Cocaine is a powerful and addictive stimulant drug, primarily used recreationally. Cocaine users experience high energy and euphoria. Use can lead to accelerated heart rate, mood swings, difficulty sleeping, and cognitive distortions. When consumed in large amounts, cocaine addiction can lead to drug-induced psychosis, heart attacks, or strokes. Cocaine addiction can be successfully treated with a combination of evidence-based approaches, including behavioral therapy, peer support and relapse prevention medication.
What Is Cocaine?
Cocaine results from the processing of chemicals that naturally occur in the plant species Erythroxylon coca. Cocaine can be snorted, smoked, or injected intravenously. The drug has two main forms: a loose powder and a hard, rock-like substance commonly known as “crack.” Once cocaine enters the human bloodstream, it has a strong stimulating effect on the central nervous system. It speeds up the normal rate of activity between the nerve cells that form the backbone of the nervous system’s outgoing and incoming communications. Both forms of cocaine also trigger intense feelings of euphoria in the brain’s pleasure center, which can lead to addiction. Since crack cocaine produces more intense feelings than powdered cocaine use, and also has a shorter-term effect, it can be more addictive.
Because cocaine produces euphoric experiences, users are motivated to use more of the drug. Once a recurring pattern of use is established, the brain will eventually come to view the presence of cocaine as a normal part of its chemical environment, leading to physical dependence.
Facts and Statistics
According to The Substance Abuse and Mental Health Services Administration’s (SAMHSA) reports on the number of American preteens, teenagers, and adults affected by cocaine-related abuse or addiction, in 2016, roughly 867,000 people met diagnostic criteria for cocaine addiction. This is the equivalent of approximately 0.3 percent of all individuals over the age of 11.
Cocaine use is highest in adults between the ages of 18 and 25. However, addiction occurs most often in adults over the age of 25. Just 0.1 percent of American preteens and teenagers qualify for a diagnosis of cocaine use disorder or cocaine addiction.
Symptoms and Diagnosis of Cocaine Addiction
Cocaine abuse symptoms frequently appear before the onset of full-blown addiction. Potential signs of cocaine use include:
- Unusual talkativeness
- Atypical rapid body movements
- Moving quickly from topic to topic in conversation
- Bouts of euphoric moods, and mood swings
- A declining desire for sleep
- Reduced appetite
- Rapid, unpredictable mood changes
- Angry outbursts
- Unusual nervousness
- Unexplained bouts of fatigue
- Unexplained periods of sadness
Additional signs and symptoms may appear in people who use cocaine in different ways. For example, a person who snorts the drug can develop nosebleeds and frequent runny noses. A person who injects the drug may develop track marks at the injection site, which can be evidence of chronic intravenous drug use. A person who smokes crack may have darkened fingertips on one hand or both hands.
Diagnostic criteria for Cocaine Use Disorder can be found in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Telltale symptoms include:
- A need to take increasing amounts of the drug in order to feel “high”
- Loss of the ability to set a limit on the number of times cocaine use occurs
- Loss of the ability to set a limit on the amount of the drug consumed during episodes of use
- The appearance of cocaine cravings between episodes of use
In many forms of addiction, increased tolerance means that habitual users may be able to use significant quantities of a drug without overdosing. However, even when taking a dose of the drug that has caused no problems in the past, a habitual user may develop symptoms of an overdose with little or no warning.
Typical symptoms of a cocaine overdose include:
- Forced or irregular breathing
- Nausea and vomiting
- Intense mental agitation
- Intense anxiety or agitation
- Muscle tremors
- Chest pain
- A high fever
- Tachycardia (i.e., rapid heartbeat)
- Sensory hallucinations
- Convulsions or seizures
- A delirious state accompanied by aimless body movements, excessive sweating, an extremely high fever, and (in some cases) violent or aggressive behavior
All methods of cocaine intake can lead to an overdose. However, people who inject the drug intravenously have higher odds of overdosing, which in some cases can be fatal.
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Causes and Risk Factors of Cocaine Addiction
Cocaine addiction is caused by long-term changes in the way the brain uses and makes several important neurotransmitters, which are chemicals that communicate information in the brain. In particular, repeated use of the drug alters the output of the neurotransmitter glutamate, which speeds up the rate of activity inside the central nervous system. Glutamate alterations are especially notable in the section of the brain known as the amygdala, which responsible for producing pleasurable sensations. Factors that increase addiction risks include:
- Genetic predisposition
- Underdeveloped social skills
- Aggressive or violent behavior during childhood
- Ready access to cocaine as a teenager
- A wider pattern of drug experimentation as a teenager
- The presence of mental illness
In most cases, the preconditions for adult addiction are already established during adolescence or at an earlier age.
