Science Research Report on Cocaine
New research on patients with Cocaine Use Disorder (CUD) was published in the June 17, 2016 issue of Science by Karen Ersche from the University of Cambridge, UK. The article full-text is available here.
Dr. Ersche’s team reported results from behavioral experiments conducted with CUD patients and healthy participants. Using simple learning tasks with punishment and reward outcomes, the researchers demonstrated that CUD impairs goal-oriented behavior and that CUD patients have a tendency to repeat automatically awarding behavior without regard for its consequences. The evidence was consistent with previous findings in animal models with malfunctioning dopamine transporters or physical lesions interrupting the dopamine reward neuronal circuits in the brain.
The report’s findings have direct implications for treating CUD. The findings explain the apparent inefficacy of cognitive interventions aimed at increasing appreciation of bad outcomes and positive alternatives to continued cocaine use. The evidence also undermines CUD treatments based on punitive interventions aimed at reprimanding patients for bad choices or outcomes of their actions.
Instead, Dr. Ersche’s work suggests that CUD can be best treated by interventions that focus on establishing new habitual behaviors that replace maladaptive, automatic using habits of CUD patients. These habitual behaviors should consist of daily routines that are health-promoting and offer simple rewards that increase every-day well-being. However, it is important to note that the success of the intervention depends on it being a repeated practice leading to eventual habit formation, rather than some rationalization or consideration of potential reward outcomes, extrapolating from the report’s main conclusions.
The authors also suggest that clinicians should aim to protect CUD patients both from the immediate physiological adverse effects of their substance use and from the consequences of repeated poor decision-making. At the same time, a long-term goal of psychiatric interventions for CUD patients should be to restore functional goal-oriented learning by gradually, over-time, reversing neurotoxic damage caused by cocaine in the dopamine-reward and associated neuronal circuits of the brain. Unfortunately, lack of neuropharmacological options makes behavioral therapy based on new habit formation the expected most successful approach.
