A powerful stimulant drug with few medicinal properties inside the United States, cocaine is considered largely an illegal drug, much of it making its way into the country by way of South America where the coca plant is native. According to information published by NBC News, Columbia produces close to 500 million tons of the drug each year. The United States Drug Enforcement Administration (DEA), reports that 90 percent of the cocaine powder found in America comes from Columbia.
Within the US, cocaine is considered a Schedule II drug by the DEA, meaning that although it has limited medicinal properties as a topical anesthetic and for reducing bleeding, it is rarely used for these purposes, and most of its use is for recreational, and therefore illegal, purposes. The National Institute on Drug Abuse (NIDA) publishes that in 2014, 1.5 million Americans (aged 12 and older) were current users of cocaine, meaning that they used the drug in the month prior to the national survey. Abuse is most common in individuals between the ages of 18 and 25, per NIDA.
Spotting Cocaine Abuse and Addiction
Signs that a person is abusing cocaine may include severe mood swings, questionable decisions, weight fluctuations, changes in sleep patterns, and financial strain. In addition, the presence of drug paraphernalia, such as small glass pipes, burnt spoons, rubber tubing, or syringes, can indicate cocaine abuse.
When a person can no longer control their urge to use cocaine and ends up taking more than they meant to at one time, it may signify addiction. Someone who struggles with addiction likely spends most of their time figuring out how to get cocaine, using it, and recovering from its use. They may shirk regular responsibilities and not be as productive or successful at work or school. Individuals battling addiction may not be interested in activities that were important to them before, and they may become more secretive and withdrawn. Social circles can change, and personality may even be altered. Individuals who struggle with cocaine addiction may continue to use the drug even though they know it brings multiple negative consequences, and they may not be able to avoid using it in potentially risky or hazardous situations.
Physically, track marks from injecting cocaine, chronic nosebleeds or runny nose from snorting it, or a perpetual cough from smoking it may be evident in someone addicted to cocaine. Individuals battling addiction may appear malnourished, have dark circles under their eyes from lack of good sleep, have little regard for their personal appearance and hygiene, and may develop skin sores from picking at their skin.
Cocaine dependence can lead to a withdrawal syndrome when the drug leaves the system. Withdrawal symptoms may include depression, anxiety, fatigue, increased appetite, drug cravings, dysphoria, mental cloudiness, irritability, paranoia, apathy, irregular heart rate, and disorientation.
How Is Cocaine Abused?
Cocaine is made from the leaves of the coca plant into its freebase rock form, known as crack, or cut with agents into a white powder form, often called coke, flake, or snow on the streets. Cocaine powder may be snorted, smoked, or injected, and crack cocaine is generally smoked using a crack pipe.
Cocaine acts on the central nervous system, increasing heart rate, respiration, blood pressure, and body temperature. It decreases the need for sleep, suppresses appetite, and increases energy levels. It also produces a “high,” as cocaine affects dopamine levels in the brain. Dopamine is one of the brain’s messengers, or neurotransmitters, that tells a person when to feel happy. Cocaine causes a surge of dopamine in the brain, which is what causes the euphoric effect.
The National Highway Traffic Safety Administration (NHTSA) reports that cocaine takes effect very rapidly and also wears off rather quickly. When smoked, cocaine enters the bloodstream almost instantaneously, taking effect practically immediately, with effects lasting 5-15 minutes. Snorting cocaine also produces a rapid onset high that generally lasts about 15-30 minutes, while injecting the drug usually means it takes 15-30 seconds to start working.
When cocaine wears off, individuals may experience a kind of “crash,” wherein they feel fatigued, lethargic, drained, and depressed. Drug cravings may ensue. Since cocaine has such a short-lived and intense high, individuals may take it in a binge pattern, meaning that they take dose after dose to prolong the good feelings. This pattern of cocaine abuse may lead to drug dependence and addiction.
Dangers of Short-term Cocaine Abuse
Cocaine abuse creates a rapid onset “rush” of energy and euphoria, and it can make an individual feel more alert, awake, talkative, energetic, and happy. Individuals under the influence of cocaine have impaired judgment and may put themselves into potentially dangerous or hazardous situations. Accidents, increased risk-taking behaviors, and questionable sexual encounters may be the result of poor decisions made while intoxicated.
In some cases, cocaine can cause irritability, restlessness, tremors, anxiety, paranoia, or violent behaviors. Elevated blood pressure and heart rate, as well as dilated pupils, heightened body temperature, and constricted blood vessels, are side effects of cocaine abuse. The Drug Abuse Warning Network (DAWN), reports that in 2011, over 40 percent of all negative drug interactions resulting from drug abuse or misuse leading to an emergency department (ED) visit involved cocaine.
Cocaine may be mixed with other drugs, like heroin, for amplified effects. The combination of heroin and cocaine is called a “speedball.” Since heroin is a central nervous system depressant while cocaine is a stimulant, the thought is that the negative effects of one drug will be counteracted by the other. Combining the two can cause dangerous side effects, however, potentially increasing the risk for a life-threatening overdose.