Withdrawal and Detox
In addition to other common symptoms, addicted users of powdered cocaine and crack can develop symptoms of withdrawal if the brain’s established requirements for the drug go unsatisfied. Typical withdrawal indicators include things such as:
- A general sense of unease
- Vivid dreams or nightmares
- A depressed mental state
- A sharp decline in energy levels
- Mental agitation
- Extreme paranoia
- Intense drug cravings
In people who have used the drug heavily for months or years, depression and intense cocaine cravings can linger long after active intake has ended. In addition, some individuals withdrawing from cocaine may experience suicidal ideation. In treatment, cocaine withdrawal can be closely monitored during a period of medical detoxification, or detox. This medical oversight helps prevent any serious complications in people going through the withdrawal process. It also helps prevent a relapse back into cocaine use and any attempts to substitute other addictive substances for the drug.
Co-Occurring Disorders and Substance Use
Some people struggling with cocaine addiction also have other mental health issues not directly caused by their drug use. When substance problems appear at the same time as mental illness, doctors refer to these overlapping conditions as co-occurring disorders. According to National Institute on Drug Abuse (NIDA), cocaine addiction often affects people who are also dealing with stress-related mental illnesses such as Post-Traumatic Stress Disorder (PTSD) and Obsessive-Compulsive Disorder (OCD).
Polysubstance use and addiction—the practice of taking more than one substance simultaneously—is also common in people who are users of or addicted to cocaine and crack cocaine. The most dangerous and frequently combined substances with cocaine are alcohol and heroin.
Cocaine and Alcohol
There are serious risk factors and long-term health concerns from the use of just cocaine and alcohol alone; when used concurrently, these risks and health consequences increase significantly. Users often choose to combine the substances as a means to decrease the effects of alcohol intoxication, enhance the sensation of the cocaine high, or to lessen any withdrawal symptoms once the cocaine begins to wear off. What makes this combination most dangerous is that the use of cocaine and alcohol together creates a psychoactive substance known as cocaethylene. Cocaethylene is highly cardiotoxic and the risk of an immediate fatal response is 25 times greater than if the user had overdosed on cocaine without the simultaneous use of alcohol.
Cocaine and Heroin
The combination of cocaine and heroin, typically intravenously, is most commonly referred to as a speedball. Users may choose to combine cocaine and heroin as a means to experience the stimulant effects of the cocaine without the crash, as well as stay awake throughout the relaxation of the heroin high. What makes this combination particularly dangerous is that the cocaine often masks the warning signs of a potential heroin overdose, which usually occurs from severe respiratory depression. Likewise, the warning signs for cocaine overdose can sometimes involve pain, but are also often camouflaged by the opiate effects of the heroin, or are dismissed as a common effect of the heroin itself, rather than a cocaine overdose.
Cocaine Addiction Treatment and Prognosis
Help is available for cocaine addiction. The road to recovery begins with cessation of drug intake and monitored detox. For people addicted to alcohol or opioid drugs or medications, there are medications available to reduce the severity of withdrawal. However, no specific medications have proven effective for people detoxing from crack or powdered cocaine.
Instead, treatment for cocaine-related stimulant use disorder centers on the use of behavioral therapy. Specific types of therapy known to produce positive outcomes include:
- Residential treatment
- Individual and group therapy
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavior Therapy (DBT)
- Family therapy
- Peer support
- 12-step facilitation
People participating in therapy learn how to recognize the everyday cues and triggers that make cocaine use more likely to occur. In addition, they develop coping abilities that allow them to navigate these cues and triggers without taking the drug.
Residential programs are preferred for addiction treatment, especially for people moderately to severely affected by their condition. These programs provide benefits that include:
- A monitored environment that reinforces the goal of sobriety
- Reduced access to cocaine or other substances of abuse
- Ongoing monitoring of relapse risks
- An opportunity to learn and practice recovery skills
- Rapid response times for episodes of relapse that do occur
- Integrated treatment of co-occurring disorders
The therapies used to treat cocaine addiction can also help prevent relapses from occurring. Cognitive behavioral therapy provides a benefit by preparing recovering drug users to face places, events and everyday social situations that create a high relapse risk.
Longer stays in treatment tend to increase the odds of maintaining a stable, substance-free lifestyle. A combination of residential treatment, evidence-based therapies, integrated treatment for co-occurring disorders, active peer support, and relapse prevention medication can give individuals the best chance of lasting recovery from cocaine addiction.