Cocaine/Crack Addiction

Cocaine Essentials: Use, Abuse, Addiction, Treatment and Recovery

Cocaine is a powerful stimulant drug which is directly derived from the South American native, coca plant. Cocaine has been a part of American medicine, pop culture, and the center of the country's ire and rage. Whether heralded as the party drug of a decade or the main cause of destruction in the lives of millions, cocaine's long and enduring journey through the modern-day United States has been made possible only because of its highly addictive nature.

History of Cocaine in America

Cocaine is believed to have first been isolated from the coca plant in the 1860 but the plant itself had been used for thousands of years before that. Indigenous people from the Andes Mountains and Amazon Rainforest had been chewing coca plant leaves for an energetic high, and it was used by the Incan people for religious and cultural ceremonies, long before Europeans discovered its uses.

Cocaine spread throughout Europe, attracting enormous speculation, mostly in experimental circumstances. In fact, Sigmund Freud, founder of psychoanalysis became addicted to cocaine as he thought he could use it to cure a morphine-addicted friend. In his own fascination with the drug, Freud wrote about cocaine in his book, Über Coca in 1884.

In 1886, an American pharmacist named John Pemberton concocted a beverage made of a sugary syrup and cocaine, and named it Coca-Cola. Until 1899, Coca-Cola was only available to middle-class whites as a fountain drink and was enormously popular. From 1899 to 1903, Coca-Cola expanded its product to bottles, which made it available to lower classes and to minority Americans, until tighter regulations forced cocaine to be removed from the popular drink altogether. Just 11 years later, the Harrison Narcotics Act of 1914 was passed into law, effectively outlawing the sale of all cocaine and opium products.

Cocaine's Criminal U.S. History

Cocaine, the former "wonder drug", was banned in 1914 and for some time fell from the lens of public scrutiny. With the rise of concerns over amphetamines and heroin, which were issues largely resulting from World War II and Vietnam, cocaine was a relative non-issue, and society essentially forgot about its addictive and abusive potential.

As the 1970's came into establishment, cocaine found its way back onto the scene, as the rich man's drug of choice. Cocaine was fashionable and trendy, but since it was isolated to wealthy Americans, alarms were not raised. Around the late 1970's cocaine was so popular and being used at such a ferocious rate, the US market was flooded with it, and prices began to sharply decline.

Looking for new ways to make money from cocaine, drug dealers discovered a cheap and easy way to turn the powder into a hyper-concentrated solid and sold it as crack. The new smoke-able crack not only provided a faster and more intense rush of euphoria, it was a lot cheaper than powder cocaine.

The crack epidemic of the 80's spread through, and decimated inner cities across the country, disproportionately affecting African American populations and prompting the federal Anti-Drug Abuse Act of 1986 which set mandatory sentencing minimums and penalized crack sale and possession convictions at a 100:1 ratio over the penalties of powder cocaine sale and possession. Although this law was in effect for the next 24 years, it was the Fair Sentencing Act of 2010 which reversed the 5-year mandatory minimum sentencing and reduced the penalty ratio for crack and powder cocaine from 100:1 to 18:1.1 To this day, powder cocaine and its smokeable form continue to be social and health concerns as the powerfully addictive nature of cocaine never has loosened its grip on those who get caught in the throes of its euphoric allure.

Effects of Cocaine

Cocaine is a powerful stimulant drug which is highly addictive and can create significant changes in the brain and its functionality. Cocaine can be used in four different ways:

  1. snorting through the nose
  2. smoking and inhaling, typically in crack form through a pipe, or heated on aluminum foil and smoked through a straw (referred to as chasing the dragon)
  3. orally, by rubbing cocaine on the gums
  4. diluting in water and injecting intravenously

The effects of cocaine come fast, regardless of the administration of the drug, and typically do not last more than 20-30 minutes. The way in which cocaine is used may alter the intensity of the high. For example, injecting or smoking cocaine tends to lead to more immediate euphoric effects, than snorting the drug. All methods of using cocaine lead to a short-lived period of euphoria, followed by a crash which is accompanied by intense cravings for more of the drug.

What Causes Cocaine's Euphoric Effects?

