Cocaine is a stimulant drug that is derived from the coca plant, largely found in South America. It is considered a Schedule II controlled substance in the United States by the Drug Enforcement Administration, or DEA, as it does have some minor medicinal uses as a local anesthetic, although it is rarely used this way. It is mostly considered an illicit substance of abuse with a high potential for addiction.
Cocaine is abused either in rock form, as crack cocaine, or in powdered form. It may be snorted, smoked, injected, swallowed, or even placed into body orifices for a short-lived and intense high. According to the 2013 National Survey on Drug Use and Health (NSDUH), 1.5 million people at least 12 years old in the United States abused cocaine in the month prior to the survey, classifying these individuals as current cocaine abusers.
Cocaine Abuse and Addiction Potential
Initially, when someone abuses cocaine, levels of the neurotransmitter dopamine, which is related to how people feel pleasure, are increased. In addition, dopamine may be blocked from being reabsorbed creating a sort of flood of “happy cells” in the brain and causing the intense high, or burst of euphoria. Over time, cocaine acts on the limbic system in the brain, which is considered the “reward center” as it serves to build up what makes someone feel good and then encourages this behavior to be repeated in order to enhance pleasure. The better something makes people feel, the more likely they are to do it again; thus, when people continuously abuse cocaine and alter dopamine levels, the limbic system may push them to repeat this behavior, possibly leading to addiction. The limbic system contains both the amygdala and the hippocampus, both of which are involved in emotional regulation, pleasure sensations, learning, and memory, and these functions are impacted by cocaine abuse, the journal Current Topics in Behavioral Neurosciences reported after examining some of CNS functions and neuroplastic changes in the limbic system likely caused by cocaine exposure.
The National Institute on Drug Abuse (NIDA) publishes that drugs like cocaine increase levels of dopamine artificially in the brain, and as a result, the brain may start to make less of it without the drug. This makes it difficult for an individual to feel pleasure naturally and potentially increases the desire to abuse drugs to increase pleasure, which can become a cycle of problematic drug abuse that leads to addiction. The journal Addiction Science & Clinical Practice also reports that cocaine abuse interferes with the frontal cortex region of the brain, the part of the brain involved in decision-making, impulse control, and willpower, potentially decreasing a person’s ability to refrain from drug-seeking behaviors and control substance abuse.
In addition to the chemical changes in the brain, cocaine abuse can create an emotional dependency. Individuals addicted to cocaine may experience powerful drug cravings and difficult emotional withdrawal symptoms after “coming down” from the drug. Depression, anxiety, irritability, restlessness, agitation, and suicidal thoughts may be indicative of cocaine withdrawal. Relapse may be avoided and recovery enhanced by a specialty addiction treatment program that manages both the physical dependence and psychological effects of cocaine abuse and addiction.
Stimulant drugs increase brain activity and some of the functions of the central nervous system (CNS), such as blood pressure, respiration, heart rate, and body temperature. Cocaine increases energy levels and may improve focus for a short period of time while decreasing the need to eat or sleep. In some cases, cocaine can induce paranoia, panic, psychosis, aggression, feelings of restlessness, and irritability instead of bringing euphoria.
The effects of cocaine are relatively short-lived as the drug has a short half-life, meaning that the high comes on very quickly, but also that the drug leaves the system quickly. The National Highway Traffic Safety Administration (NHTSA) reports that depending on the method used to take cocaine, with injection being the fastest route of administration and ingestion being the slowest, cocaine takes effect from within seconds to minutes.
The high may dissipate in as quickly as five minutes and rarely lasts longer than an hour or two. Users may take cocaine in a sort of binge pattern, taking several doses of the drug back-to-back to increase the length of the high. This can increase the chances for a dangerous overdose and enhance the odds of developing a dependency on and addiction to the drug as well. When cocaine wears off, individuals likely experience a “crash” and may be overly tired, less energetic, hungry, and generally feel low.
Over time, cocaine may decrease an individual’s ability to feel pleasure without the drug, as dopamine receptors in the brain may shrink with chronic exposure to the stimulant, possibly accounting for the increased drug cravings and high rates of relapse for those addicted to cocaine, NIDA publishes. When dopamine levels are low, individuals likely feel depressed, listless, and basically the opposite of the high feelings felt during cocaine intoxication. Natural stimuli may no longer work to increase pleasure, encouraging individuals to return to using cocaine to feel good again. Depression, anxiety, and difficulties sleeping are all side effects of withdrawal from cocaine, which can be emotionally intense.
