Cocaine is an intense, euphoria-producing brain stimulant with strong addictive potential. Short- and long-term consequences resulting from cocaine use can be detrimental to an individual, both mentally and physically. The drug’s complexity presents a difficult road to recovery; however, effective treatment options often prove successful for patients for restoring a healthy lifestyle.
A History of Cocaine
In the United States, cocaine reached the height of its popularity in the 1980s when extensive use of the drug hit the party and club scene. However, coca leaves, the source of cocaine, have been chewed and ingested for thousands of years. The Erythroxylon coca bush grows primarily in Bolivia, Peru, and Colombia, with Colombia producing 90% of the cocaine powder reaching the United States.
One of the oldest known psychoactive substances, the purified chemical cocaine hydrochloride, has been used for more than 100 years. In the early 1900s, purified cocaine acted as the main ingredient in most tonics and elixirs developed to treat a wide variety of illnesses.
These days, medical use of cocaine is rare due to its overwhelming abuse rates. Under the Controlled Substances Act, cocaine ranks as a Schedule II drug, meaning it has a high potential for abuse, limited medical use, and may lead to severe psychological or physical dependence.
Methods of Cocaine Use
Cocaine comes in two forms and is often diluted (or "cut") with a variety of substances, commonly sugars and local anesthetics. The water-soluble hydrochloride salt form can be injected or snorted as a fine, white, crystalline powder, known on the street by such monikers as coke, blow, yao, and sugar boogers.
The water-insoluble hydrochloride salt form, a cocaine base (or freebase), becomes processed with ammonia or baking soda and water. When heated, this form produces a smokable substance. Crack has become the street term for freebasing cocaine due to the sound the drug makes when heated.
Cocaine has a high potential for abuse, limited medical use, and may lead to severe psychological or physical dependence.
Depending on the consumption method used, the intensity and duration of the drug’s effects vary. Injecting or smoking cocaine delivers the drug rapidly into the bloodstream and brain, producing a quicker and stronger -- but shorter lasting -- high than snorting. The high from snorting cocaine may last around 15-30 minutes, while the high from smoking lasts 5-10 minutes.
Chemical Effects on the Brain
A strong central nervous system stimulant, cocaine increases levels of dopamine in the brain circuits, regulating pleasure and movement. Normally, neurons release dopamine in these circuits as a response to enjoyable sensory experiences, such as the smell of food. Dopamine continues to be recycled in the brain, shutting off the signal between neurons.
However, cocaine prevents the dopamine from being reused, causing excessive amounts to build up. This results in amplifying the dopamine signal and ultimately disrupting normal brain communication. Hoarded dopamine in the brain causes the sensation of being “high.”
Early phases of the high may bring about feelings of well-being, alertness, dizziness, self-absorption, mental clarity, talkativeness, and general arousal and excitement. Physical side effects include an increase in blood pressure and heart rate, dilated pupils, insomnia, nausea, vomiting, and a loss of appetite.
Prolonged abuse has led to severe physical consequences such as cardiac arrest, seizures, strokes, malnourishment from loss of appetite, and even death. Also, one risks psychosis with confused and disoriented behavior, delusions, and hallucinations.
Coming down from the short-lived high (or crashing) results in mental and physical exhaustion, depression, restlessness, irritability, anxiety, aggressiveness, anti-social behavior and paranoia. The extreme high, followed by the equally intense crash, may contribute to users typically binging on the drug until they reach complete exhaustion or run out of it.
Chasing the High
Often, users increase the frequency and amount of consumption due to a quickly developed tolerance to the drug’s effects. With extensive use of cocaine, the brain adapts, becoming less sensitive to the drug and natural dopamine production. Many cocaine abusers report constantly seeking but failing to achieve as much pleasure as they did from their initial experience on the drug.
Not only does frequent abuse of the drug threaten one’s immediate psychological and physiological well-being, but it increases the risk for contracting HIV and viral hepatitis. Sharing needles in order to inject the drug, as well as risky sexual behavior as a result of intoxication, commonly occur among cocaine addicts.
Who Uses Cocaine?