Human brains are complex superhighways of information being transported throughout the brain, controlling our movements, sensations, feelings, reactions, and thoughts. Our reward center is just one part of our brain, but it is stimulated by a chemical messenger called dopamine. This is how we feel pleasure from naturally rewarding activities like exercise, eating and sex. In typical brain function, dopamine is released from a transmitting neuron to be accepted by a receiving neuron, and any extra dopamine recycled back to transmitting neuron, through a dopamine transporter. When cocaine is present, the dopamine transporter which is tasked with recycling unneeded dopamine back to the transporting neuron is blocked. This results in the receiving neuron taking in extraordinary amounts of dopamine since the transmitting neuron is blocked from recycling the released dopamine. Now the reward center of the brain is on overload due to a buildup of dopamine, which causes the intensely euphoric effects.

Short Term and Long Term Effects of Cocaine Use

Cocaine's effects are relatively short-lived, especially in comparison with other drugs of abuse and addiction. Snorting cocaine through the nasal passages usually means a slower onset of effects lasting 15 to 30 minutes, while smoking and injecting cocaine tends to be immediate, and effects last only 5 to 10 minutes.

Short term effects of cocaine are relatively consistent with stimulant drugs, including:

  • euphoria
  • talkativeness
  • hypersensitivity to sight, sound and touch
  • mental alertness
  • restlessness
  • irritability
  • anxiety
  • heightened blood pressure
  • rapid or erratic heartbeat
  • paranoia
  • dilated pupils
  • increased body temperature

According to the National Institute on Drug Abuse (NIDA), cocaine use can cause severe medical complications like heart arrhythmia, seizures, strokes, and coma, and in rare cases, sudden death can occur with cocaine abuse. As a result of the short length of action cocaine has on users, abuse of the drug tends to occur in binges, or frequent and increasingly higher doses of cocaine over a period of several hours or days. When the sustained habit of binge use of cocaine has been developed, some of the long-term effects of the drug can begin to present themselves, and they can include several serious psychological and physical issues. Some common effects of long term cocaine abuse include the following:

  • sensitization to adverse effects, in which less cocaine is needed to produce anxiety, paranoia, and convulsions
  • higher and more immediate levels of irritability, paranoia, hallucinations, restlessness and panic attacks
  • loss of smell, nosebleeds, hoarseness, and problems swallowing (with chronic and long-term snorting of cocaine)
  • cognitive functions and brain impairments like reduced attention, impulse inhibition, memory making decisions, and performance of motor tasks

The longer an individual continues to abuse cocaine, a dually inverted effect occurs: It begins to take more cocaine to produce the feelings of euphoria and pleasure. At the same time, it takes smaller amounts of the drug to produce the negative effects of paranoia, anxiety, restlessness, and irritability.

The most impactful and potentially damaging effect of long-term cocaine abuse is growing tolerance and eventual addiction. The more cocaine a person uses, the more of the drug that is needed, to feel euphoric effects from it. This is how tolerance grows and while growing tolerance is not the same as addiction, it is an integral part of the process to becoming addicted.2

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Dangers of Cocaine Abuse

Cocaine abuse is an easy habit to develop and continue, since the drug has a fast onset, and only last for less than an hour. The need to continue use at a higher and more frequent level is inherent with cocaine abuse, and that can lead to serious medical and psychological consequences.

Some have said that cocaine can cause addiction from the first time a user tries it, and for some who are introduced to the drug by binge use, this can be true. Since the drug wears off in 30 minutes or less, depending on the method of use, cocaine must be used continuously over several hours of time, in order to maintain a high and avoid the inevitable come down once a user stops using the drug.

Resulting from the short length of a cocaine high and frequency of binge use of the drug, chronic use of cocaine can become habitual quickly and it is very dangerous, leading to significant health concerns and complications.

Physical Health Risks

Chronic cocaine abuse has enormous effects on the physical body, and can lead to serious health complications which can include the following:

  • convulsions and seizures
  • severe lung damage (for those who smoke cocaine)
  • increased risk for heart disease, heart attack, or stroke
  • nasal tissue damage, loss of smell and problems with swallowing (for those who snort cocaine)
  • high risk for contraction of hepatitis C and HIV/AIDS for intravenous cocaine users

In addition to these physical risks, there is some research which suggests that the brains of cocaine-addicted individuals show nearly twice the loss of grey matter than their counterparts who do not take drugs.