A study was done on individuals dependent on cocaine, and it was found that close to half (43.5 percent) had attempted suicide at some point. The journal Archives of Suicide Research postulates that cocaine dependency may increase the risk for suicidal behaviors.
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Even though cocaine is not the number one abused drug in America – in fact, according to the 2013 NSDUH, it ranks fourth in most-abused illicit drugs by adults in the month before the survey – cocaine is the number one illicit drug involved in emergency department (ED) visits in the United States, with over 500,000 Americans, totaling more than 40 percent of all illicit drug-related ED visits, the Drug Abuse Warning Network (DAWN) of 2011 published.
- Delusions, paranoia, or hallucinations
- High temperature
- Elevated blood pressure
- Irregular, or racing heart rate
- Severe confusion
- Loss of consciousness
Cocaine can raise heart rate, breathing, temperature, and blood pressure to high levels that can be dangerous or even toxic. In 2013, NIDA reported that there were about 5,000 cocaine overdose fatalities in the United States, which represented almost a 30 percent rise from 2001 cocaine overdose deaths. A cocaine overdose occurs when the drug reaches toxic levels in the bloodstream, and the body cannot safely break it down.
An overdose is a medical emergency, as the Open Journal of Pharmacology reports that cocaine toxicity can lead to stroke, heart attack, or cardiovascular collapse, which can be fatal. Overdose can happen in a person abusing the drug for the first time or long-time users. The method of abuse, or mixing cocaine with other drugs or alcohol, contributes to increased risk of overdose.
- Respiratory issues: fluid in the lungs, respiratory failure, agitation of asthma symptoms
- Cardiovascular problems: irregular heart rate, cardiac arrest, heart failure, arrhythmia, constricted blood vessels, hypertension
- Neurological concerns: hemorrhaging of brain tissues, infection in the brain, seizures, stroke
- Other physical issues: nausea, headaches, trouble sleeping, weight loss, malnourishment, kidney damage or kidney failure, sexual dysfunction
Depending on the way cocaine is abused, specific physical health problems may arise. Potential complications related to specific methods of abuse are outlined below.
- Scar tissue or “track marks” near injection sites
- Increased risk for contracting infectious diseases like HIV/AIDS or hepatitis from sharing dirty needles
- Collapsed veins
- Respiratory issues
- Irritation to lung tissue
- Lung infections
- Permanent damage to lung tissue
- Reduced blood flow
- Bowel gangrene
- Perforation of stomach or intestines
- Decreased sense of smell
- Damage to nasal and sinus cavities
- Irritation of nasal septum
- Chronic runny nose
- Difficulty swallowing
When people abuse a drug like cocaine, brain chemistry is artificially altered, which may decrease inhibitions, raise self-confidence, and reduce the ability to make sound decisions while high. Those abusing cocaine may be overly excited, energetic, and talkative. Individuals may feel as if they are invincible and may therefore engage in more potentially dangerous behaviors without fear of any negative consequences. Cocaine may also block pain receptors, making individuals feel impervious to physical pain, while also possibly increasing other sensations.
Risky sexual encounters, less concern about rules or legal pressures, and driving while impaired may all be signs of cocaine abuse. Those abusing drugs may have problems with law enforcement or legal troubles, as they may be more likely to be involved in or perpetuate a crime, either in an attempt to get more drugs or as a result of their drug abuse or the mind-altering effects of the drugs.
Cocaine has long been linked to violence and bouts of aggression, as some of the nerve firings are turned up as a result of the drug’s interaction in the brain.
One study of prisoners in the United Kingdom tested violent offenders for drugs over a seven-month period. Fifty percent tested positive for drugs, and of those people, 86 percent had cocaine in their system at the time of arrest, the Telegraph reports.
