Perhaps the most important
advancement in the treatment of crack cocaine addiction is one that has
brought treatment efficacy from less than 10% to as high as 80%. This
dramatic increase in effectiveness has been brought about by Recognition
of the fact that:
1) Addiction to crack cocaine is, in part, a physical disease and
must be treated as such. This is done through the use of dopamine agonists
and re-uptake blockers in the early stages of treatment and the use of
amino acid precursor loadings to rebuild the dopamine supply so heavily
depleted during cocaine use.
2) A healing process must be undertaken that includes:
a) Detoxification under close medical attention until physical
stability is reached. This usually takes up to ten days.
b) Inpatient or residential/day care intensive counseling and
medical monitoring until psychological stability has begun. This may take
two or three months. Nutrition is often a critical factor in this phase.
c) Continuing (e.g. halfway house) care and establishment of twelve
step activities as a routine. In this phase, the patient/client is trained
or retrained in becoming a useful member of society and given the tools to
maintain his/her sobriety. This phase is often extended to a "three
quarter way house" (usually an apartment) in which the client has
total responsibility for himself or herself but has a "home
base" in which there are only fellow recovering persons and no drug
d) In extended care each client must rejoin society at large and
function independently. (Twelve step activities may last the rest of the
A prime example of this process is found in the work of
several cooperating organizations in Houston Texas. It begins in a
hospital in the heart of the city. Any crack cocaine addict who wishes to
get sober can contact them or the nearby cooperating halfway house, at any
hour. If there is a hospital bed available, he or she is admitted
immediately. If one is not available, but one is expected soon, the person
is "warehoused" in the halfway house facility. As soon as
admitted, the patient is put under the care of the addiction recovery
The recovery team's treatment regimen begins with
anti-craving medications. Patients addicted to crack cocaine usually
suffer from severe craving which both interferes with their ability to
participate in the treatment process and reduces their likelihood of
treatment. The cause of this severe craving is a significant depletion of
the neurotransmitter, dopamine, which is stored in the hypothalamic area
of the brain.
The team uses five (5) medications within the American
Society of Addiction Medicine's four treatment levels.
A.S.A.M. Level I
(1) Desipramine, is given in doses ranging from 100-250 mg daily.
Desipramine antianxiety qualities have been proven by double-blind
studies, conducted in 1987, to increase the sobriety rate of recovering
cocaine addicts from 15% to 60%. They were conducted by Frank H. Ga win,
M.D., Professor of Psychiatry at Yale and Herbert D. Kieber, M.D.,
Professor of Psychiatry at Yale.
In as much as the Desipramine does not take affect for two weeks,
the team uses (2) Bromficriptine several times daily in dosages of 1.25 to
2.5 mg two to four times daily and PRN during the two weeks. When used
PRN, it will eliminate craving within 20 minutes for approximately 4 to 6
hours. Bromocriptine is a dopamine agonist thus acting like dopamine at
the postsynaptic receptor area. Bromocriptine is administered four to six
weeks during the hospital stay and after discharge. This use of
Bromocriptine was developed by Mark Gold, M.D., Director of Research, Fair
Oaks Hospital, Summit, New Jersey. (Its use is controversial as some
researchers believe it to possibly be addictive.)
The team uses, three times daily, an aminoacid and vitamin
supplement, (3) NuRecover-SA, the primary ingredients of which are 300 mg
of 1-phenylalanine, and 200 mg ofltyrosine. These act through precursor
loading to increase dopamine availability levels. This adjunct to therapy
was formulated by Dr. Kenneth Blum, Department Head for Substance Abuse
Recovery at the University of Texas Health Science Center in San Antonio,
Texas. Dr. Blum is known internationally for his discovery of the genetic
link between the D, receptor and a propensity for alcoholism.
The medication, (4) Amantadine, is given for ten days only, at the
onset of treatment, and acts by enhancing the release of active dopamine
from its storage sites. Amantadine is given in the dosage of 200-400 mg.
(It is similarly controversial)
The medical staff feels that none of the above medications have
addictive properties when properly used. There are minimal side
effects and these are controllable through reduced dosages. The team has
found the medications have afforded an early window of opportunity for
patients to receive and comprehend treatment. There has also been a dramatic reduction in discharges against medical advice.
In addition to the above medications and adjuncts to therapy,
patients receive from a physician ,a minimum of two hours weekly of
didactic education on the use and effects of these medications. The
medical staff and its associated counselors begin use of twelve step model
counseling as soon as the patient is physically able.