Synonymous with the phrase "party drug," cocaine is used by many people in search of a stimulant to help them stay awake far beyond nightfall. Once thought of as a glamorous drug because of its high monetary value, cocaine maintains popularity among the rich and famous. On the other hand, crack cocaine sells extremely cheap on the street, making the drug’s demographic quite widespread. The spectrum of affected users can be traced from experimenting students to affluent businessmen, and even people living on the street.
The risks involved with cocaine use and its potential for addiction have prompted researchers to learn more about its past and current use. In 2011, research conducted by the National Survey of Drug Use and Health (NSDUH) revealed that amongst ages 12 and older, 14.3% of people had used cocaine at some point in their life, an additional 3.2% used crack cocaine. Reports of those currently using reached .5% or 1.4 million people for cocaine and .1% for crack cocaine.
With a drug as wicked as cocaine, the threat of addiction exists just after first time use. In 2007, cocaine accounted for 13% of all admissions to drug abuse treatment programs. Even after treatment, refraining from cocaine use can be extremely difficult. Studies show that during periods of abstinence, the memory of or exposure to associations with the drug can trigger tremendous cravings. Additionally, chronic relapse of the drug, characterized by uncontrollable drug-seeking no matter the consequences, occurs due to changes in the brain caused by exorbitant drug use.
Studies show that during periods of abstinence, the memory of or exposure to associations with the drug can trigger tremendous cravings.
Along with extreme drug cravings, cocaine withdrawal symptoms produce effects that threaten one’s physical and psychological well-being. Intense depression, agitation, restlessness, paranoia, hostility, and general malaise puts one in danger of harming themselves and, in some instances, has even led to suicide. The physical aspects of withdrawal include vivid and unpleasant dreams, fatigue, severe chest pains, muscle spasms, panic attacks, and insomnia.
Although cocaine recovery presents many uphill battles, the drug’s widespread abuse rates have influenced efforts to develop more treatment programs specifically designed for cocaine addiction. Because of the neurological, social, and medical aspects of abuse, treatment should be comprehensive in order for one to stop using, avoid relapsing, and begin to enjoy a drug-free life.
A pharmacological approach to treatment has shown some promise. Although the FDA has not approved any medications yet, several medications marketed for other diseases (vigabatrin, modafinil, disulfiram) have proven beneficial to reducing cocaine use in clinical trials. A cocaine vaccine, which prevents the entry of the drug into the brain, yields some hope for reducing the risk of relapse as well.
Although scientists hope to find medication advantageous for cocaine addiction treatment, more options and success result from behavioral treatment approaches. Some community programs find favor in using contingency management, or motivational incentives, to achieve initial abstinence and to encourage the addict to remain in treatment. This system rewards patients with prizes for producing a clean urine test.
Cognitive-behavioral therapy can help patients who have relapsed to recognize and avoid certain situations that may threaten another relapse. This type of treatment teaches patients new ways of coping with problems and behaviors associated with their cocaine use.
Cocaine Anonymous, an outpatient program, uses a 12-step system similar to that of Alcoholics Anonymous. The 12 steps focus on conquering short-term goals toward sobriety. Acknowledging the fact that addicts undergo common problems and issues during drug use -- and, more importantly, throughout recovery -- participants of Cocaine Anonymous find support among their peers through sharing similar experiences.
Detox and Treatment Centers
No matter what approach to recovery one chooses, a detox center may be necessary. Intense withdrawal symptoms can cause serious physical and psychological harm. Withdrawal can last anywhere from 1-3 weeks, so supervised detoxing proves to be safest and most effective.
Inclusive to cocaine addiction treatment, therapeutic residential rehabilitation centers typically require 6-12 months of residency at the facility, although some provide outpatient services. Patients in these programs receive individual and group therapy, along with medical consultation in a safe and supportive sober living community. These centers address patients’ issues that may have led to their initial drug use, while focusing on successful reintegration into society.
Cocaine users risk devastating psychological and physiological consequences. The drug’s vigorous grasp endangers one’s future, while abuse and addiction may be waiting just beyond the first line snorted. Many atrocious obstructions stand in the pathway to recovery; however, successful sobriety is achievable through a comprehensive and determined treatment plan.