1. Cognitive Behavioral Therapy as Treatment for Cocaine Abuse and Dependency Bre Sullivan Dayton Latty

2. Brief History of Drug Use Coca leaves chewed for stimulant-like effects 1859: Albert Niemann discovers extraction of cocaine from coca leaves 1880’s: Moves into popularity in medicine Inclusion in Coca-Cola Banned in 1922 –Medical research revealed harmful effects 5.7 Million Addicted in 1985

3. Legality of Cocaine Schedule II Controlled Substance: High potential of abuse –Less than that of schedule I drugs Dangerous to consume Prolonged use can cause physical and/or psychological dependence

4. Current Use In 2013: 14.3% over age of 12 have tried at least once –12.5 fall between 12 and 26 years old 1.2% report using within the past year Over time 2002 had 2.4 Million Americans addicted to cocaine Compared to 1.2 million in 2012

5. Drug Effects Dopamine reuptake inhibitor –Blocks sites where dopamine is supposed to be taken back into the presynaptic cell –In this way more dopamine is collected in the synapse –Less dopamine is recycled and reused, more is being produced –Downregulation of natural DA in brain

6. Drug Effects Con’t Physiologically: Blood vessels constrict Pupils dilate Increased: –Body temperature –Heart rate –Blood pressure Psychologically: Anxiety Panic Irritability Paranoia

7. Pathology of Addiction Tolerance: After continued use brain adapts to the level of cocaine being taken More cocaine now needed to be consumed for the same effect to occur in the body Dealing with the reward system leaves the user with positive reinforcement upon using cocaine

8. Case Study with Mice Mice given chance to explore which chamber they prefer: vanilla or cinnamon Mice then given injection of saline, placed into room they preferred previously Mice given injection of cocaine, placed into chamber they did not initially pick Mice, sober, given option between two chambers again… Sober, mice chose room associated w/cocaine

9. These results show that drug seeking stimulus and thoughts have an effect on behavior Can be applied across species –Can readily explain human behavior with drugs RESULTS

10. Dependency? Dopamine Receptor down regulation causes less dopamine production –DA is associated with happiness and pleasure Addicts require cocaine to reach pleasure levels of DA –Experience crashes and depression (withdrawal) from lack of DA

11. Withdrawal It feels like: Pains and aches all over user’s body Fatigue Chills Depression Increased anxiety Withdrawal : After prolonged use and dependence has developed, and the intake of cocaine has abruptly stopped. Can occur by accident Inability to gain access to drug Can occur if user willingly attempts to stop use

12. What is CBT? Identifying faulty thinking patterns & self-destructive thoughts & challenge Rationalize why frame of mind is not law Focuses on goal- directed thinking & behavior Planning out future rewards for behavior that negates positive regard toward cocaine

13. Is it Effective? Studies show: Following cocaine abusers through treatment: –CBT was just as effective as Contingency Management long term Users learned long term situational coping skills in CBT –CBT has been shown to be twice as effective when supplemented with a pharmacological substance such as desipramine hydrochloride –CBT decreases likelihood of relapsing due to coping strategies – More successful than unstructured clinical counseling

14. Disulfiram Trial

15. Health Care in Cocaine Abuse or Dependency Currently no accepted medication for cocaine addiction In 2012: 6.5 million people aged 12 and over who were in need of treatment did not receive it Reasons reported why treatment did not occur: Lack of money Lack of health insurance coverage Fear of being without drug Fear of negative stigma from neighbors & co- workers

16. Is Treatment Affordable? Inpatient care stay: $20,000 - $30,000 Outpatient care: $10,000

17. Thoughts?

18. References Cocaine: A Short History. (2006, January 1). Retrieved April 6, 2015, from http://www.drugfreeworld.org/drugfacts/cocaine/a-short-history.html Cocaine. (2013, December 1). Retrieved April 6, 2015, from http://www.drugabuse.gov/drugs-abuse/cocaine 7.1 Substance Dependence or Abuse. (2013, September 1). Retrieved April 6, 2015, from http://archive.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/ NSDUHresults2012.htm#ch7.1 What are the short term effects of cocaine use? (2010, September 1). Retrieved April 6, 2015, from http://www.drugabuse.gov/publications/research-reports/cocaine/what-are-short-http://www.drugabuse.gov/publications/research-reports/cocaine/what-are-short- term-effects-cocaine-use What are the long term effects of cocaine use? (2010, September 1). Retrieved April 6, 2015, from http://www.drugabuse.gov/publications/research-reports/cocaine/what-are-long-http://www.drugabuse.gov/publications/research-reports/cocaine/what-are-long- term-effects-cocaine-use Cognitive Behavioral Therapy (CBT)? (2012, July 1). Retrieved April 6, 2015, from http://www2.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/ About_Treatments_and_Supports/Cognitive_Behavioral_Therapy1.htm

19. References Cont. Carroll, K., Fenton, L., Ball, S., Nich, C., T, F., Shi, J., & Rounsaville, B. (2004). Efficacy of Disulfiram and Cognitive Behavior Therapy in Cocaine-Dependent Outpatients: A Randomized Placebo-Controlled Tria. JAMA, 61(3). Retrieved April 1, 2015, from http://archpsyc.jamanetwork.com/article.aspx?articleid=481973http://archpsyc.jamanetwork.com/article.aspx?articleid=481973 Carroll, K. et all. (1994, December 1). One-Year Follow-up of Psychotherapy and Pharmacotherapy for Cocaine Dependence Delayed Emergence of Psychotherapy Effects. Retrieved April 6, 2015, Epstein, D. (2003, March 1). Cognitive-behavioral therapy plus contingency management for cocaine use: Findings during treatment and across 12-month follow-up. Retrieved from http://psycnet.apa.org/journals/adb/17/1/7 Rawson, R. et all. (2001, October 12). A Comparison of Contingency Management and Cognitive-Behavioral Approaches During Methadone Maintenance Treatment for Cocaine Dependence. Retrieved April 6, 2015, from http://archpsyc.jamanetwork.com/article.aspx?articleid=206714 What treatments are effective for cocaine abusers? (2010, September 1). Retrieved April 6, 2015, from http://www.drugabuse.gov/publications/research-reports/cocaine/what-treatments-are-effective-ccocaine-abusershttp://www.drugabuse.gov/publications/research-reports/cocaine