Cocaine Addiction

According to the National Survey on Drug Use and Health, active cocaine use in America has hovered around 0.6% of the total population since 2009. Adults aged 18 to 25 do have higher active use rates (at 1.4%) and cocaine addiction rates than any other age demographic and 15% of all Americans surveyed have admitted to using cocaine at least once in their life.

Cocaine is a general Central Nervous System stimulant. The word “cocaine” specifically refers to the powdered form of the drug Benzoylmethylecgonine, an extract of the Erythroxylon Coca plant, and which is typically rendered for use in a hydrochloride salt and is abused mainly through insufflation (snorting), but can also be smoked or injected intravenously (shooting up). It is possible to eat cocaine, but because most of the psychoactive molecules would be neutralized or destroyed by stomach acid, you would need to eat a significant amount to have any effect. It would also take much longer to reach your brain through the ingestion route. Because of the duration of action and the amounts involved, it is rarely if ever eaten.

The effects of cocaine vary in intensity depending on the method it is taken, but all routes of intake produce a euphoric rush which makes one feel energized, extremely happy, talkative, and experience a general sense of well-being. The duration of this euphoria is fairly short; lasting anywhere from 20-30 minutes when snorted, or about 10 minutes when smoked or injected.

While there are no serious cocaine withdrawal symptoms from a physical standpoint, the psychological effects of cocaine addiction and subsequent neurological damage done by it are severe and can take years to recover from. Depending on the quantities used and duration of use the damage may be permanent.

Cocaine Addiction

Because of cocaine’s effect on such basic neurotransmitter function, the potential for psychological addiction is extremely high. This begins when, after prolonged use, the brain adapts to the increased levels of present dopamine, and will decrease sensitivity to dopamine to compensate (known as dopamine downregulation). This has the practical effect of building tolerance. You need more of the drug to produce the same effects.

A 2011 study found that cocaine was involved in over 505,000 drug-related emergency room visits.

DAWN (Drug Abuse Warning Network)

This will also amplify the “hangover” after using cocaine. This is because after your brain has had to manufacture excess dopamine in response to cocaine and to compensate for the lack of reuptake, the neurotransmitter precursors for dopamine in the brain are depleted, leading to lower global levels of dopamine. Because of decreasing sensitivity to dopamine due to chronic use, these cocaine hangovers will get worse and worse over time. Symptoms of a cocaine hangover can include fatigue, restlessness, irritability, depression, and anxiety.

Couple this with cocaine’s limbic interactions with memory, emotion, learning, and motivation, and you can see that a cocaine user is remembering good emotions associated with cocaine, and has learned that cocaine equals good feelings, and will thus be motivated in the pursuit of more cocaine to recapture those good feelings. Because all of these faculties are managed by the limbic system, where cocaine has its strongest effect, the desire for cocaine will be strongly enforced. Additionally, cocaine use causes a buildup of Delta FOSB, a genetic transcription factor which, among other things decreases production of dynorphin, which has the effect of increasing sensitivity to reward, and thereby further reinforces reward seeking behavior and entrenches the desire for the high produced by cocaine even further.

This is the beginning of a downward spiral where someone feels very bad when they don't have cocaine, so they do some to feel better. Doing cocaine further decreases dopamine sensitivity and lowers the present dopamine levels, making them feel worse the next time they don't have any, and they repeat the cycle, getting worse and worse over time. This is cocaine addiction.

