Case Report Is Aripiprazole Useful to Refrain From Cocaine Use After Detoxification (Avoiding Relapses)? Giovanni B. Cassano, MD, Lorenzo Lattanzi, MD, Antonella Litta, MD, Valentina Lombardi, MD, Alessandro Tatulli, MD, Alessandra Benedetti, MD, Antonio Longobardi, MD, and Icro Maremmani, MD Abstract Cocaine abuse/addiction is a recidivist, chronic dis- turbance and it represents a crucial issue of public health, because of physical and psychic distur- bances, associated to the use of this substance. Nowadays, no specific drug has been approved by the Food and Drugs Administration for the treatment of cocaine addiction. In the treatment of cocaine abuse/addiction, both agonist dopaminergic drugs (ropinirole, amantadine, pergolide, and psychosti- mulants), and antagonist action drugs (traditional antipsychotics) have been proposed. Aripiprazole is an atypical antipsychotic, marketing in the USA since 2003 for the treatment of schizophrenia, mania, and mixed bipolar episodes, with peculiar pharmacolo- gic properties in comparison with the other second generation’s antipsychotics. Here we describe 3 cases of cocaine abuse in comorbidity with bipolar mood disorder successfully treated with aripiprazole. Key Words: cocaine abuse/addiction, aripipra- zole, bipolar disorder (Addict Disord Their Treatment 2009;8:161–166) INTRODUCTION Cocaine abuse/addiction is a reci- divist, chronic disorder and it repre- sents a crucial issue of public health, with core signs and symptoms (craving and relapsing behavior) associated with the use of this substance. Craving is characterized by impul- sive (discontrolled) behavior in sub- stance seeking and a compulsive urge to take substances again. Relapsing be- havior is underlined by a loss of control and is displayed in so-called ‘‘post-with- drawal abstinence,’’ which is an ensem- ble of symptoms called ‘‘hypophoria,’’ such as a strange feeling of nervousness, low pain and stress thresholds, and an inability to be ‘‘functional’’ in high- priority and low-priority tasks. 1 When relapsing behavior is recog- nized as the crucial aspect of addictive diseases, this leads to a relapse-target- ing therapeutic intervention. The Italian Population Survey on Alcohol and Drugs 2 reports that cocaine abuse in a population aged between 15 and 54 years has increased from 0.1% in 2001 up to 1.5% and 2.2% in 2003 and 2005, respectively. The effect of cocaine seems to occur, particularly in mesolimbic and accumbens nuclei, by blocking Dopa- mine’s Active Transporters in the pre- synaptic area, with the consequence of an increase in dopamine levels. Despite the growing knowledge of the neurobiology of cocaine abuse/ addiction, so far no specific drug has been approved by the Food and Drugs Administration for its treatment. Several drugs have been proposed for the treatment of cocaine addiction (such as desimipramine; antiepileptics, such as carbamazepine, gabapentin; lithium salts; disulfiram). Dopaminergic agonists (ropinirole, amantadine, per- golide, and psycho stimulants), particu- larly those with high affinity for D3 receptors (eg, ropinirole) have shown promising results, as reported in some studies. 3,4 Dopaminergic agonists can reduce the anhedonia and lethargy, which seem after the cessation of co- caine abuse, but in some cases these drugs themselves display a potential for inducing addiction. 5–8 ADDICTIVE DISORDERS & THEIR TREATMENT Volume 8, Number 4 December 2009 161 From the Department of Psychiatry NPB, University of Pisa, Italy, EU. Reprints: Icro Maremmani, MD, ‘‘Vincent P. Dole’’ Dual Diagnosis Unit, ‘‘Santa Chiara’’ University Hospital, Department of Psychiatry NPB, University of Pisa, Via Roma, Pisa 67 56100, Italy, EU (e-mail: maremman@med.unipi.it). Copyright r 2009 by Lippincott Williams & Wilkins www.addictiondisorders.com