title: [Cocaine and opiate related disorders].
abstract: Cocaine and the opiates are--together with alcohol--involved in the genesis of the "three great addictions". The medical conceptualisation of the dependence phenomenon has evolved on the grounds of a critical observation of different ways of use and treatment endeavours, mainly during the last three centuries. Whereas the prohibitionists favoured (and still favour) total abstinence from all psychotropic drugs, defect theoreticians emphasise analytically-oriented psychotherapeutic procedures aiming at healing a supposed underlying self-defect. Contrarily, proponents of the "Metabolic Theory" of the addictions suggest a mainly medication-based approach in order to normalise a--in their eyes causal--still in some aspects hypothetical metabolic defect. Based on a short survey of recently emerging trends of consumption patterns (speed-balling, chasing, multi-substance-use) in Europe, the most important newer treatment types and forms are presented. Finally, a multimodal, integrated, and individualized approach is recommended.
authors.affiliation: Psychiatrische Universitätsklinik Zürich West, Zürich.
authors.forename: R
authors.initials: R
authors.lastname: Stohler
authors.forename: K M
authors.initials: KM
authors.lastname: Dürsteler-MacFarland
mesh_terms: D003042:Cocaine / Q000633:toxicity*; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000209:etiology* / Q000534:rehabilitation*; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D006801:Humans; D009294:Narcotics / Q000633:toxicity*; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation; D013557:Switzerland
chemical_list: D009294:Narcotics; D003042:Cocaine