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Cocaine Dependence Treatment — MRCPsych Paper B MCQ

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ModerateSubstance MisuseCocaine Dependence TreatmentMRCPsych Paper B

A 28-year-old man who uses crack cocaine daily presents to a substance misuse service seeking abstinence. He has experienced paranoid ideas while intoxicated, but these resolved fully during a recent period of abstinence and there is no evidence of a persistent psychotic disorder. He is not dependent on opioids or alcohol and has no other comorbidity. After assessment of his immediate physical and psychiatric risks, which ongoing treatment plan best reflects NICE guidance for primary cocaine dependence?

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Correct answer: D — Psychosocial treatment without maintenance medication

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · C = shown as D

C is correct. There is no licensed or NICE-recommended pharmacological maintenance treatment for cocaine dependence; psychosocial interventions are the mainstay. NICE CG51 recommends contingency management with incentives contingent on drug-negative tests (for example, cocaine-free samples) to reduce use and promote engagement, with keyworking, self-help referral and CBT reserved for comorbid mental health problems. Methadone (A) and buprenorphine (B) are opioid-substitution treatments and have no role here as he is not opioid dependent. Naltrexone (D) is for relapse prevention in selected detoxified, formerly opioid-dependent patients (and in alcohol dependence), not stimulant dependence. Acamprosate (E) is an alcohol relapse-prevention agent acting on glutamatergic transmission with no efficacy evidence in cocaine dependence. Antipsychotics may be used briefly for cocaine-induced psychosis, but that treats a complication of intoxication, not the dependence itself; here the paranoia had already resolved with abstinence.

Reference: National Institute for Health and Care Excellence. Drug misuse in over 16s: psychosocial interventions (CG51), Recommendations (contingency management for drug misuse, including cocaine). 2007, current. https://www.nice.org.uk/guidance/cg51/chapter/1-guidance