Cocaine is an extremely potent stimulant that has direct effects on the brain. Use of this drug became extremely popular in the 1980’s and 1990’s, and during this time span cocaine was the main active ingredient in tonics and elixirs used for many conditions. While not fully recognized at the time, many individuals who used these remedies became addicted to them due to the ease of access.
Cocaine is not a new substance, however. In fact, it is one of the oldest psychoactive substances of abuse, as the source of cocaine, the leaves of the coca plant, have been used for their energy increasing properties for thousands of years. The purified chemical form of cocaine that is derived from these leaves has been used for over 100 years.
Cocaine continues to be used by numerous individuals, including adolescents and adults, though increasing rates of use and abuse are being seen in younger children, due to greater targeting of this age group by dealers. Although cocaine cannot be legally obtained by individuals due to its high abuse potential, it can be used by physicians for certain medical purposes, such as local anesthesia for minor types of surgeries including those that are carried out for eye, ear, and throat problems. When cocaine is abused in the powder form it is either snorted or mixed with water and injected, and the base form of the drug, referred to as crack, is smoked.
Also referred to as “snow”, “coke”, “flake”, “C,” or “blow.” Cocaine is usually sold in the form of a powder. It is often diluted with various inert and active substances to increase the profit. Some dealers may cut the drug with cornstarch, talcum powder, or sugar, although it may also be mixed with other drugs, including other stimulants such as amphetamine or heroine, an opiate. Since people who regularly use cocaine may not always know if what they buy is mixed with an inert substance that reduces its strength or another drug which greatly multiplies and augments its effects, overdose is a significant risk.
Smoking or injecting cocaine results in an almost immediate high, while fast absorption through mucus membranes results in similarly quick results when the substance is snorted. The drug then enters the bloodstream, which takes it to the brain. Once in the brain, cocaine affects the pleasure and reward centers of the brain resulting in a rush, described by users as a sense of euphoria, increased energy, alertness, and overall well-being. The quick acting effects, combined with the sense of elation produced, are largely responsible for repeated use, the development of dependence and tolerance, and subsequent Cocaine addiction.
The past year prevalence rate for cocaine abuse in people over the age of 17 in the U.S. was estimated at .3%, while for those ages 12-17 the twelve month prevalence rate was estimated at .2%. Overall, rates are higher in males (.4%) than females (.1%). In addition to gender effects, age effects have also been discovered. The highest rates of cocaine abuse were found in those ages 18-29 (.6%) while those ages 34-65 where shown to exhibit the lowest rates (.1%).
As with any substance abuse disorder, the development of additional substance related problems is common for individuals who are dependent on cocaine. The most common co-occurring substance use disorder is alcohol abuse, as this is frequently used to increase the pleasurable effects of cocaine while decreasing negative effects, such as feeling nervous or on edge. Opiates and benzodiazepines are also frequently used with cocaine for similar reasons. Common disorders that co-occur with cocaine use include:
- Alcohol Abuse
- Opiate Abuse
- Benzodiazepine Abuse
- Cannabis Abuse
- Post-traumatic Stress Disorder
- Anti-Social Personality Disorder
- ADHD (adult onset)
- Gambling Disorder
- Cardiopulmonary Problems
- Agranulocytosis (severely lowered white blood count)
- Febrile Neutropenia (fever with infection and low white blood count)
Causes of Cocaine Abuse
It is agreed that there is likely no individual cause that accounts for any type of substance abuse, including cocaine abuse. However, certain factors have been linked to the development of cocaine abuse and addiction.
Genetic – As with all substance use disorders, those who have a first degree relative suffering from cocaine abuse or dependence are more likely to develop the disorder than those without a similar history.
Temperamental Qualities – Certain individuals are born with temperamental qualities that predispose them to prefer feeling extremely alert, active, and stimulated, which can lead to use and subsequent abuse of cocaine to achieve these feelings on a regular basis. Other research suggests that individuals who are born with temperamental qualities that lead to shyness, inhibition, or lack of spontaneity may also be predisposed to abuse cocaine. This is due to the effects of the drug that help the individual correct for these qualities, becoming more social, less inhibited, and more comfortable with spontaneity.