A.S.A.M. Level II
As soon as this detoxification program is complete the patient
becomes a client/resident of the halfway house. For eight weeks the
clients are transported daily from there to an outpatient licensed
counseling facility. During this eight week program, each day includes
eight hours of psychological therapy. The counseling is generally of the
twelve step model and is designed to achieve psychological stability along
with the physical stability being sought by the medical treatment. This
therapy is interspersed with physical treatment including, on a patient
specific basis, the use of the above antidepressants and precursor
loadings, and also, as stress is a major cause of slipping, an amino acid
stress effect inhibitor, (5) beCALM'd™ is used. beCALM'd™ is an amino
acid and vitamin formulation containing, primarily, 150 mg each of d-phenylalanine, 1-phenylalanine, and 1-glutamine. This adjunct to therapy
is designed to help prevent stress from causing the patient to go back to
cocaine and alcohol, "his/her old stress medication".
A.S.A.M. Level III
At the end of the professional counseling program the patient
becomes the full time client of the halfway house program. The patient
continues to be given the nutritional supplement, beCALM'd. The Level III
program usually takes about eight to ten months. However, it sometimes
requires. less than six months and occasionally lasts a year or more. The
client does not leave until he or she is ready in his or her own opinion
as well as that of the program leaders.
The halfway house program begin with the assignment of simple tasks
leading to independence within the facility. To remain in the program the
client's sleeping and personal items area must be kept neat and clean. The
client must cook for himself or herself and clean what ever kitchen ware
is used in the process. The clients earn living room, television, etc.
privileges by proving their ability to live with the other clients
in the program on a friendly, cordial basis. The older, more experienced
and stable clients help the newer ones. Attendance in twelve step programs
is mandatory, and attendance at the meetings of the religion of the
client's choice is strongly encouraged.
As soon as the client is able, he or she begins working, even if
only for two hours a day. From this point forward, take-home pay is split
three ways: 1/3rd for the client, 1/ 3rd for the halfway house and 1/3rd
paid toward the client's hospital bill (or what ever portion was not
covered by insurance.) The hospital portion is continued until it is paid
off. The halfway house 1/3rd continues until it reaches a maximum of
$600 per month.
The most important part of the counseling at the halfway house is to
prepare the clients for a job and then help them to learn how to keep it.
In some cases the clients may be highly educated people who must learn how
to handle the stress of professional work without returning to the use of
cocaine when things get difficult. More often the clients have gone from
their parents' home at an early age and have little education or working
skills. Some even must be taught to read! All of this training is made
available to them through the help of a wide variety of charitable
organizations, government agencies, and, of course, other clients who can
Most of the clients need help in how to interview for a job. This is
one of society's most difficult and stressful interfaces, and yet
everything begins with it. Time after time the entry level worker must
face rejection at a time when building self confidence is already a most
difficult and important task. With the help of the halfway house staff,
nearly all finally succeed in getting through it.
Next, the client must work through the paradox of learning
competitive teamwork. During the time he or she was a practicing addict,
the client learned the ability to control others to a fine art. Each
addict becomes ingrained with the idea that rules are only for those
"dumb enough" to get caught. In short, the idea of working with
others for mutual benefit and helping others just for the sake of doing it
are very foreign concepts to the recovering addict. Learning or, in most
case, relearning these ideas is part of a long healing process.
The healing process began with the taking of responsibility for
maintaining one's self, one's sleeping area and one's cooking and eating
facilities. If the client does not, the mess is deleterious to everyone
else in the facility and
it will cost the client valued privileges. Training continues with salary
sharing, as he or she begins to earn one, with the halfway house so that
it can continue to house, clothe, and feed the client.
The client's responsibility to others is made even more clear as the
debt to the hospital is paid off. And, ultimately, the client pays for
more than his or her keep so that others less far into the program can be
taken care of as the client was cared for in his or her early days of
sobriety. These same new clients that the client is helping in a financial
way are also a part of a new family, the staff and clients he or she has
met and worked with at the halfway house.
The new family concept is a major part of the healing process. It
becomes a group of people who are important as a support group. Further,
their very existence provides a strong reason not to slip as doing so
would be an affront to them. Those who do slip along the way must return
to whatever stage is appropriate from which they can try again.
Most of the clients leave the halfway house to return to active
society and maintain their sobriety. In the average case the program cost,
above that paid for by the client, is about $100 per month.
A.S.A.M Level IV
The client is now ready to enter a "three-quarter way house.
That is, to live independently in an apartment complex containing only
recovering Level IV clients. Organized treatment at this level takes the
form of weekly or bi-weekly group therapy and at least three support group
(12 step) meetings per week. The people the client meets here become an
important part of his or her new family.
The use of beCALM'd cannot be required in this Level, however,
experience has shown it to be almost mandatory. Its use in times of stress
is highly recommended for the next ten years.
The above combination of programs have had year to year success
rates varying from 70 to over 90 percent. This remarkable outcome is
believed to be linked to an overall program which maintains a long term
physical and psychological healing process in accordance with the A.S.A.M.
criteria and, where necessary, job and job acquisition training.