Psychological and Mental Health Risks

The stimulant effects of long term cocaine use can alter the reality and perceptions of users. As the brain continuously adjusts to the presence and effects of cocaine, several chemical changes take place which effect essential functions of the brain, including:

  • impulse control
  • cognitive function
  • irritability
  • anxiety
  • paranoia
  • confusion
  • delirium
  • psychosis

Individuals who are high on cocaine may experience euphoria as an immediate effect, but many of the negative psychological effects of cocaine use may linger long after immediate administration, and become more severe in withdrawal from cocaine.

Cocaine Addiction Risks

The most consequential risk of cocaine abuse is the development of addiction to the drug. It is important to understand that abuse and growing tolerance are not the same things as addiction. Statistically, only around 20% of cocaine users become addicted to the drug, but addiction to any drug is a life-threatening condition. Cocaine abuse presents many serious risks, but addiction is among the most severe because of the inherent dangers of being a cocaine addict.

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Signs and Symptoms of Cocaine Addiction

Cocaine abuse generally requires binge use, making the very act of using the drug compulsive in nature. This compulsive consumption of cocaine is for the purpose of maintaining the euphoric and energetic feeling produces by the drug. However, compulsive use of a drug is consistent with the description of drug addiction, so how would cocaine abuse be differentiated from cocaine addiction?

What is Addiction?

It is no longer sufficient for us to rely on a general definition of the word addiction, as the effects of addiction on individuals, families, and societies is much more complex than what we can find in a dictionary. Rather, the American Society of Addiction Medicine (ASAM) defines addiction in very specific and definitive terms, characterizing the condition by a few key features:

  • inability to consistently abstain
  • impairment of behavioral control
  • craving
  • diminished recognition of significant problems with relationships and behaviors
  • dysfunctional emotional response

There are many other symptoms of cocaine addiction, most evident through behavioral and lifestyle changes. Functions of the brain, cognition, thought processes, prioritization, and impulse, among many others, are all severely altered by addiction. These alterations control the behaviors in addicts and are why the idea that a cocaine addict can simply stop whenever he or she may choose, is completely erroneous. One research paper based on several studies, which was published in the U.S. National Library of Medicine explains the overwhelming power of cocaine addiction. The research cites studies which observed cocaine-dependent animals working more avidly for cocaine, than any other drug (by pressing a bar for intravenous administration of the drug). The research found one study in which primates pressed the bar 12,800 times for a single dose of cocaine, worked for cocaine despite a receptive female being present, and also pressed the bar for cocaine in preference to food, even though they are physically starving.

The overwhelming power of cocaine addiction displayed in primates is just the beginning of describing the true effects of cocaine addiction. The devastation and dangerous effects of cocaine addiction on the men and women who struggle with it are palpable, and can include the following:

  • Sudden and severe financial problems which are inexplicable
  • Frequent absences, either disappearing several times during an event or failure to show for events
  • Significant deterioration of personal hygiene and appearance
  • Notable and significant loss of appetite
  • Engagement in illegal and dangerous behavior such as robbery, fraud, and prostitution
  • Significant behavioral changes such as defensiveness and irrationality
  • Severe mood swings and emotional instability
  • Sleep disturbances like sleeping during usual waking hours of the day
  • Physical signs of cocaine use like track marks, runny or bleeding nose, or burn marks on fingertips and lips
  • Suddenly frequent or consistent paranoia

Often, one of the most devastating parts of cocaine addiction are the behavioral changes which take place due to the individual's need for more cocaine, as required by the nature of addiction. Much to the heartbreak of loved ones, addicts can become abusive and otherwise attentive parents can become completely absent and neglectful to their children. The combination of cocaine's lure and the fear of withdrawal symptoms add up, to keep addicts in a constant state of drug-seeking which takes precedence above all else.

Cocaine Detox and Addiction Treatment

Cocaine addiction can destroy the lives of the addicts, their loved ones, and the immediate community. Once addicted to cocaine, reducing usage to a recreational level is not an option, as the brain has become dependent on very high and frequent amounts of the drug. The only way out of cocaine addiction is detox and abstinence, with the important step of addiction treatment to provide a foundation for recovery.

