The self-medication hypothesis and psychostimulant treatment of cocaine dependence: an update.

Background: Stimulant medications have shown promise as a treatment for cocaine dependence (CD) for several decades, yet these treatments have not been widely studied and substantial barriers to clinical implementation remain. The "Self-Medication Hypothesis," posits that an individual's choice to use a particular substance is to some degree based on the substance's effect on subjective painful affects or unpleasant emotional states which may or may not be associated with a psychiatric disorder.

Objectives: The Self-Medication Hypothesis remains relevant, particularly when considering the scenario of cocaine dependence, both with and without and co-occurring attention-deficit/hyperactivity disorder (ADHD).

Envelopments: immersion in and emergence from drug misuse.

Contemporary psychodynamic therapists, as contrasted with early ones, are more active and interactive, less dependent on interpretations, and more focused on affects, self-regulation, and interpersonal relations, with a premium placed on the therapeutic alliance. Evidence supports the utility and effectiveness of the psychodynamic paradigm. Two cases are presented that demonstrate how a well-trained psychodynamic therapist is able to effectively apply such an approach to individuals with substance use disorders, in one instance a client in early treatment still immersed in her addictions, and, in the second case a client in early abstinence emerging from a long standing dependency on alcohol and cocaine.

The MICA Case Conference Program at Tewksbury Hospital, Mass.: an integrated treatment model.

This report describes the MICA (Mentally Ill Chemically Abusing) Program at the Tewksbury Hospital campus in Tewksbury, Massachusetts. Several campus facilities collaborate in the MICA Program. Through Expert Case Conferences, principles of integrated psychosocial treatment with dual diagnosis patients are demonstrated.