Signs of Cocaine Addiction

Cocaine addiction (as with any drug addiction) is more a pattern of learned behavior than simply chemical dependence. Addiction begins when someone starts to alter their plans with work, friends, family, or school in order to get high. Some signs of cocaine addiction may be:
  • Insomnia
  • Unreliable Behavior (last minute cancellations or no-call, no-shows to events or planned meetings)
  • Constant Appeals to Borrow Money (the reasons for borrowing money may get more ridiculous with time, or even repeated)
  • Paranoia (unreasonable suspicion of other people, places, or things)
  • Frequent Nosebleeds
  • Frequent Jaw Clenching or Rubbing Gums
  • Extreme Talkativeness (usually involving grand plans for the future)

The Science Behind Cocaine Addiction

The mechanism of action to produce the euphoria of a cocaine high is quite complicated, and involves any area of the brain where dopamine is utilized, but is highly concentrated in the limbic system. The limbic system is a deep and old (being present in mammals, avians, and reptiles) neural complex which helps mediate memory, emotion, learning, and motivation. It also more directly controls emotional response to stimulus, and links those emotions to memories. The direct effect of cocaine is to act as a general serotonin, norepinephrine, and dopamine reuptake inhibitor with a specificity for dopamine reuptake inhibition. This means that dopamine, a major excitatory neurotransmitter, will not be reabsorbed by dopamine transporter molecules and will pool in the synaptic cleft of neurons. This acts to amplify any normal regulatory, excitation, or pleasure signals sent by the brain. The physical effects of this include vasoconstriction (a constriction of blood vessels), increased heart rate, increased blood pressure, pupil dilation, tremors, sweating, and increased body temperature.

Effects of Cocaine Use

When you use cocaine the heart will beat faster, the blood vessels constrict, and blood pressure goes up as a result. This can lead to many physical complications, and paired with the risks taken by the preferred route of intake of cocaine, these can include:
  • Tremors
  • Headaches
  • Nausea
  • Nosebleeds / Nasal Perforation / Loss of Smell (due to insufflation)
  • Tachycardia / Heart Palpitations
  • Muscle or Tissue Damage / Collapsed Veins / Necrosis (due to injecting)
  • Tooth Decay / Gingivitis (caused by Bruxism)
  • Diaphoreses (excessive sweating)

The neurological effects of prolonged cocaine use are quite scary as chronic use can cause permanent, irreversible damage and changes to the structure and signalling pathways in your brain. Aside from dopamine downregulation and other neurotransmitter imbalances that could take years to recover from, there is also a buildup in the nucleus accumbens, frontal cortex, and amygdala of the genetic transcription factor Delta FOSB, the levels of which are commensurate with the intensity of addiction-like and reward seeking behavior and this may engender long lasting changes to limbic neuronal structures.

Long Term Effects of Cocaine Abuse

The extent of the long term effects of cocaine on the neurological health and behavior of humans has not been studied in a controlled setting, as to do a controlled study of this sort would be wildly unethical. However the analogous studies done with other mammals (mice & rats) indicate that these structural changes are permanent. Some of the more immediate psychological effects of chronic cocaine use are:
  • Insomnia
  • Adult Onset ADHD
  • Severe Paranoia
  • Auditory Hallucinations
  • Loss of Appetite
  • Tremors / Convulsions (various types of Dyskinesia)

Cocaine Overdoses and Other Dangers

The potential to overdose on cocaine is very real and it is common due to the short duration of the euphoria produced, which causes many addicts to do a large amount in a short time. Even though the euphoria wears off fairly quickly, the stimulant effects are still present, leading to consecutive doses to build upon each other. Once you reach a critical limit (which varies from person to person based on factors like tolerance, weight, liver function etc.) the overdose will occur and can present many dangerous effects including:

  • Stroke
  • Heart Attack
  • Seizure
  • Hallucinations
  • Trouble Breathing
  • Heat Stroke / Overheating

Cocaine was responsible for nearly 40% of ALL drug-related ER visits in 2011.

DAWN (Drug Abuse Warning Network)

More Dangers of Cocaine Abuse

One of the reasons cocaine has such a massive impact on the neurology of a user is that due to its specific chemical structure it is able to penetrate the blood brain barrier (BBB) very easily and directly interface with the brain. Chronic cocaine use is known to degrade the integrity of the BBB and allow greater permeability and even leakage from blood to the brain of certain proteins in the body as well as greater neural penetration of foreign organisms such as viruses and bacteria.

