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Under the Controlled Substances Act, cocaine is classified as a Schedule II drug. This reflects that it has a high potential for abuse but also some legitimate medical uses. Cocaine may be used as a local anesthesia in eye, ear, or throat surgeries.2
Although cocaine had its heyday in the 1980s and 1990s, its use remains prevalent across the nation. The National Survey on Drug Use and Health (NSDUH) is one of the most reliable and comprehensive data providers regarding drug use patterns in the US. In 2013, the NSDUH made the following findings about cocaine use in America:
Texas Cocaine Trade in the News
In May 2015, lifeguards on a beach in Galveston retrieved a 66-pound bundle from the shore. The bundle was revealed to be bricks of cocaine, stamped with a dolphin, the signature of the longstanding Gulf Coast Mexican drug cartel. The cocaine’s street value was estimated at $3.5 million.
The drug bundle was the sixth to have washed up recently on the Galveston beach. Of all six bundles, two contained cocaine. While the bundles suggest a mishap occurred at sea, no information about an accident or other cause was reported.
Source: NY Daily News
According to a multicomponent survey review conducted at the University of Texas at Austin, as of 2014, there was an overall decline in use of cocaine in Texas.4 However, the decline may be largely be due to circumstances around the distribution. Cocaine supply may have waned due to an increase in demand in Europe, lower production of the drug in South America, and the use of a chemical (levamisole), which dilutes the purity of cocaine, making it less desirable on the street. Regarding use of cocaine, the report highlighted the following trends:
Overall, 6.26 percent of residents of Texas use illicit drugs, which is below the national average of 8.02 percent.
Source: Executive Office of U.S. President
While cocaine abuse or addiction is associated with myriad losses, the greatest of all is the loss of life. In 2013, there were 411 known poisoning deaths in Texas that involved cocaine. The number of lives lost was down from 778 in 2006. The average age of those in this group was 46 years old. Death from cocaine has a strong race association as 77 percent of individuals in this group were Caucasian, 11 percent were Hispanic, and 8 percent were African American.6
Despite these rates, fewer people in Texas pass away from drug-induced death compared to America as a whole. In 2007, 9.8 Texans in every 100,000 experienced a drug-induced death compared to a national average of 12.7 per every 100,000.7
The Texas School Survey of Substance Abuse provides extensive information on drug use patterns among adolescents in the state. The 2014 survey involved 33,463 participants in grades 7-12 across 93 school districts, all of whom were asked questions about their drug use.8 The survey found a decline in the use of cocaine from 2012 to 2014. In 2012, 4.6 percent of students reported they had used powder cocaine or crack cocaine at least once in their lives. About 1.4 percent reported using either form of the drug in the month prior to the survey. In 2014, 2.2 percent of the student participants had used powder cocaine or crack at least once in their live
Texas Treatment Rates
A national survey estimates that in 2013 22.7 million Americans aged 12 or older needed rehab treatment for alcohol or illicit drug abuse but only 2.5 million underwent treatment at a rehab center.
In 2013, rehab programs funded by the Texas Department of State Health Services showed that 11 percent of admissions were for cocaine (either powder or crack), which was a sharp decrease from the rate of 35 percent in 1995.9 Information on the method of administration (i.e., snorted versus injected or smoked) shows variation in age and race markers. Of all treatment admissions, individuals who inhaled (i.e., snorted) cocaine tended to be Hispanic and in younger age groups. Most people who injected cocaine were Caucasian and younger than the inhaler group but older than the smokers. In terms of the amount of time between the first period of regular use and admission to treatment, individuals who snorted cocaine took an average of 12 years to enter rehab while individuals who injected took an average of 18 years.10
Information from the same survey as above, but conducted in 2012, provides additional helpful information on trends in cocaine use. This particular report considers both powder cocaine and crack cocaine. In 2012, 9,735 individuals in Texas were admitted to state-funded drug rehab programs for cocaine use.11 Of this group, the majority were people who smoked crack cocaine (5,538) followed by those who inhale powder cocaine (3,310) and then those who inject powder cocaine (292).
