pharmacology and Therapeutics. 1997; 62 (1) 89-105
83 Hatsukami D, Keenan R, Halikas J, Pentel P R, Brauer L H. Effects of carbamazepine on acute responses to smoked cocaine-base in human cocaine users. Psychopharmacology. 1991; 104 120-124
84 Alim T N, Rosse R B, Vocci F J, Linquist T, Deutsch S I. Diethylpropion pharmacotherapeutic adjuvant therapy for inpatient treatment of cocaine dependence: a test of the cocaine-agonist hypothesis. Clinical Neuropharmacology. 1995; 18 (2) 183-195
85 Ritz M C, Kuhar M J. Relationship between self-administration of amphetamine and monoamine receptors in brain: comparison with cocaine. J Pharmacol Exp Ther. 1989; 248 (3) 1010-1017
86 Little K Y, McLaughlin D P, Zhang L, Livermore C S, Dalack G W, McFinton P R, DelProposto Z W, Hill E, Cassin B J, Watson S J, Cook E H. Cocaine, ethanol and genotype effects on human midbrain serotonin transporter binding sites and mRNA-levels. Am J Psychiatry. 1998; 155 (2) 207-213
87 Walsh S L, Preston K L, Sullivan J T, Fromme R, Bigelow G E. Fluoxetine alters the effects of intravenous cocaine in humans. J Clin Psychopharmacol. 1994; 14 (6) 396-407
88 Covi L, Hess J M, Kreiter N A, Haertzen C A. Effects of combined fluoxetine and counseling in the outpatient treatment of cocaine abusers. Am J Drug Alcohol Abuse. 1995; 21 (3) 327-344
89 Batki S L, Washburn A M, Delucchi K, Jones R T. A controlled trial of fluoxetine in crack cocaine dependence. Drug and Alcohol Dependence. 1996; 41 137-142
90 Giannini A J, Loiselle R H, Graham B H, Folts D J. Behavioral response to buspirone in cocaine and phencyclidine withdrawal. J Subst Abuse Treatment. 1993; 10 523-527
91 Golwyn D H. Cocaine abuse treated with phenelzine. Int J Addict. 1988; 23 897-905
92 Gerrits M A, van-Ree J M. Assessment of motivational aspects involved in initiation of cocaine and heroin self-administration in rats. Pharmacol Biochem Behav. 1995; 52 (1) 35-42
93 Modesto-Lowe V, Burleson J A, Hersh D, Bauer L O, Kranzler H R. Effects of naltrexone on cue-elicited craving for alcohol and cocaine. Drug Alcohol Depend. 1997; 49 (1) 9-16
94 O'Malley S S, Jaffe A J, Chang G, Schottenfeld R S, Meyer R E, Rounsaville B. Naltrexone and coping skills therapy for alcohol dependence. A controlled study. Arch Gen Psychiatry. 1992; 49 (11) 881-887
95 O'Connor P G, Kosten T R. Rapid and ultrarapid opioid detoxification techniques. JAMA. 1998; 279 (3) 229-234
96 McCance-Katz E F, Kosten T R, Jatlow P. Chronic disulfiram treatment effects on intranasal cocaine administration: initial results. Biol Psychiatry. 1998; 43 540-543
97 Carroll K M, Ziedonis D, O'Malley S, McCance-Katz E F, Gordon L, Rounsaville B. Pharmacologic interventions for abusers of alcohol and cocaine: a pilot study of disulfiram versus naltrexone. J Drug Addiction. 1993; 2 77-79
98 Van Etten M L, Higgins S T, Budney A J, Bickel W K, Hughes J R, Foerg F. Disulfiram therapy in patients abusing cocaine and alcohol. NIDA Res Monogr. 1994; 141 443
99 Carroll K M, Nich C, Ball S A, McCance-Katz E F, Rounsaville B J. Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction. 1998; 93 (5) 713-727
100 Crosby R D, Pearson V L, Eller C, Winegarden T, Graves N L. Phenytoin in the treatment of cocaine abuse: a double-blind study. Clin Pharmacol Ther. 1996; 59 (4) 458-468
