title: The self-medication hypothesis and psychostimulant treatment of cocaine dependence: an update.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  Psychostimulant treatment of cocaine dependence is consistent with the Self-Meidcation Hypothesis and is deserving of further study.
authors.affiliation: Division of Substance Abuse, New York State Psychiatric Institute, New York, New York; Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: John J
authors.initials: JJ
authors.lastname: Mariani
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Khantzian
authors.forename: Frances R
authors.initials: FR
authors.lastname: Levin
mesh_terms: D000328:Adult; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D008875:Middle Aged; D012651:Self Medication
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate