Cocaine Addiction and Abuse

What is Cocaine?

Millions of Americans have tried cocaine, but despite its reputation in popular culture, it is a dangerous and sometimes deadly drug. It’s a powerful stimulant drug that has an extremely high potential for addiction. Cocaine addiction usually requires treatment and therapy in a rehab facility.

Cocaine is derived from the coca plant. Coca plants are found in South America. It typically comes in the form of white powder. When it is processed with other chemicals to make a rock-type form, it is called crack or crack cocaine. Recreational use is illegal in the United States.

By the Numbers

The National Survey on Drug Use and Health (NSDUH) reports the following regarding cocaine use in 2014:¹

About 1.5 million Americans ages 12 and older reported using it in the past month.

That works out to about 0.6% of Americans who reported using it in the past month.

Americans ages 18 to 25 years old are the group with the highest rates of currently using it compared to any age group.

About 1.4% of young Americans ages 18 to 25 years old stated they used it in the past month.

Is Cocaine Addictive?

This drug is highly addictive, which is the reason why the medical community no longer uses it as an anesthetic. In addition:¹

The NSDUH report for 2014 stated that approximately 913,000 people in the United States met the standards for for cocaine dependence or abuse in the past twelve months.

A 2011 Drug Abuse Warning Network (DAWN) survey reported that there were 505,224 cocaine-related emergency room visits out of about 1.3 million drug-related visits. This means that more than one in three drug misuse/abuse visits to emergency rooms (40%) involved cocaine.

Drug Class

Cocaine is defined as a stimulant drug. Stimulants speed up the body’s central nervous system.

Drug Schedule

Cocaine is classified as a Schedule II drug.² A Schedule II drug is one that has a high potential for misuse or abuse. A Schedule II drug also carries a high risk for severe psychological or physical dependence.

Other drugs that are classified as Schedule II drugs include methamphetamine, hydromorphone, methadone, oxycodone, fentanyl, Ritalin and Adderall.²

Street Names

Some of the street names include:

Blow

Coke

Crank

Line

Pearl

Snow

Bump

Crack

Flake

Nose Candy

Rock

Yeyo

Is Cocaine Safe?

It’s unsafe in any form for several reasons.

This drug is usually mixed with other chemicals before it is purchased. It is virtually impossible to know what is contained in a dose. It could be mixed (or cut) with something as benign as baby laxative, cornstarch or baking soda. It could also be mixed with dangerous elements such as amphetamine or fentanyl.³

It has been deemed a common cause of "sudden death" in young people.⁴

It can cause harmful short- and long-term side effects.

How is Cocaine Used, and How Does it Work?

How Is It Used?

The drug is taken in several ways: by mouth, snorting it, injection, or by smoking it.⁵

When the drug is snorted, a powder form is inhaled through the nostrils. It enters the bloodstream via the nasal tissues.

Some people also may rub the drug onto their gums.

Some people mix it with water and inject the solution. This type of use allows the drug to hit the bloodstream directly, resulting in an intense level of stimulating effects.

Other people smoke it. As the vapor or smoke gets into the lungs, it is absorbed into the bloodstream almost as quickly as when it is injected. The rapid euphoria that results from smoking it is one reason why there was a crack epidemic in the United States in the 1980s.

How Are the Effects Produced?

The human brain has a reward system that gives pleasure when engaged in stimuli, such as, sleep, or other enjoyable activities. This system also regulates motivation and emotions. When this system works normally, dopamine is released and carries signals between neurons. A protein then removes the dopamine, so it can be recycled in the future.

Drug abuse can disrupt this chain of events. Cocaine blocks the dopamine from being removed. This results in an accumulation of dopamine that creates the rush.

What are the Effects of Cocaine?

