At last year's inaugural Cocaine, Meth & Stimulant Summit, University of Kentucky Professor Craig R. Rush, PhD, offered a sobering projection of how long it might take to see a viable medication candidate to treat stimulant dependence. At this year's summit in Miami, Rush hopes to leave his audience with a promising outlook toward non-medication strategies to assist this population.
Addiction Professional spoke with Rush, who works in the university's Department of Behavioral Science, about research on impulse control that could help guide meaningful clinical interventions. His summit presentation on this topic will take place Nov. 9. Rush's comments have been edited for length and clarity.
What has been your experience in research on therapeutic strategies for cocaine use?
My colleague and good friend Mark Fillmore here at the university was doing a bunch of impulse control work with drinkers. I thought, “We can do a study like this with cocaine abusers.” Our research initially showed that cocaine, methamphetamine and stimulant abusers have poor impulse control. We also found that in cocaine users, this is really impaired in the presence of drug-related stimuli such as images of paraphernalia and powder drugs. The idea is that with behavioral interventions, we can remediate these impairments.
What does the research say about behavioral interventions' potential?
There has never been a good clinical trial on this, but we did a feasibility study looking at cocaine. We tested inhibitory control training for eight weeks. It was a computerized intervention for which patients in the treatment arm came in three times a week. We also got a urine from them each time they came into the clinic. We did a minimal treatment with them also. The effects of the training were expected to be small, so we didn't want to do treatment that was so intensive that it might overshadow the effects. There were two study arms with 20 participants in each. We found that the training was feasible and acceptable to patients, and it had a small effect. We have a much larger grant now under review.
Describe the urgency of the need to identify beneficial treatments for stimulant dependence.
The crisis is now. If we wait for a medication, it could be decades. The time that it took for buprenorphine to progress from its synthesis to FDA approval for opioid dependence was 36 years. I believe that we've got to continue the medication work, but it's not going to produce anything soon. The clinicians who were in my talk last year, judging from their questions, were saying, “We need something now.”
How translatable would an impulse control intervention be in typical clinical practice?
If we can show efficacy in larger trials, this could be implemented in clinical practice. It is a computerized intervention, so it could be modified for use on a smartphone or a tablet. There would be no extra cost to the provider. It requires minimal clinical involvement.
Join clinical and public safety professionals at the Cocaine, Meth & Stimulant Summit, Nov. 8-10 in Miami, to discuss strategies to combat the stimulant crisis. Visit https://www.stimulantsummit.com for more information.