Brain Chemistry – It has been shown that the presence of cocaine in the brain can alter the levels of a specific neurotransmitter (chemicals responsible for neuronal communication). This neurotransmitter, dopamine, is associated with producing sensations of pleasure and excitement. As the brain perceives the effects of cocaine to be similar to the effects of dopamine, repeated use causes the brain to begin to substitute cocaine for naturally occurring dopamine until the brain produces negligible amounts of the neurotransmitter. This increases the likelihood of dependence, due to the negative withdrawal effects when an individual attempts to decrease the amount taken or quit taking the drug entirely. Since there is little naturally occurring dopamine in the brain, the positive effects caused by the dopamine are lost and the individual experiences a negative mood state that becomes distressing.
Need for Increased Energy – We all have times when expectations of our performance are high and we feel pressured to do what it takes to live up to these expectations. Unfortunately, this can lead to an increase in stress and anxiety, which can decrease our ability to perform well and lead to feelings of fatigue, further lowering our capacity for meeting expectations. We may try various stimulants in an effort to improve productivity and performance. As the effects of cocaine are significantly greater than over the counter stimulants, if exposed to this drug, many individuals may use it with the intention of quitting once they’ve reached their goal. Unfortunately, upon reaching that point, many may find themselves addicted.
Signs and Symptoms of Cocaine Abuse
Symptoms of cocaine use depend on the amount used, length of addiction, purity of the drug and other factors. Symptoms of cocaine use include:
- Mood/Psychological symptoms:
- A sense of elation or exhilaration
- Psychological cravings leading to increased amounts taken
- Depression (after long-time use)
- Increased ability to concentrate and pay attention (at low to moderate doses)
- Confusion and disorientation (at high doses)
- Paranoia (at high doses)
- Behavioral symptoms:
- The drug is taken in larger doses or for longer periods of time than was originally intended
- Attempts to cut down or quit are unsuccessful
- Much time spent getting, taking, or recovering from the drug
- Drug use results in inability to fulfill responsibilities
- Use of cocaine in situations that could lead to harm or self or others
- Increased energy levels
- Social or interpersonal problems due to not censoring what is said
- Marital problems or divorce
- Use leads to failure to participate in important social, occupational, or recreational activities
- Continued use despite awareness the cocaine use is leading to many problems in the individuals life
- Physical cravings leading to increased amounts taken
- Decreased appetite
- Need for increased amounts to maintain the desirable effects
- While using same amount desirable effects decrease over time
- Drug is used to avoid known withdrawal symptoms
- When drug is stopped negative symptoms result, including fatigue, unpleasant dreams, changes in activity level, and increased appetite, among others
- Physical symptoms:
- Decreased sense of smell
- Trouble swallowing
- Irregular or rapid heart beat
- Chronically runny nose
- Decreased Sleep
Effects of Cocaine Abuse
There are numerous effects of cocaine use. At the beginning, the individual experiences mostly positive effects, such as the sudden sense of elation, energy, and well-being. Overtime as the individual develops a tolerance to the drug increased doses are needed, which leads to the positive effects being largely replaced with negative ones. Common effects of cocaine abuse include:
- A sense of well-being and optimism
- Increased energy and activity levels
- Constant excitement and interest related to everything the individual does
- Increased comfort in social situations and increased social interactions
- Loss of appetite, with decreased weight
- Believing that one’s physical strength and ability have increased
- Increased mental sharpness
- Increased pain tolerance with decreased ability to experience pain
- Greater sense of control and influence in life
- Greater sense of self-competency in all areas (may be due to delusions of grandeur)
- Increased verbosity
- Experience of a constant positive mood state even in situations when inappropriate (in beginning stages of cocaine use)
- Increasing frequency of negative mood states that come to replace positive mood (in later stages of cocaine use)
- Frequent laughing in response to appropriate and inappropriate cues
- Fickleness and flirtatiousness
- Inability to appropriately regulate emotions
- Agitation, inability to sit still
- Teeth grinding
- Dilated pupils
- Ulcerated nasal septum often accompanied by a bloody nose
- Cocaine psychosis resembling paranoid schizophrenia
- Mania-like symptoms
- Confusion and disorientation at high doses
- Death from a variety of medical complications
While most individuals are concerned about the physical withdrawal symptoms, there are also psychological withdrawal symptoms which must be attended to.
- Cold sweats
- Increased need for sleep
- Fear that the individual can’t interact effectively without the drug
- General fear that the individual will be incapable of normal functioning without the drug
- Psychomotor retardation