101 Markowitz J S, Finkenbine R, Myrick H, King L, Carson W H. Gabapentin abuse in a cocaine user: implications for treatment? [letter]. J Clin Psychopharmacol. 1997; 17 (5) 423-424
102 Margolin A, Kosten T, Tetrakis I, Avants S K, Kosten T. Bupropion reduces cocaine abuse in methadone-maintained patients. Arch Gen Psychiatry. 1991; 48 87
103 Margolin A, Avants S K, Chang P, Birch S, Kosten T R. A single-blind investigation of four auricular needle puncture configurations. Am J Chin Med. 1995; 23 (2) 105-114
104 McKay J R, McLellan A T, Alterman A I. An evaluation of the Cleveland criteria for inpatient treatment of substance abuse. Am J Psychiatry. 1992; 149 1212-1218
105 Alterman A I, O'Brian C P, McLellan A T, August D S, Snider E C, Droba M, Cornish J W, Hall C P, Raphaelson A H, Schrade F X. Effectiveness and cost of inpatients versus day hospital cocaine rehabilitation. Journal of Nervous and Mental Disease. 1994; 182 (3) 157-163
106 Budde D, Rounsaville B, Byant K. Inpatient and outpatient cocaine abuser: clinical comparisons at intake and one-year follow-up. J Subst Abuse Treat. 1992; 9 337-342
107 Schmitz J M, Oswald L M, Jacks S D, Rustin T, Rhoades H M, Grabowski J. Relapse prevention treatment for cocaine dependence: group vs. individual format. Addictive Behav. 1997; 22 (3) 405-418
108 Weinstein S P, Gottheil E, Sterling R C. Cocaine users in medical practice: A five-year follow-up. Am J Drug Alcohol Abuse. 1997; 18/2 157-166
109 McKay J R, Alterman A I, Cacciola J S, Rutherford M J, O'Brian C P, Koppenhaver J. Group counseling versus individualized relapse prevention after following intensive outpatient treatment for cocaine dependence: initial results. J Cons Clin Psychology. 1997; 5 778-788
110 Carroll K M, Rounsaville B J, Gawin F. A comparative trial of psychotherapies for ambulatory cocaine abusers: relapse prevention and interpersonal psychotherapy. Am J Drug Alcohol Abuse. 1991; 17 229-247
111 Higgins S T, Budney A J, Bickel W K. Applying behavioral concepts and principles to the treatment of cocaine dependence. Drug and Alcohol Dependence. 1994; 34 87-97
112 Higgins S T, Budney A J, Bickel W K, Hughes J R, Foerg F, Badger G J. Achieving cocaine abstinence with a behavioral approach. Am J Psychiatry. 1993; 150 763-769
113 Higgins S T, Budney A J, Bickel W K, Foerg F E, Donham R, Badger G J. Incentives improve outcome in outpatient behavioral treatment of cocain dependence. Arch Gen Psychiatry. 1994; 51 568-576
114 Getter H, Litt M D, Kadden R M, Cooney N L. Measuring treatment process in coping skills and international group therapies for alcoholism. Int J Group Psychotherapy. 1992; 42 419-429
115 Wells E A, Peterson P S, Gainey R R, Hawkins J D, Catalano R F. Outpatient treatment for cocaine abuse: a controlled comparison of relapse preventions and twelve-step approaches. Am J Drug Alc Abuse. 1994; 20 1-17
116 Stephens R S, Roffman R A, Simpson E. Treating adult marijuana dependence: a test of the relapse prevention model. J Consult Clin Psychology. 1994; 62 92-99
117 Rawson R A, Obert J L, McCann M J, Ling W. Psychological approaches for the treatment of cocaine dependence - a neurobehavioural approach. J Addictive Dis. 1991; 1 (2) 97-119