Short-term Effects

Beyond the higher levels of energy that it can produce, people frequently become talkative and more mentally alert after taking the drug. They may also become hypersensitive to sounds, touch and sights. It can also cause the user to temporarily ignore food and sleeping needs. Other short-term effects include:⁶

Anxiety/Panic

Irritability

Restlessness

Headache

Nausea

Enlarged pupils

Constricted blood vessels

Elevated blood pressure

Heart attack

Muscle twitches

Seizures

Coma

Paranoia

Aggressive, erratic behavior

Dizziness

Abdominal pain

Increased body temperature

Rapid heart rate

Abnormal heart rhythms

Stroke

Shakiness

Sudden death (can occur on first instance of use)

Long-term Effects

Chronic use can affect areas of the brain that regulate certain functions and can result in:⁷

Poorer decision-making abilities

The inability to realize the powerful negative consequences drug use is causing

Other long-term effects can include:⁸

Sleep deprivation

Recurring panic attacks

Psychosis

Loss of appetite

Dehydration

Heart attack

Heart muscle damage

Movement disorders (i.e. Parkinson's disease)

Irritability

Paranoia

Hallucinations

Weight loss

Malnutrition

Stroke

Bleeding of the brain

Long-term effects from snorting it:⁸

Problems with swallowing

Loss of sense of smell

Nasal ulcers

Hoarse throat

Nosebleeds

Nasal irritation

Holes in the nasal cavity

Runny nose

Long-term effects from injecting it:⁸

Fatal allergic reactions from cocaine or the impure chemicals with which the drug was mixed

Skin abscess

Sepsis

Communicable illnesses from needle sharing or high-risk sexual behaviors

A Caution About Mixing with Alcohol

Some people who abuse cocaine also use alcohol to counteract the agitation the drug can cause as it wears off. Alcohol and cocaine can produce a chemical called cocaethylene, which can have toxic effects on the heart.

A Caution About Mixing with Heroin

The combination of cocaine and heroin is called a “speedball” on the street. Mixing these two drugs is also highly dangerous. Some people mix the two drugs because cocaine’s highly stimulating effects are evened out by the heroin’s sedating effects. The dangers of doing this often result in the person overdosing on heroin without realizing it. Respiratory depression occurs where breathing becomes very slow or stops. More than 72% of cocaine-related deaths in 2017 also involved opioids (such as heroin or prescription painkillers).⁹

Overdose and Withdrawal

Can You Overdose on Cocaine?

Yes, one can overdose. Just one dose, even the first dose, can cause a heart attack, stroke or sudden death.

From 2015 to 2016, the Centers for Disease Control (CDC) reported that cocaine-related deaths increased by more than 52%.⁹
In 2017, cocaine-related overdose deaths numbered 13,942.⁹

What is Withdrawal Like?

Long-term use can physically change the way the brain is wired. The abnormal dopamine levels desensitize the brain requiring higher and higher doses to gain the same previous effects or to relieve withdrawal symptoms. Withdrawal symptoms can include:

Anxiety

Depression

Increase appetite

Fatigue

Bad dreams

Severe insomnia

Slow-down in thinking

Muscle pain

Chills

Bone pain

Suicidal thoughts

Strong cravings

The powerful cravings create high risks for relapse, even for those who have been sober for long periods of time. Studies have shown that during sober periods, the memory of how cocaine was experienced or cues associated with drug use can trigger strong cravings, leading to relapse.⁹

What are Treatment Options for Cocaine?

In 2013, about 6% of those admitted to drug treatment programs did so because of a cocaine problem.¹⁰ Of these, in 2013, 68% sought treatment due to crack usage and were likely to have problems with more than one substance.¹⁰ Due to these factors, treatment should:

Take the approach that addiction is a complex disease

Address the changes in the brain that occur from using the drug

Address the variety of social, family, and environmental aspects that can contribute to (and be affected by) addiction

Treat any other co-occurring mental health issues at the same time

Inpatient vs. Outpatient Addiction Treatment Programs

The top-level choice is deciding if a residential rehab or an outpatient program is the best fit. Effective, evidence-based therapies can be found in both settings. The best option is typically based on the unique needs of the person that include:

The severity of the addiction

How long the addiction has existed

The level of withdrawal symptoms

The amount of any past relapses

In the case of severe addiction that has been in place for a long time and has serious withdrawal symptoms, an inpatient program may be the better choice. This is especially true if there is a history of relapse.

If an individual has used cocaine for a short period of time, has mild to moderate withdrawal symptoms, and few or no relapses, an outpatient substance abuse program may be a good fit.

The best way to decide what type of program is the better option is to consult a physician or an admissions specialist at a treatment program. An in-depth assessment can be done to help determine the best choice.

