Cocaine, also known as benzoylmethylecgonine, is a powerful stimulant well known for its use as an illegal recreational drug. It’s responsible for the devastation of many communities in the 1970s and 1980s due to its severely addictive nature, especially once crack cocaine, a cheaper form of the drug, was introduced to low-income areas. Cocaine addiction and abuse are still serious problems in the US, with 14.8 percent of citizens 12 and older trying the drug at least once in their lifetimes, according to the 2014 National Survey on Drug Use and Health.
Cocaine works by increasing the concentration of the neurotransmitters dopamine, serotonin, and norepinephrine in the brain. This can create a feeling of euphoria or intense happiness, followed by a period of increased energy and excitability. Once the drug wears off, feelings of depression and fatigue tend to follow.
The history of cocaine is long and complex. The drug is derived from natural coca leaves first found in South America that locals would chew or brew in a tea for energy, much like caffeine. It was later used recreationally by upper-class Americans and used in the medical field as a local numbing agent in certain surgeries. This application has been largely replaced by more controlled and predictable anesthetics, so most of its use is now recreational despite the fact that it was made illegal in the 1920s. It’s currently considered a Schedule II controlled substance by the US government, with the only legal use being a few highly controlled medical procedures.
In recreational use, cocaine is most commonly snorted, smoked, or injected. For many years, snorting the fine white powder up the nose was the typical method of intake. Once snorted, the drug is absorbed into the mucus membranes of the sinuses and passes into the bloodstream. It then travels to the lungs where the blood can be oxygenated and pumped through the heart to the rest of the body. Once it reaches the brain, in about 5-10 minutes, the effects begin.
The cocaine powder can also be dissolved into a solution and injected directly into veins. The introduction of crack cocaine popularized the smoking method, as the small “rocks” of the drug created by the process of making crack can be placed in a heated pipe, producing a drug-laced smoke that can be inhaled directly into the lungs. This way, the drug travels directly from there to the brain, producing a high in just 1-2 minutes. Getting so much of the drug to the brain all at once produces an intense high referred to as a “rush” that produces very pleasant effects in the user.
Thankfully, the recreational use of cocaine and crack cocaine has been declining over the past several years, including among youth. As of 2014, current (within the past month) and past-year use of cocaine was higher among those 26 or older than among those 12-17 or 18-25. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), nearly 2.8 million individuals over 26 are estimated to have used cocaine in the past year compared to just over 1.6 million people who are 18-25.
When it comes to race, non-Hispanic white people are significantly more likely to use cocaine than any other race in the US. Crack cocaine use, however, is higher among black, Native American, or mixed race individuals, though not by much. This is likely due to the fact that crack is significantly cheaper than the standard form of cocaine, and race and poverty are still strongly linked in the US.
Men are more likely to use cocaine and crack cocaine than women. This includes lifetime, past-year, and past-month use. This is fairly typical among the more intense and dangerous illicit drugs as men are generally more likely to engage in risky behaviors than females. Cocaine use is also highest among the unemployed, and, interestingly, among those with “some” college-level education across the board.
Abuse and Addiction
Though occasional use of cocaine can be risky, the real danger comes from developing an addiction and falling into heavy, long-term abuse of the drug. Cocaine has a high addiction potential, and the more it’s used, the more damage it can do to the body and brain. Over time, negative health effects can become permanent and threaten the afflicted person’s life.
Part of the reason cocaine is so addictive comes from the common methods of intake. A large aspect of addiction relates to how the brain associates behavior with reward. If there’s a short period of time between the behavior (taking the drug) and the reward (euphoria and high), the brain is likely to associate the two and cause the individual to crave the drug, knowing that it produces highly pleasant effects.
Cocaine also causes users to quickly develop a tolerance, meaning that higher and higher doses are necessary to produce the same effect. Taking higher doses increases the chance of becoming addicted, as does taking it frequently. Eventually, it gets to the point that affected individuals feel they can no longer get through the day without cocaine. Being on the drug becomes their new normal.
Substance addiction is a more common occurrence than most people think. According to the National Institute on Drug Abuse, 23.5 million Americans age 12 and above were considered to be in need of treatment for a substance use disorder in 2009. Unfortunately, due largely to stigma around the condition, only 2.6 million of those people received any treatment for their illnesses.
The best way to stop addiction is to prevent it from happening. If that isn’t possible, then getting into treatment as soon as possible can increase the addicted person’s chances of recovering and avoiding future relapse. Because of this, it’s important for people to be aware of the signs of drug abuse and addiction.
Signs of cocaine addiction include:
- Unexplained change in mood
- Unusual excitability, overconfidence, or aggression
- Paranoia or delusions
- Poor judgment
- Dilated pupils
- Frequent runny or bloody nose from snorting the drug
- Signs of frequent injections (“track marks”)
- Burned lips or fingers from smoking
- Increased energy followed by depression and exhaustion
- Change in social circles
- Financial, social, and/or legal troubles
- Changes in hygiene or grooming habits
- Anxiety or agitation when the drug is not available
- Avoiding situations in which taking the drug will not be an option
- Falling ill when intake of the drug stops (withdrawal)
- Increasing inability to meet life responsibilities
- Unwillingness or inability to quit using the drug
Although addiction is a serious problem, the history of cocaine addiction is long and the condition is well researched. There are many treatment facilities – 14,500 in the US alone – and options out there for people who find themselves addicted to this drug.
Unfortunately, there are no options for medicated addiction treatment for cocaine. However, there are still several options to choose from in terms of types of treatment programs. Addiction treatment often involves detox, which is followed by a rehabilitation program that can be inpatient or outpatient. This program may involve 12-Step programs, therapy, workshops, and support group meetings. The key is to tailor the recovery process to what works best for the addicted individual.
Many hospitals and specialized treatment centers offer medically assisted detox in which the client stays in monitored treatment in a hospital room for the duration of withdrawal. Once all intake of the drug stops, unpleasant symptoms may emerge in the addicted person; however, many of these symptoms can be controlled with medication. The goal of medically assisted detox is to make withdrawal as easy as possible. Generally, cocaine withdrawal does not involve life-threatening physical withdrawal symptoms; however, psychological withdrawal symptoms can be intense in some cases.
Residential treatment consists of several weeks, or months, in a controlled facility with no access to substances except for medications deemed necessary by a doctor. This time is spent talking to specially trained therapists, attending support groups, and learning how to cope with life outside of the facility without intoxicants. Outpatient programs are more flexible, allowing the client to stay at home as long as they visit the treatment center a certain number of times per week for the same training and therapy as well as regular drug tests.
One of the most important aspects of rehab is screening for co-occurring disorders. It’s common for individuals with substance use disorders to have another mental illness at the same time. These could be part of the cause of the addiction and fuel the behavior. Undiagnosed and untreated physical disorders can also contribute to addiction. It’s important that these other health issues are treated in addition to the substance abuse disorder; otherwise, relapse is likely.
Addiction to cocaine can be devastating. The nature of the drug makes it so addiction happens fast and is difficult to overcome on one’s own. However, it’s completely possible to live a normal life clean of the drug even after developing an addiction. Seeking out professional treatment is the first step in discovering what led to the substance abuse and how to change one’s situations so that cocaine is no longer needed.