118 O'Brien C P, Chilldress A R, McLellan T, Ehrman R. Integrating systemic cue exposure with standard treatment in recovering drug dependent patients. Addict Behav. 1990; 15 355-365
119 Schiffer R. Psychotherapy of nine successfully treated cocaine abusers: techniques and dynamics. J Subst Abuse Treat. 1988; 5 (3) 131-137
120 Khantzian E J, Halliday K S, McAuliffe W E. Addiction and the vulnerable self: Modified dynamic group therapy for substance abusers. New York; Guilford Press 1990: 81-91
121 Galanter M, Egelko S, DeLeon G, Rohrs C. A general hospital day program combining peer-led and professional treatment of cocaine abusers. Hosp Community Psychiatry. 1993; 44 644-649
122 McKay J R, Alterman A I, McLellan A T, Snider E. Treatment goals, continuity of care and outcome in a day hospital substance abuse rehabilitation program. Am J Psychiatry. 1994; 151 254-259
123 Weiss R D, Marinez-Raga J, Griffin M L, Greenfiled S F, Hufford C. Gender differences in cocaine dependent patients: a 6-month follow-up study. Drug Alcohol Depend. 1997; 44 35-40
124 Kosten T A, Gawin F H, Kosten T R, Rounsaville B J. Gender differences in cocaine use and treatment response. J Subst Abuse Treat. 1993; 10 (1) 63-66
125 Crits-Christoph P, Siqueland L, Blaine J, Frank A, Luborsky L, Onken L S, Muenz L R, Thase M E, Weiss R D, Gastfriend D R, Woody G E, Barber J P, Butler S F, Daley D, Salloum I, Bishop S, Najavits L M, Lis J, Mercer D, Griffin M L, Moras K, Beck A T. The National institute on drug abuse collaborative cocaine treatment study. Psychosocial treatments for cocaine dependence. Arch Gen Psychiatry. 1999; 56 493-502
126 Carroll K M, Rounsaville B J, Gordon L T, Nich C, Jatlow P, Bisighini R M, Gawin F H. Psychotherapy and pharmacotherapy for ambulatory cocaine abusers. Arch Gen Psychiatry. 1994; 51 177-187
127 Hall S M, Tunis S, Triffleman E, Banys P, Clark H W, Tusel D, Stewart P, Presti D. Continuity of care and desipramine in primary cocaine abusers. J Nerv Ment Dis. 1994; 182 (10) 570-575
128 Carroll K M, Nich C, Ball S A, McCance E, Rounsaville B J. Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction. 1998; 93 (5) 713-727
129 Smith M O. Acupuncture treatment for crack: clinical survey of 1500 Patients treated. Am J Acupuncture. 1988; 16 241-247
130 Margolin A, Kosten T R, Avants S K, Wilkins J, Ling W, Beckson M, Arndt I O, Cornish J, Ascher J A, Li S H, Bridge P. A multicenter trial of bupropion for cocaine dependence in methadone-maintained patients. Drug Alcohol Depend. 1995; 40 (2) 125-131
131 Avants S K, Margolin A, Chang P, Kosten T R, Birch S. Acupuncture for the treatment of cocaine addiction. Investigation of a needle puncture control. J Subst Abuse Treat. 1995; 12 (3) 195-205
132 Frawley P J, Smith J W. Chemical aversion therapy in the treatment of cocaine dependence as part of a multimodal treatment program: treatment outcome. J Subst Abuse Treat. 1990; 7 21-29
133 Landry D W, Zhao K, Yang G X, Glickman M, Georgiadis T M. Antibody-catalyzed degradation of cocaine. Science. 1993; 259 1899-1901
134 Meyer R E. New Pharmacotherapies for cocaine dependence. Revisited Arch Gen Psychiatry. 1992; 49 900-904

Dr. Ulrich W. Preuß

Psychiatrische Klinik und Poliklinik

der Ludwig-Maximilians-Universität München

Nußbaumstr. 7

80336 München

eMail: up@psy.med.uni-muenchen.de