In terms of sex, there was a near even split of 51 percent male and 49 percent female. In terms of race and method of cocaine use, Caucasian men were in the lead for injecting powder cocaine, African American men for smoking crack cocaine, and Hispanic men for inhaling cocaine. Among these men, there was a high rate of referral from the criminal justice system, including 45 percent of men in the smoking group, 40 percent in the injecting group, and 61 percent in the inhaling group. Of these men, employment rates were low but highest for the powder cocaine inhalers. Homeless rates were low but highest among the group of male crack cocaine smokers (20 percent).12
The following is a 2010 ranking of the most common drugs involved in treatment admissions in Texas, ranked from most common to least common:
Source: Executive Office of the President
The Texas Department of State Health Services provides statistical information on the rate of treatment admissions to state-funded rehabs in Texas. The information is not cocaine-specific, but the following findings provide insight into the extent of drug abuse and addiction treatment among youth in 2009:
Few studies aim to review the success of rehab treatment for cocaine and other drugs of abuse because of the myriad challenges involved. First, recovery defies definition. Second, there is no clinical standard as to what length of time constitutes success. Rather than look at recovery in terms of success, it is helpful to consider the potential advantages of treatments that have been proven to be effective (research-based approaches) in helping individuals to achieve and maintain abstinence.
Numerous research studies show that cocaine abuse or condition is responsive to treatment. Some research efforts have identified specific forms of therapy that are particularly beneficial for those individuals in recovery from cocaine abuse.
Individuals may engage recovery services in Texas for a host of reasons. In some instances, selecting a rehab center in Texas may be a matter of geographic convenience. In other instances, a recovery center may offer niche treatment services based on identity markers, such as programming for adolescents, executives, pregnant women, or elderly clients. In still other instances, a trusted source may refer recovering people or their concerned loved ones to a specialist center in Texas even though they reside in another state. While the clinical approaches to recovery treatment are not geographically specific, many centers make optimal use of their locations to provide complementary treatment services, such as adventure hiking or equine-assisted therapy.
Drug abuse and addiction are complex issues because they stem from biological occurrences in the brain in addition to numerous personal, environmental, social, and familial factors. For this reason, treatment is necessarily multidimensional and must address the biological, psychological, environmental, and familial aspects of this illness.
Medical DetoxFrom a structured treatment perspective, the process typically begins with a supervised medical detox. After detox, recovering individuals immediately begin intensive therapy, whether they are in an outpatient or inpatient program. Detox may occur on site at the rehab facility or at a hospital or clinic. As the National Institute on Drug Abuse discusses, there are currently no FDA-approved medications for use in cocaine detox or as an abstinence maintenance therapy.14
During medical detox at a rehab center, individuals may experience side effects of cocaine withdrawal. Side effects vary based on the individual’s physiology, as well as factors such as length and volume of cocaine abuse.
Examined from a wide angle, cocaine withdrawal typically occurs in three phases characterized by the crash, a cravings period, and an elimination period.15 The crash can set in a few hours or days after last use. During this period a person may experience a host of side effects, such as increased appetite and/or exhaustion, but not necessarily cravings for the drug.
The next phase may result in intense cravings. In chronic users, this phase may last 1-10 weeks. During this phase, a person may feel lethargic, irritable, and/or unable to concentrate. In the elimination phase, which may occur around the 10-week mark and last up to 30 weeks, a person may have intermittent cravings for cocaine, but with less intensity than in the second stage. These cravings are typically due to environmental cues (people, places, and things associated with past cocaine use). Around the 30-week mark, cravings are often gone.
One of the most forceful side effects of cocaine withdrawal is the emergence of cravings for this drug, which causes some individuals to relapse during the withdrawal period.16 Undergoing medical detox in a professional setting of care adds a strong layer of defense against relapse. Attending medical staff can help to ease the discomfort or pain associated with withdrawal by providing medications, psychological encouragement, and proper nutritional support. In addition, individuals who are monitored and supported during a supervised detox have an added safeguard against relapse. After recovering individuals are stabilized in a detox program, intensive therapy begins.
