Recent advances in the pharmacotherapy of cocaine dependence.

The pharmacotherapy of cocaine dependence is a rapidly developing field of research that may soon produce efficacious medications. Expanding research on reward-related brain circuitry, which is acutely activated and chronically dysregulated by cocaine, has helped reveal the neurobiological features of cocaine dependence and is guiding pharmacologic strategies that have significant potential to improve clinical outcome. Cocaine dependence is a multifaceted disorder with distinct clinical components that may respond to different pharmacologic approaches. Pharmacologic strategies for this disorder include blocking euphoria, reducing withdrawal and negative mood symptoms, ameliorating craving, and enhancing the prefrontal cortical function that seems to be impaired in cocaine-dependent patients. One medication may not be sufficient to treat these diverse elements of cocaine dependence because preliminary studies report efficacy with medications that have opposite actions on reward-related circuits. This review highlights pertinent advances in cocaine neurobiology, recent clinical trials, and controversies in the pharmacologic treatment of cocaine dependence.