Cocaine Use and Addiction
Cocaine is a well-known stimulant that can have major ramifications on the lives and health of the people who use it. Learn more about cocaine use disorder, withdrawal, and recovery.
What is cocaine?
Cocaine is an addictive stimulant derived from the leaves of the coca plant. In the late 19th century, cocaine began to be used as an anesthetic and stimulant, and addiction quickly followed. In 1914, recreational use and sale of cocaine were outlawed in the U.S. As a street drug, cocaine looks like a fine, white, crystal powder.
Cocaine is heavily associated with the 1980s, partly due to the emergence of crack cocaine during that time. It conjures images of high-pressure business deals, speeches from President Reagan, and episodes of Miami Vice. Contrary to this reputation, cocaine is still a commonly used stimulant and has been seeing a resurgence in use. An estimated 2.2 million Americans are regular cocaine users. A study examining data from 2011-2015 found that cocaine use disorder is on the rise in several demographics, and especially among people older than 50.
Effects of cocaine
Cocaine causes a surge of the feel-good neurotransmitter dopamine and interferes with the way the brain processes it. This creates a build-up of dopamine that impedes normal brain function and hijacks the brain’s reward system. With continued use over time, the person using cocaine develops a tolerance, requiring larger amounts more frequently to achieve the same results.
The National Institute on Drug Abuse tells us that cocaine has these short-term effects:
- a rush of euphoria and energy
- increased sense of mental alertness
- hypersensitivity to sight, sound, and touch
- irritability
- feelings of paranoia and distrust
- possible erratic and violent behavior
- high blood pressure
- dilated pupils (pinprick pupils)
- nausea
- raised body temperature
- fast or irregular heartbeat
- twitchiness and tremors
- restlessness
The short-term effects of cocaine usually diminish quickly.
Long-term health effects of regular cocaine use can include:
- If cocaine is snorted: sinus infections, perforated septum, loss of smell, nosebleeds, lung disease
- If cocaine is smoked (more common with crack): cough, asthma, reduced lung capacity, higher risk of infections like pneumonia
- If cocaine is taken orally: cavities and tooth decay, bowel decay
- If cocaine is injected: scarring, collapsed veins, increased risk for contracting HIV, hepatitis C, and other bloodborne infections
- Regardless of method: malnourishment, movement disorders including Parkinson’s disease, irritability and restlessness, paranoia, auditory hallucinations
Cocaine can also cause heart attack and stroke, which are deadly.
Symptoms of cocaine addiction
Cocaine addiction can affect an individual’s physical well-being, mental health, and social behavior. According to the DSM-5, a diagnosis of stimulant use disorder includes the repeated occurrence (within a 12 month period) of two or more of the following eleven problems:
- Giving up or reducing important social, work, or recreational activities
- Difficulty fulfilling responsibilities at school, home, or work
- Continued use despite knowing that it is harming physical or psychological health
- Continued use despite knowing it’s creating social and interpersonal consequences
- Spending excessive time obtaining, using, or recovering from using stimulants
- Taking more than intended
- Craving to use the stimulant
- Persistent desire and/or attempts to stop using or to decrease the amount used
- Tolerance, which is the need to take larger or more frequent amounts of stimulants to get the desired effect
- Recurring use of stimulants in physically dangerous situations
- Withdrawal symptoms
Basically, when using cocaine affects a person’s health, habits, or quality of life, it is usually time to seek help.
The most common form of naloxone is an easy-to-administer nasal spray. It’s important that a person who experiences an overdose receives medical care even if naloxone is given, so call 911. Most states have Good Samaritan laws protecting people who call emergency services in case of overdose.
Treatment for cocaine addiction
There is no clearly established gold standard for treating cocaine use disorder. Traditionally, it has been treated with psychosocial therapies, like cognitive behavioral therapy. The 12-step program Cocaine Anonymous also provides the encouragement and example of other people in recovery who understand the challenges of cocaine addiction. Therapy and mutual aid groups are effective for some people, but others require additional support.
Contingency management, an evidence-based strategy that rewards program compliance with variable, tangible rewards, is associated with greater retention in treatment programs. This can lead to a higher likelihood of long-term recovery.
While the FDA has not approved any medications to treat stimulant use disorder, recent research suggests that some medications can help to reduce cravings and lower the risk of relapse. These medications are sometimes prescribed off-label to treat cocaine addiction or co-occurring mental health disorders at the discretion of the provider.
Citations
1. John, W. S. & Wu, L. Trends and correlates of cocaine use and cocaine use disorder in the United States from 2011 to 2015, Drug and Alcohol Dependence, 2017; 180 (376-384). https://doi.org/10.1016/j.drugalcdep.2017.08.031.
2. History Channel. Cocaine. Updated August 21, 2018.
3. Harrison Narcotics Tax Act (1914). https://www.naabt.org/documents/harrison_narcotics_tax_act_1914.pdf.
4. Tashkin, D. P., Gorelick, D., Khalsa, M. E., Simmons, M., & Chang, P. (1992). Respiratory effects of cocaine freebasing among habitual cocaine users. Journal of addictive diseases, 11(4), 59–70. https://doi.org/10.1300/J069v11n04_05.
5. Kampman K. M. (2019). The treatment of cocaine use disorder. Science advances, 5(10), eaax1532. https://doi.org/10.1126/sciadv.aax1532
6. American Psychiatric Association. (2013) Diagnostic And Statistical Manual Of Mental Disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