Cocaine Detox

Recovery from cocaine addiction must start with detoxification, which is the body's natural process of removing cocaine and its byproducts from the system. There is no way to expedite this process, but cocaine's short length of action is comparable to the time it takes for the drug to leave the body. Typically, cocaine detox can be completed in less than 5 days, but the drug may still be detectable in urine for up to 30 days and in hair follicles for up to 90 days. Cocaine detox is not life-threatening, as withdrawal has no physical symptoms which are present in withdrawal from other drugs like opioids, benzodiazepines, and alcohol. Some of the most common symptoms of cocaine withdrawal are psychological and include the following:

  • Agitation
  • Fatigue
  • Slowed activity, or lethargy
  • Vivid and frightening dreams
  • Depression
  • Restlessness
  • Intense cravings
  • Anhedonia, or inability to feel pleasure

Like with any drug of addiction, the discomfort of withdrawal symptoms and intense cravings are severe enough for a complete abandonment of the process, without the aid of medical supervision or support. To manage some of the more severe symptoms of cocaine withdrawal, clinicians may use low dosages of long acting benzodiazepines. These medications help induce sleep and lessen the intensity of agitation and restlessness. Other medications may be used as necessary during the detox process, but that determination is made by the supervising physician on an individual basis.

It is not uncommon for some symptoms to linger after the detox process has been completed. Symptoms like anhedonia, depression and mood swings can continue for several weeks or months after detox from cocaine has been completed. The length of time these types of symptoms linger largely depends upon the severity of the cocaine addiction, and any potential mental health issues. In fact, dual diagnosis, or the presence of addiction and co-occurring mental health disorder, is extremely common in addiction treatment, especially treatment for cocaine. Research conducted by the National Institution on Drug Abuse (NIDA) showed that after marijuana, cocaine is the second most commonly abused drug among those with mood and anxiety disorders.3

Cocaine detox can be completed in a few days, but it is only the first step to recovery from addiction. Treatment, whether inpatient or outpatient, provides the tools, education, and support for addicts to learn how to live a life of recovery and sobriety.

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Cocaine Addiction Treatment

The journey to recovery from cocaine addiction must start with detox, but is planned and developed through addiction treatment. Like any drug of addiction, cocaine dependence changes the way in which the brain functions, affecting things like cognition, impulse control, judgment, and emotional stability. Addiction treatment provides each person with tools and skills to find their most effective path toward recovery. Each person's recovery path is based upon several factors which include:

  • individual needs ranging like dual diagnosis or chronic pain management
  • coping skills focused on individual challenges like anger management, communication, or self-esteem
  • recovery tools like aftercare planning, resume building, job searches, and support contacts
  • therapeutic care targeting individual issues like therapy and counseling aimed at addressing emotional or traumatic contributors to addiction

In addiction treatment, addicts are also provided with education to learn about things related to addiction and its connection to genetics, environments, behaviors, and influences. One of the most important things addicts learn in treatment is how people and places can contribute to relapse, once back in a home environment. Approximately 40%-60% of addicts experience relapse, and there are many reasons why relapse may occur. Some of the most common among them are people, places, and things which are associated with previous cocaine abuse. Effective addiction treatment and aftercare can help recovering addicts to withstand more influences and triggers for relapse, while also connecting with supportive people and groups in the addict's community.

Cocaine addiction is dangerous and creates devastation for everyone it effects, but it can be treated, and recovery is possible. Depending on individual circumstances, addiction treatment is tailored to provide each addict with the most effective approach and a plan for recovery which is realistic and sustainable.

At Pax House, we understand that addiction impacts people from all walks of life and every part of the country, and we know of the heartbreak it causes. We are here to help restore health and balance to each of our clients, with an individually tailored and compassionate recovery program. If you, or your loved one is struggling with cocaine addiction or abuse, we are ready to help you with inpatient or outpatient care, whichever is right for your situation. Please call us now, to confidentially discuss your situation and options for receiving the important care necessary to get your life back on track and have freedom from cocaine addiction.

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