Medications for Cocaine Addiction Treatment

Currently, there are no FDA-approved drugs to specifically treat cocaine addiction. If there are any co-existing mental health disorders, such as depression or psychosis, treatment programs may use medications that treat those specific conditions. This can help prevent relapse and relieve the symptoms of a particular mental health condition.

Behavioral Interventions for Addiction Treatment

Contingency Management (CM)

Contingency management is a form of behavioral therapy that gets effective results in treating people with cocaine use disorders.¹⁰ CM, also known as motivational incentives, uses a reward-based system to motivate people to stay sober. Vouchers or prizes reward clients who stay away from drug use.

Drug urine tests are performed to make sure the person is drug-free. When the test shows the person is abstaining, points or chips are earned that can be traded for items that encourage a healthy lifestyle. Some examples of prizes include gym memberships, a meal at a local eatery, or tickets to the movies or fun parks. CM has been shown to work well for clients initially staying away from drugs in the early stages of rehab and for keeping them in the program.¹⁰

Research shows that CM is effective for pregnant women and women with young children who have substance use disorders.¹⁰ These women were able to stay sober longer compared to those who received vouchers with no restrictions. CM treatment also helped to significantly reduce psychiatric symptoms associated with depression, hostility and emotional distress.¹⁰

Cognitive Behavioral Therapy (CBT)

Cognitive-behavioral therapy is an effective treatment method for relapse prevention.¹⁰ CBT helps clients develop the practical skills necessary for long-term sobriety. These skills include:

Being able to recognize situations in which they are most likely to use cocaine (drinking alcohol, having extra cash, feeling sad or happy, and certain social situations)

How to avoid theses situations

How to cope more effectively with a wide variety of problems that are associated with drug use

Cravings are also addressed in CBT. Due to the nature of drug abuse, cravings can pop up long after the last use. CBT aims to help clients learn how to handle these cravings and thoughts by practicing:

Distractions

A list of enjoyable activities at the ready that can be done easily (inexpensive and can be done alone) is an effective way of coping that can help redirect thoughts away from drugs.

Review of Negative Consequences

Another method CBT uses to maintain sobriety is to have the client make a list of the negative consequences he or she experienced when using drugs. Then when thoughts occur, the person reviews those consequences to demotivate the urge to use.

Talking

Reaching out to a supportive friend or loved one can be a good way to understand and work through a craving episode. Thoughts that seem compelling (I need cocaine now) often lose their hold on the person when he or she expresses them to trusted others.

Developing an All-Purpose Coping Plan

Even with the best of efforts, unexpected, negative situations will arise that result in high-risk situations. Several examples are stressful events, death of a loved one, illness of a loved one, job loss or divorce. Also, positive events can also lead to high risk situations, such as a new romance or coming into a large sum of money. Events like these can pop up anytime, so an all-purpose plan at the ready to address them is helpful.

Case Management

CBT takes a comprehensive approach and examines the psychological and social problems a client may have that exist along with cocaine abuse. Some of these issues are addressed after a time of sobriety has passed. Other problems need to be addressed right away to help a person get and stay sober in the short term. CBT addresses these issues using problem-solving strategies within treatment to aid clients in using social services. This way, the knowledge and tools needed to deal with issues outside of the CBT treatment program are ready to use during and after CBT is completed.

Family CBT sessions

CBT sessions may be held with friends or family members. The purpose of these sessions is to boost social support. Also, it offers loved ones the opportunity to learn about the treatment. Another goal is to explore methods in which they can help the client stay sober.

Alternative Complementary Therapy

Alternative therapies can also help clients struggling with a cocaine use disorder. Yoga and meditation classes allow participants to get in touch with their inner feelings and learn how to relax. Yoga and meditation help quiet the mind as well, which can help reduce anxiety, increase focus and allow deeper insights. Yoga also helps improve physical fitness. Yoga and meditation can be used as lifelong coping skills during drug abuse recovery.

Finding the Right Help for Cocaine Addiction and Abuse

If you or someone you love is struggling with cocaine addiction or recreational use who want to stop, professional treatment can help. Treatment programs provide the care needed for those struggling with addiction. Consult a physician or the staff at a rehab center about how to begin the path to recovery. With the right help, long-term sobriety and a healthy, revitalized life without cocaine are possible. If these are your goals, reach out for help today.