As the National Institute on Drug Abuse explains, while there are numerous therapeutic approaches that have been designed for or adapted to the substance abuse treatment setting, a combination of Contingency Management (CM) interventions and Cognitive Behavioral Therapy (CBT) has been shown to be effective in cocaine recovery programs.17
CM may be particularly useful in the early stages of recovery from cocaine abuse, in order to encourage participation in a rehab program. This approach is based on a rewards system. Programs may give out vouchers, prizes, or points based on good behaviors, such as testing negative on drug exams. The rewards support healthy activities and can include a gym membership, movie tickets, or vouchers for meals at restaurants. This method of therapy is aimed at helping recovering individuals increase their recovery time and therefore their odds of maintaining abstinence in the long-term.18
CM is not typically a standalone therapy, and CBT has proven to be a complementary approach as it targets the cognitive processes and behavioral responses underlying cocaine, or other drug, abuse.19 CBT is based on the assumption that drug use is essentially a maladapted learning process. Somewhere along the way, those who abuse drugs developed an idea that doing so would provide a benefit, such as helping them to cope with stress. This idea in turn led to drug use behaviors. CBT sessions rewind this cause-and-effect process.
In a CBT session, a therapist will help an individual or group to identify and investigate the thought processes that underlie drug use and think about responses that can be taken other than drug use. For instance, when individuals have thoughts that they are depressed, identifying these feelings can help to intercept potential drug use responses. Rather than use a stimulant drug like cocaine, a person can learn to respond with a healthy behavior, such as going for a walk or going to the gym. The benefits of CBT sessions have been shown to continue even after therapy ends, and this stems from CBT’s dedication to teaching recovering individuals how to think critically about substance abuse and make healthy drug-free decisions on a day-to-day basis.20
Recovery necessarily continues after the intensive phase of treatment at an inpatient or outpatient center ends. Known as the aftercare process, this phase is largely self-directed and sometimes pulled together in a patchwork type fashion.
Aftercare options are community-based but typically include recovery group meetings, sober living homes, individual therapy (with a therapist in private practice or at a mental health clinic), group therapy (therapist-led), ongoing drug testing and counseling, and meetings with social workers for case management services (including social services, such as free legal representation, housing support, educational support, job training, or job placement).
First started in Los Angeles in 1982, Cocaine Anonymous (CA) meetings are now held throughout the US, and groups have formed in Canada and Europe. Published in 1994, CA’s first book, Hope, Faith, and Courage: Stories from the Fellowship of Cocaine Anonymous, provides insight into how this fellowship operates as well as the helpful support it has provided to the community.
A later publication, A Quiet Place, provides guidance on how to cultivate a daily meditation practice as well as sobriety supportive verses on which to meditate. Those interested in attending a local CA group can learn about what to expect from the organization’s downloadable outline of a typical meeting format.
Source: Cocaine Anonymous
For many recovering individuals, group recovery meetings are cornerstones of their aftercare programs. Groups are member-led and governed. Many, but not all, groups follow the 12-Step model.
Individuals who are in recovery from cocaine abuse and interested in group recovery meetings modelled after the 12 Steps have the option of attending Cocaine Anonymous (CA) meetings. Adapted from the 12-Step model set forth by Alcoholics Anonymous, CA does not charge for meetings and does not accept contributions from external sources. The funding structure of this fellowship helps to support its commitment to its members alone.
The official website for CA maintains a directory of meetings.21 Those in recovery from cocaine abuse are not limited to only Cocaine Anonymous meetings. All Anonymous fellowships expressly state that they are open to anyone with a desire to stop using drug(s) of abuse, whatever they may be.
The overall decline in cocaine abuse across Texas is a significant statistical finding; however, it must be viewed against the backdrop of substance patterns across different drugs. Research as to whether individuals in Texas who formerly used cocaine have achieved abstinence or migrated over to different (potentially even more dangerous) drugs would provide greater context to the available data on cocaine use rates.
Although the extent of the drug problem in Texas cannot be looked at through the keyhole of cocaine use alone, a review of available research on treatment admissions for cocaine abuse makes clear that the state is dedicated to supporting recovery among its residents. Irrespective of a person’s particular drug of abuse, cocaine or otherwise, treatment is available and can be instrumental to the recovery process.