Cocaine Addiction: Facts and Treatment Options

Cocaine originated in the hills of South America, where for millennia the leaves of the Coca plant have been chewed for its energy enhancing effects. But it has come a long way since. Over 150 years ago, a young Austrian physician discovered that with minimal effort, a highly potent white powder could be extracted from coca leaves. He called the substance Cocaine, and in the time since it has grown into a multi-billion pound dollar industry, fuelled a war that continues to ravage large parts of the world, and led millions of people into addictions that are incredibly hard to shake.

Cocaine use has been steadily rising in the UK for the last two decades.

As the industry has grown, prices have fallen and cocaine has become an increasingly common addition to many people’s nights out. Last year, almost a million people snorted, dabbed, smoked or injected cocaine, making it the second most popular drug in the country, after cannabis. For many of them, cocaine might seem relatively harmless; a treat saved only for special occasions, to be taken or left. The effects are understandably appealing; cocaine increases energy levels and alertness, and rushes the brain with feelings of pleasure.

But for others it becomes a more regular habit that very quickly tips over into a dependency. Research shows that up to 1/5 of all cocaine users develop an addiction, which in turn can cause a number of harmful physical and psychological symptoms.

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For years, cocaine has been the champagne of the drug world, associated with the glitzy rich. This was partly to with price – regular cocaine consumption requires significant disposable income. But over the past decade its appeal has widened, and for people across the social spectrum cocaine has increasingly become a typical feature of a ‘good night out’, whether it is to the pub, club or just a night in with friends.

Crack cocaine is the drug’s darker twin. Chemically, it is identical; crack is just cocaine powder mixed with baking soda, which causes it to turn into ‘rocks’ so it can be smoked. But the method of ingestion makes all the difference. Because of the speed with which crack travels to the brain, it creates a rush of euphoria many times stronger than that of coke. But it is also considerably more dangerous; crack is believed to be between two and three times as addictive as powder cocaine and is more likely to lead to serious physical and mental health disorders. Because of the brevity of the high, crack users in general consume far more of the drug than cocaine powder users, sometimes smoking over £1000 of crack in a single sitting. Like powder cocaine, crack use his risen in the UK in recent years.

How does it work?

Like most drugs, cocaine does most of its work right in the centre of the brain, in a place called the Ventral Tegmental Area (VTA). This is the part of the brain responsible for the basics – eat, fight, reproduce. Crucially, it is also responsible for pleasure, through the brain’s ‘reward system’, and it is this reward system which cocaine is interested in. The reward system is powered by a chemical called dopamine. Normally, dopamine is released in response to potential rewards (like the smell of good food), and then recycled back into the cell from which it came.

Cocaine disrupts this pattern in two ways, according to the National Institute of Drug Abuse. First, when you take cocaine, it travels through the bloodstream and up into the brain, where it causes the release of a particularly large dose of dopamine in the ‘pleasure circuits’ of the VTA. But rather than being recycled back into the brain cells, the dopamine stays in these circuits, causing excessive amounts of the chemical to build up. This means that cocaine can give the user far greater feelings of pleasure than they may ever feel from natural measures.

The brain is tuned to survival, so when cocaine is taken repeatedly over a period of time, the brain starts to physically adapt.

Over millions of years the VTA has evolved to release dopamine as a reward when we engage in necessary activities, like sex, eating and fighting. So when dopamine levels are boosted by taking cocaine, the brain registers this as a new necessity. In response, it starts to change shape to accommodate these new, higher levels of dopamine. The problem is that once the brain adapts like this, the natural amounts of dopamine start to barely register and, as such, the amount of pleasure natural activities create diminishes. Then, the only thing that can give you pleasure – or even make you feel normal – is more cocaine.

Causes of cocaine addiction

Although cocaine addiction may start in the brain, there are a number of factors which make someone more likely to become a cocaine addict. Research suggests that it is most likely that a mixture of genetic, environmental and psychological work together to lead to addiction.

Over the last few decades, a large body of research has built up supporting the idea that certain inherited genetic traits can greatly increase the chances of becoming an addict. Scientists believe that genetics make up 50% of the risk of developing an addiction. How this works is complex, as there is no one specific gene which is responsible for addiction, but rather a series of genetic variations that make some individuals more vulnerable to addiction than others.

Genetics don’t work alone, and often they can be very hard to tell apart from environmental family influences. Individuals who have come from unstable home environments are believed to be at a higher risk of addiction than those with a stable family background. This is especially true if someone has grown up around drug abuse, as they are more likely to grow up believing these activities are normal, or even harmless. These influences don’t have to come only from the family – friends, colleagues or partners can also encourage a person towards cocaine abuse.

Cocaine can make the user feel invincible, as if they have nothing to fear. As such, it is often used as an antidote to social anxiety. This can lead to a reliance on the drug and a belief that without it, it would be impossible to relax and ‘be themselves’ in social situations. Mental health issues are higher among cocaine addicts than the general population, as it is often used as a form of self-medication and as a coping method.