The BBB degradation can lead to extensive complications regardless, especially if someone were to have HIV. Even if someone has HIV or AIDS that is kept at bay with medication for the physical threats, neural infiltration of HIV or AIDS can lead to NeuroAIDS or HIV-Associated Dementia (HAD), for which there is no effective cure or treatment. BBB degradation has been shown to give HIV/AIDS a much faster route of ingress into the central nervous system, and subsequently, a much more rapid onset and progression of the symptoms of NeuroAIDS or HAD.

Cocaine Cutting Agents

Aside from the damaging effects of cocaine itself, the cutting agents used in cocaine production/distribution can vary greatly and can be damaging if taken on their own, and can be exceptionally dangerous when cocaine containing them is taken for long periods of time, or used in excess. Some adulterants include:

  • Baking Soda
  • Creatine
  • Caffeine
  • Lidocaine / Benzocaine / Procaine (for their anesthetic/numbing properties)
  • Levamisole (a drug used to treat heartworms in cattle and known to cause Agranulocytosis in Humans)
  • Phenacetin (a relative of acetaminophen and known to cause Nephritis in Humans)
  • Fentanyl (found by the DEA in cocaine seized in Pennsylvania in 2018)

Many cutting agents or adulterants are used by cocaine manufacturers and distributors to add weight, meaning that they can turn 1 kilo into 1.5 kilos by adding a much cheaper additive. Adding cutting agents to cocaine is extremely common, and the more steps in the distribution chain, the more likely it is to have additives.

Detoxing from Cocaine

Cocaine withdrawal and detox can be very unpleasant, but because of the lack of dangerous physical withdrawal symptoms, it is not life-threatening. Most of the challenges faced are due to the neurotransmitter imbalances incurred through cocaine use and the brain will take time to adapt to the absence of cocaine. It should be noted that cocaine withdrawal varies greatly in intensity and duration between individuals but generally after 10 weeks, symptoms have abated enough to have a feeling of normalcy return. Some of the more common cocaine withdrawal symptoms include:

  • Extreme Fatigue
  • Vivid Dreams / Nightmares
  • Restlessness
  • Inability to Concentrate
  • Unsynchronized or Erratic Motor Function
  • Extreme Irritability / Anxiety
    • Intense Mood Swings
    • Depression (with or without suicidal ideation)
    • Anhedonia (inability to experience pleasure)
    • Intense Cravings
    • Insomnia (first few days)
    • Hypersomnia (~10 weeks)

During the first week, the symptoms of withdrawal will be the worst, with sleep being elusive. After several days however, your appetite will begin to return as the drug continues to be eliminated from your system. A few days in, you may start exhibiting a more normal sleep/wake cycle. This should greatly improve the cognitive deficits and may lighten the depression. In many cases, after 7-10 days the worst will be behind you and it will be up to you to seek out support either from a treatment program, or regular attendance at 12 Step meetings.

Cocaine Addiction Treatment

Recovery from cocaine addiction requires ongoing treatment and aftercare if it is to be successful. Medication can only help the symptoms, but you will need to address the causes if you want any kind of lasting relief. Some common treatment options include:

  • Inpatient Treatment: You live onsite and attend counseling, therapy, and support activities daily.
  • Outpatient Treatment: You come in daily or several times a week for counseling, therapy, and meetings.
  • Sober Living: Usually (but not always) involved in an outpatient program, you will live with others who are also in recovery.

Twelve Step programs have shown some of the highest rates of successful recovery out of any known treatment regime, and most of them can be attended for free. Cocaine Anonymous is one such 12 Step program and has meetings in 27 countries (as of September 2019) all over the world. To find a meeting, visit Cocaine Anonymous’ Meeting Finder. Once finding and attending a meeting, it would then be advised to get a sponsor. This is a person who can walk you through the 12 Steps of the program and explain them in detail in a 1-on-1 setting. Find someone who you can relate to, who maybe shared during the meeting and what they said really spoke to you, and who has more time sober than you do.