Over time, patterns of use and specific behaviors may be signs of addiction to cocaine. Some of the following may indicate it is time to seek help for a cocaine addiction:
- Mood swings from euphoria to depression depending on where individuals are in their usage pattern (i.e., high or crashing)
- Social and personal isolation and withdrawal
- Increased secrecy
- Episodes of violence or self-harm
- Inability to stop using cocaine regardless of consequences or desire to do so
- Increased risk-taking behavior or using drugs in potentially hazardous situations
- No desire to participate in activities previously found enjoyable
- Unreliability, and family, work, or school obligations may go unfulfilled
- Work and/or school performance may suffer
- Unpredictable and potentially erratic behavior
- Possible denial that a problem exists
- Inability to feel pleasure from everyday actions or activities
- Change in sleeping and eating habits
Physically, there are several things to keep an eye out for that may indicate cocaine addiction, such as weight loss and malnourishment; these occur because cocaine decreases appetite and may deplete necessary nutrients. Personal hygiene may be neglected as individuals may no longer care about their appearance. Scar tissue may be noticeable if someone has been injecting the drug, and irritation around the nose and mouth as well as evidence of white powder on the face may be signs that someone is regularly snorting cocaine. A smoker of cocaine may cough more or have burn marks on the hands or face from smoking crack cocaine in a crack pipe. Cocaine tolerance – needing more of the drug to feel high each time – and withdrawal symptoms between doses are also possible signs of a cocaine addiction that can be effectively addressed in a comprehensive drug treatment program.
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Drug treatment programs range in structure, intensity, comprehensiveness, duration, and services provided, although most will contain the basics: group and individual therapy sessions, counseling, education, skills training, and relapse prevention and recovery support. Addiction is a highly personal disease, and no two people will experience it exactly the same way, meaning that treatment should also be unique to the individual’s personal circumstances.
An individual’s immediate needs should be assessed in order to determine what level of care may be most appropriate; this assessment can be accomplished through a comprehensive evaluation that addresses medical and biological factors, as well as family history and genetics, support systems, environmental factors, and mental health concerns. For example, many people who abuse drugs may do so in order to self-medicate possible mental illness symptoms, or they may have increased mental illness symptoms due to cocaine abuse.
Mental illness and drug abuse co-occur at high rates, the journal World Psychiatry reports. Co-occurring disorders are best treated by a collaboration of medical and mental health professionals in an integrated treatment model that manages both disorders simultaneously.
An individual’s level of addiction, or chemical dependency on cocaine, will also play a role in the type of drug treatment program chosen. Injecting, snorting, or smoking cocaine may lead someone to be more heavily dependent on the drug than someone who ingests it, and individuals using cocaine in a binge pattern, or large amounts of the drug for a long period of time, may experience heightened dependency levels as well. Using more than one drug or substance at a time can increase overdose and health risks, as well as increase dependency.
There are currently no medications specifically approved for the treatment of cocaine addiction, although research is ongoing. Some pharmacological approaches may be useful, as the epilepsy medication Topamax (topiramate) seems promising in reducing cravings, as evidenced by a study published in the journal JAMA Psychiatry.
Medications may also be beneficial during medical detox, which may be the first stage of a cocaine treatment program. Medical detox involves removing the drug from the brain and body in a safe and secure environment that provides around-the-clock mental health and medical supervision. Medications may serve to reduce emotional withdrawal symptoms, stabilize moods, and decrease suicidal ideations.
Typically, frontline treatments for cocaine abuse are behavioral interventions, such as Cognitive Behavioral Therapy (CBT) and Motivational Interviewing (MI). CBT helps individuals to form new coping strategies and positive thoughts that can influence behaviors. MI is a nonconfrontational acceptance strategy that allows individuals to decide on their own that change is necessary for progress.
Other things to consider when picking a substance abuse treatment program are financial constraints, location, and potential childcare or other obligations, such as work or school responsibilities that may influence schedule flexibility. Outpatient treatment is generally the most flexible option and may be best suited for someone with limited flexibility, low levels of dependence, a strong support system, and a healthy home environment. The next step up is intensive outpatient treatment, which may offer all the comprehensive services included in a residential program, but the individual returns home at night.
Residential treatment programs are generally considered the most comprehensive options available. Residential care often provides the most treatment offerings, designed to offer a strong foundation for recovery. This level of care may help to decrease instances of relapse via transitional, aftercare, and continuing recovery services. Individual needs may change during treatment, so people may move between levels of care as needed. Addiction specialists can help individuals and their loved ones decide on a treatment program that can provide the optimal building blocks for sustained recovery.