Are Cocaine abusers at risk for contracting HIV/AIDS and hepatitis B and C?

Yes, cocaine abusers are at increased risk for contracting such infectious diseases as human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and viral hepatitis. This risk stems not only from sharing contaminated needles and drug paraphernalia but also from engaging in risky behaviors as a result of intoxication. Research has shown that drug intoxication and addiction can compromise judgment and decision-making, and potentially lead to risky sexual encounters, needle sharing, and trading sex for drugs- by both men and women. In fact, some studies are showing that among drug abusers, those who do not inject drugs are contracting HIV at rates equal to those who do inject drugs, further highlighting the role of sexual transmission of HIV in this population.

Additionally, hepatitis C (HCV) has spread rapidly among injecting drug users. Nearly 50 percent are exposed within 2 years of initiating injection drug use, and infection rates are between 40 and 98 percent in those injecting for more than 2 years. Although treatment for HCV is not effective for everyone and can have significant side effects, medical followup is essential for all those who are infected. There is no vaccine for the hepatitis C virus, and it is highly transmissible via injection; thus, HCV testing is recommended for any individual who has ever injected drugs.

What Are the Effects of Maternal Cocaine Use?

The full extent of the effects of prenatal cocaine exposure on a child are not completely known, but many scientific studies have documented that babies born to mothers who abuse cocaine during pregnancy are often prematurely delivered, have low birth-weights and smaller head circumferences, and are shorter in length than babies born to mothers who do not abuse cocaine.

Nevertheless, it is difficult to estimate the full extent of the consequences of maternal drug abuse and to determine the specific hazard of a particular drug to the unborn child. This is because multiple factors- such as the amount and number of all drugs abused, including nicotine; extent of prenatal care; possible neglect or abuse of the child; exposure to violence in the environment; socioeconomic conditions; maternal nutrition; other health conditions; and exposure to sexually transmitted diseases;can all interact to impact maternal, fetal, and child outcomes.

Some may recall that "crack babies" or babies born to mothers who abused crack cocaine while pregnant, were at one time written off as a lost generation. They were predicted to suffer from severe, irreversible damage, including reduced intelligence and social skills. It was later found that this was a gross exaggeration. However, the fact that most of these children appear normal should not be over-interpreted to indicate that there is no cause for concern. Using sophisticated technologies, scientists are now finding that exposure to cocaine during fetal development may lead to subtle, yet significant, later deficits in some children, including deficits in some aspects of cognitive performance, information processing, and attention to tasks- abilities that are important for the realization of a child's full potential.

What Treatments Are Effective for Cocaine Abusers?

In 2006, cocaine accounted for about 14 percent of all admissions to drug abuse treatment programs. The majority of individuals (71percent in 2006) who seek treatment for cocaine abuse smoke crack and are likely to be polydrug abusers, or users of more than one substance. The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for cocaine. As with any drug addiction, this is a complex disease that involves biological changes in the brain as well as myriad social, familial, and other environmental problems. Therefore, treatment of cocaine addiction must be comprehensive, and strategies need to assess the neurobiological, social, and medical aspects of the patient's drug abuse. Moreover, patients who have a variety of addictions often have other co-occurring mental disorders that require additional behavioral or pharmacological interventions.

Pharmacological Approaches
Presently, there are no FDA-approved medications to treat cocaine addiction. Consequently, NIDA is aggressively working to identify and test new medications to treat cocaine addiction safely and effectively. Several medications marketed for other diseases (e.g., baclofen, modafinil, tiagabine, disulfiram, and topiramate) show promise and have been reported to reduce cocaine use in controlled clinical trials. Among these, disulfiram (used to treat alcoholism) has produced the most consistent reductions in cocaine abuse. On the other hand, new knowledge of how the brain is changed by cocaine is directing attention to novel targets for medications development. Compounds that are currently being tested for addiction treatment take advantage of underlying cocaine-induced adaptations in the brain that disturb the balance between excitatory (glutamate) and inhibitory (gammaaminobutyric acid) neurotransmission. Also, dopamine D3 receptors (a subtype of dopamine receptor) constitute a novel molecular target of high interest. Medications that act at these receptors are just now being tested for safety in humans. Finally, a cocaine vaccine that prevents entry of cocaine into the brain holds great promise for reducing the risk of relapse. In addition to treatments for addiction, medical treatments are being developed to address the acute emergencies that result from cocaine overdose each year.

Behavioral Interventions
Many behavioral treatments for cocaine addiction have proven to be effective in both residential and outpatient settings. Indeed, behavioral therapies are often the only available and effective treatments for many drug problems, including stimulant addictions. However, the integration of behavioral and pharmacological treatments may ultimately prove to be the most effective approach.

One form of behavioral therapy that is showing positive results in cocaine-addicted populations is contingency management, or motivational incentives (MI). MI may be particularly useful for helping patients achieve initial abstinence from cocaine and for helping patients stay in treatment. Programs use a voucher or prize-based system that rewards patients who abstain from cocaine and other drug use. On the basis of drug-free urine tests, the patients earn points, or chips, which can be exchanged for items that encourage healthy living, such as joining a gym or going to a movie or dinner. This approach has recently been shown to be practical and effective in community treatment programs.

Cognitive-behavioral therapy (CBT) is an effective approach for preventing relapse. CBT is focused on helping cocaine-addicted individuals abstain ? and remain abstinent?from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and addiction. These same learning processes can be harnessed to help individuals reduce drug use and successfully prevent relapse. This approach attempts to help patients recognize, avoid, and cope; that is, they recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviors associated with drug abuse. This therapy is also noteworthy because of its compatibility with a range of other treatments patients may receive, including pharmacotherapy.

Therapeutic communities (TCs), or residential programs, offer another alternative to persons in need of treatment for cocaine addiction. TCs usually require a 6 or 12 month stay and use the program's entire "community" as active components of treatment. They can include onsite vocational rehabilitation and other supportive services and focus on successful reinsertion of the individual into society.

Community-based recovery groups- such as Cocaine Anonymous- ;which use a 12-step program, can also be helpful to people trying to sustain abstinence. Participants may benefit from supportive fellowship and sharing with those experiencing common problems and issues.

It is important that patients receive services that match all of their treatment needs. For example, if a patient is unemployed, it may be helpful to provide vocational rehabilitation or career counseling along with addiction treatment. If a patient has marital problems, it may be important to offer couples counseling.