Alcohol and cocaine may be commonly mixed as well. This combination results in the most overdose deaths from any combination of two drugs, Psychology Today reports. Cocaine powder is also often “cut” with other agents in order to make a batch last longer, and some of the additives may cause unintended interactions as well.
Cocaine overdose occurs when the drug overwhelms the body and can no longer be broken down safely. Toxicity builds quickly and can result in stroke, impaired respiration, or heart attack. Fever, tremors, agitation, trouble breathing, nausea and/or vomiting, dizziness, chills, hallucinations, aggression, chest pain, irregular heart rate and blood pressure, delirium, confusion, seizures, and trouble remaining conscious may all be signs of a cocaine overdose.
In 2014, NIDA reports that over 5,000 individuals died from a cocaine overdose in the United States. A cocaine overdose is considered to be a medical emergency. If one is suspected, individuals should seek immediate professional care.
Risks of Prolonged Abuse
Cocaine affects many different parts of the body, and with prolonged and regular use, it can damage both the cardiovascular system and the brain. The American Heart Association calls cocaine the “heart attack drug,” as it can cause walls of arteries to become stiffer, the heart muscle to thicken, and blood pressure to be raised – all of which are potential risk factors for a heart attack.
Cocaine abuse can also cause headaches, nausea, and gastrointestinal upset when used regularly. Since cocaine suppresses a person’s appetite, someone who uses it on a regular basis may become malnourished and experience rapid weight loss. As a person’s brain becomes used to certain levels of cocaine, a tolerance to that amount can be created, and an individual will need to take more cocaine each time in order to keep feeling the drug’s effects.
One of the potential complications of taking regular and large doses of cocaine is the development of excited delirium syndrome, which can cause violent behaviors, hallucinations, altered perceptions, paranoia, unusual strength, and hyperthermia. In addition, potential cardiovascular complications, respiratory distress, and even death can occur, the Western Journal of Emergency Medicine (WestJEM) reports.
The manner in which a person typically abuses cocaine can also have specific risk factors and complications related to that method of abuse. Examples include:
- Chronic runny nose
- Irritation to the nasal septum
- Damage to the nasal and sinus cavities
- Respiratory issues
- Ulcers of the mucus membrane
- Difficulties swallowing
- Loss of sense of smell
- Chest pain
- Trauma to lungs that can cause bleeding
- Respiratory distress and shortness of breath
- Burnt fingers and mouth from crack pipes
- Chronic cough
- Increased risk for developing an infectious and blood-borne disease, like hepatitis or HIV/AIDS
- Skin rashes
- Infection along injection sites
- Collapsed veins
- Scars or “track marks”
- Potential allergic reaction to cocaine additives
Cocaine also disrupts the transmission, production, and reabsorption of several of the brain’s chemical messengers, like dopamine and serotonin. When an individual takes cocaine regularly, they may develop a dependence on the drug as the reward system and ability to feel pleasure are altered. Cocaine may now be required in order for the person to feel happy, and drug cravings may be intense.
Cocaine dependence may be both physical and psychological, and it may quickly progress to severe addiction. The American Society of Addiction Medicine (ASAM) defines addiction as a disease that impacts some of the brain’s circuitry with behavioral, physical, emotional, and social ramifications and symptoms. Cocaine is considered to be a very addictive drug that over time may actually lead to a shrinkage of grey matter in the brain, impacting regions related to memory and executive functions, per Psychology Today.
Options for Treatment
Cocaine withdrawal syndrome can be psychologically intense; therefore, medical detox may be required in instances of longstanding or severe abuse. Medical detox can help to manage cocaine withdrawal in a safe and secure substance abuse treatment facility with both mental health and medical professionals on hand to monitor vitals and ensure that the individual does not present a danger to themselves or others. While there are no specific medications on the market approved for treating cocaine dependence, several may be useful when administered off-label to treat symptoms of withdrawal. For instance, beta blockers like propranolol may be helpful in reducing cravings and may help to minimize withdrawal symptoms, per Science Daily. Antidepressants and other medications may be used to target specific symptoms of withdrawal as well.
Cocaine addiction treatment is provided in both outpatient and inpatient, or residential, settings. Both options use a range of treatment methods specific to the individual’s needs and circumstances. Outpatient programs may be ideal for individuals who have family or work obligations that require sessions, meetings, and programs to be flexible in their scheduling. Residential treatment programs often provide the highest level of care as people are able to completely remove themselves from the stressors of everyday life, allowing time for new and healthier habits to become established and for the brain to heal.
Individuals who battle both mental health concerns and addiction simultaneously can benefit from integrated treatment programs that provide care for both disorders at the same time. Treatment providers work together to carry out a specialized action plan for recovery. Holistic and complementary medicine modalities, like mindfulness meditation, massage therapy, nutrition planning, fitness training, and art or music therapy, may also enhance recovery and be part of an addiction treatment program.
Families and loved ones can get involved with counseling and support groups as well. Peer support and 12-Step programs, such as Cocaine Anonymous (CA), teach relapse prevention techniques and provide a supportive environment of individuals who can relate and empathize with each other.