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).

Methods: Two case studies (N=2) and a review of the relevant literature are provided in this clinical update on psychostimulant treatment of cocaine dependence.

Results: Two case studies are presented in which psychostimulant treatment of cocaine dependence was associated with a good clinical outcome.

Discussion: While the use of psychostimulant medication for the treatment of cocaine dependence is controversial, emerging evidence suggests potential utility for this approach.

Conclusions: Cocaine use in individuals with CD may represent self-medication, and prescribed psychostimulants may have benefit in restoring dopaminergic function.

Scientific Significance: Psychostimulant treatment of cocaine dependence is consistent with the Self-Meidcation Hypothesis and is deserving of further study.