Signs and Symptoms of Cocaine Abuse

The signs that someone is currently under the influence of cocaine are fairly easy to spot. They include:

  • Dilated Pupils
  • Runny or congested nose
  • Anxiety/panic
  • Increased energy
  • Extremely talkative
  • Short attention span
  • Restlessness
  • Feelings of superiority
  • Irritability
  • Muscle twitches

As cocaine abuse continues, physical and behavioural symptoms may spread over into everyday life. These include:

  • Abandonment of activities once enjoyed
  • Decreased need for sleep
  • Increased need for sleep after usage
  • Stealing or borrowing money
  • Sexual dysfunction
  • Decreased appetite
  • Anxiety
  • Depression
  • Insomnia
  • Mood swings
  • Weight loss

Cocaine cutting agents
In recent years, a ‘two tier’ cocaine market has developed, with increasing amounts of cheap cocaine of very low purity – often less than 10% – now on the market. Though many of the substances which dealers cut cocaine with are relatively harmless, there are also a number of very dangerous cutting agents that are very commonly used. These include:

  • Phenacetin – Suspected carcinogen
  • Benzocaine – Can cause comas, seizures and respiratory failure
  • Caffeine- Exacerbates cocaine toxicity
  • Procaine – Can cause convulsions and shaking
  • Tetramisole Hydrochloride – Suspected carcinogen
Health Issues Caused by Addiction

Cocaine causes blood vessels to tighten, the heart rate to quicken and blood pressure to suddenly rise. This puts the heart at risk, as all of these effects can deprive the heart of oxygen. If the deprivation of oxygen is short, it can trigger angina. If these spasms of chest pain last longer, it puts the user at great risk of heart attack or stroke. In the US, every year half a million people present themselves at the emergency department with cocaine associated problems, of which chest pain is the most common.

Research has shown that long term cocaine use can cause irreversible damage to the heart muscle, causing lesions in cells which make them useless and block normal electrical pathways to the heart. It is likely this will be painless, so the user may not realise there is a problem. But it can make the heart beat dangerously irregular and lead to heart attack.

Despite its reputation as an aphrodisiac, cocaine can impair sexual performance. For men, over time cocaine increasingly affects their ability to maintain an erection and ejaculate, while woman may have problems reaching orgasm.

Cocaine can severely damage the appearance and function of the nose. Snorting the drug causes restriction of blood flow to the septum, which is the bone and cartilage which separates the two nostrils, causing perforation – i.e. creating a hole in the centre of the nose.

Long term cocaine abuse can cause a number of respiratory problems and, in extreme cases, fatal respiratory seizures. This is especially prevalent among crack cocaine users but also a risk from powder cocaine.

As long term cocaine abuse starts to alter the biochemistry of the brain, it can cause a number of psychological disorders. Most common among these are anxiety, depression, insomnia and irritability. Among crack users, depression is particularly common, in part due to the ‘crash’ that follows a crack high.

According to the Advisory Council on the Misuse of Drugs, up to 88% of cocaine users seeking treatment demonstrate psychotic symptoms, such as hallucinations, delusions and a lack of self-awareness. In general, these symptoms are transitory, passing after a short time. However, psychosis may be more permanent among some users who have either been dependent for many years, or use cocaine with other drugs or alcohol.

A number of studies have shown that over time, cocaine can progressively impair the function of the brain, leading to memory loss, confusion and decreased intellect. However, the evidence also suggests that these faculties are normally recovered when use of the drug stops.

Cocaine and Alcohol
More than other drugs, cocaine is invariably used with alcohol, according to the home office. This causes a number of problems, in large part as cocaine increases the amount of alcohol that can be consumed, leading users to binge drink for especially long periods of time. The concurrent health effects are extensive, increasing the risk of heart attack or stroke, psychosis, and violent behaviour.

Treatment

Cocaine differs from other drugs such as heroin or alcohol as it generally does not cause physical withdrawal symptoms. However, the psychological symptoms caused by withdrawal from cocaine can be severe, sometimes causing depression, agitated delirium and a condition known as toxic paranoid psychosis, in which the user’s ability to distinguish reality from fiction is impaired. According to the National Institute on Drug Abuse, effective treatment should focus on supporting the patient through the psychological effects of withdrawal, if necessary with the help of medication, while employing a number behavioural and group therapies to help the patient revaluate their approach to the drug.

One form of therapy which has proved to be particularly useful in treating cocaine dependence and preventing relapse is Cognitive Behavioural Therapy (CBT). Learning process play an important role in addiction, as the user’s brain adapts to the drug and creates new cognitive pathways which alter the way they think about it. But these same learning processes can be harnessed in a positive way, and used to help support abstinence form the drug and prevent relapse. [LINK TO NEUROPLASTICITY PAGE]. This approach helps users to recognise the patterns that have led them to use cocaine in the past, and cope with the cravings that are a part of recovery.

Another important aspect of treatment can be Group Therapy, where participants benefit from the fellowship of the group and peer support. Group therapy can be extremely effective in helping the patient come to understand some of the essential truths about their addiction, as members of the group work together to overcome the same issues. In the group, members exchange stories, coping strategies, hopes and difficulties. With the structure of the 12 steps program, these groups can help patients work through the process of recovery in an atmosphere of mutual respect and support.


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