Chapter 69 - Patient Responses to Guanfacine in Cocaine Addiction

Abstract

Cocaine dependence is a chronic stress state characterized by compulsive and uncontrollable drug seeking and drug use despite negative consequences. Moreover, compared with many other drugs of abuse, there are few efficacious medications that address the high rates of craving and cocaine use. Notably, the chronic use of cocaine is associated with robust adaptations to core neural stress systems that mediate stress sensitivity, anxiety pathophysiology and prefrontal regulatory function. As an alpha-2 adrenergic agonist, guanfacine’s ability to target such overlapping stress, reward, and anxiety pathophysiology suggests that it may be a useful long-term agent for attenuating the stress and cue-induced craving state in both women and men. This is supported by recent research findings from our own laboratory. Additionally, guanfacine’s improvement of regulatory mechanisms that are key to exerting cognitive and emotional control over drug-seeking behavior also suggests that guanfacine may be effective in reducing craving and relapse vulnerability in many drugs of abuse.