It is also recommended to meet new friends who are also getting and staying sober, as they will be able to relate to what you are going through, and offer help by telling you how they got through it themselves. Being around people that have been where you are can be very empowering as it is solid proof that there is life beyond addiction.

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Medications for Cocaine Addiction

There are currently no medications specifically intended, or FDA approved, to treat cocaine addiction. Talk to your doctor about your options, but some medications that may be effective at mitigating the symptoms include:

  • Naltrexone: Acts to reduce Mu opioid receptor function and increase Delta opioid receptor function in the brain and has been shown to reduce cravings for drugs or alcohol in a large number of addiction studies.
  • Samidorphan: Acts to reduce function at Mu and Kappa opioid receptor sites in the brain and may reduce cravings.
  • Buprenorphine: Stimulates Mu opioid receptor function as well as blocking Kappa opioid receptor function, which effectively reduces sensitivity to reward, and results in less pleasure seeking impulses.
  • Propanolol: Used to treat heart conditions, tremors, and migraine headaches, it also exhibits mild anti-anxiety properties which can help withdrawal-induced restlessness.
  • Amantadine: Originally used to treat Parkinson’s disease, this drug helps to balance out the levels of neurotransmitters in the brain, decreasing depression and helping with many forms of dyskinesia due to low dopamine levels.
  • Bromocriptine: Originally used to treat hyperprolactinemia, this drug also acts as a dopamine receptor agonist, making your dopamine receptors more sensitive to present dopamine as a way to compensate for the low levels during withdrawal.
  • SSRI Antidepressants: Selective Serotonin Reuptake Inhibitors (like Paroxetine) act to increase the amount of serotonin present in the synaptic cleft and having the effect of relieving depression.
  • Tri/Tetra-Cyclic Antidepressants: This class of antidepressants acts to inhibit reuptake of serotonin and norepinephrine which has the effect of helping regulate mood and relieve depression.
  • Various Mood Stabilizers: Mood stabilizers such as Aripiprazole act as a partial dopamine agonist and, through mechanisms not fully understood, have the effect of helping prevent or lessen wild mood swings.

Due to the havoc cocaine wreaks on the brains normal balancing and signalling chemicals, it's the brain itself that needs time to readjust to functioning in the absence of cocaine.

Criminal Consequences of Cocaine Use

While cocaine is rarely used in contemporary medicine, it is still a Schedule 2 drug as recognized by the DEA, meaning it has minor medical applications, mostly being utilized by ENT doctors for operations like lacrimal duct surgery and topical application for other minor nose/sinus operations. For the most part however, the drugs lidocaine and procaine are typically used in place of cocaine today.

Since it’s a schedule 2 drug, getting arrested for cocaine possession or distribution can result in very serious prison sentences. Minor possession charges (anywhere from 0.1 to 25 grams) typically result in a prison sentence between 10 and 16 months. 25 to 50 grams can result in prison sentences of between 15 to 21 months. Additionally, cocaine seems to be a standout compared to other drugs in the sense that people convicted of cocaine related offenses tend to be charged with possession above the mandatory minimum sentencing threshold more often than with any other drug.

The federal mandatory minimum sentences for cocaine possession is any amount between 500 grams and 5 kilograms carries a 5 year mandatory minimum sentence, and 5 kilograms or above carries a mandatory minimum 10 year sentence. In 2016, 60.2% of all federal cocaine possession/distribution charges resulted in a mandatory minimum sentence due to one of these thresholds being crossed (with 57% of these being the 10 year mandatory minimum). When compared with all other drugs that have mandatory minimum sentencing guidelines, powder cocaine (as opposed to crack cocaine) represented 26.2% of all cases tried in 2016.

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