Abstinence from cocaine after long-term addiction

Background. -Experimental data strongly suggest that in animal and probably in man, noradrenergic and serotoninergic become uncoupled during repeated consumption of drugs of abuse, strongly suggesting that different drugs share common mechanisms for drug-dependence. Using cocaine-dependence as model of strong addiction we speculate that careful analysis of psychic adjustments in patients who experience prolonged abstinence could be a useful tool for patient's care. Aim. - The aim of this retrospective study was first to establish similarities in patients' histories concerning modes of entrance, circumstances favouring the stopping, and modality of withdrawal. Secondly, we analysed the different ways used by subjects to substitute their cocaine-dependence. Patients and methods. - Cocaine-dependent subjects who had succeeded in supporting abstinence for at least 12 months without consumption were evaluated retrospectively by a face-to face interview. Results. - We obtained a list of circumstances associated with entries and exit from cocainedependence. Second, when seeking for similarities in addictive behaviour, before and after, between cocaine users, we proposed to classify patients according to the strength in their addictive dominant trait between strong, moderate, mild, or absence of addictive behaviour. For didactic aims, purposes are illustrated by clinical vignettes. Conclusions. - This retrospective study allows us to clear arbitrarily four types of psychical modifications associated with prolonged abstinence in cocaine-dependent patients. Prospective clinical studies are clearly needed to standardize and to validate these clinical criteria. (C) L'Encephale, Paris, 2011.