New insights and treatments: opiate withdrawal and cocaine addiction.

Basic research in the neurosciences has led to a theory of opiate withdrawal involving endogenous opioid peptides and hyperactive norepinephrine neurons. This theory predicts the efficacy of clonidine, a nonopiate agent, in the management of opiate withdrawal. Clonidine, which offers numerous advantages over methadone as a means of opiate detoxification, may be appropriate for use by general practitioners. Clonidine-aided detoxification can be followed immediately by naltrexone maintenance, which facilitates rehabilitation. Cocaine users' reports and clinical and basic studies, when pieced together, provide an outline of the natural history of chronic cocaine abuse. How certain users become addicts is not clear, however. Additional neurochemical research and neurophysiological studies are needed for the development of nonaddictive methods of detoxification (à la clonidine) and prophylaxis (à la naltrexone). In the absence of such studies, cocaine treatment programs use the methods of Alcoholics Anonymous, contingency contracting, and inpatient therapies for addiction.