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Friday, October 20, 2017

Cocaine

Overview

Cocaine is a highly addictive stimulant, and one of the most commonly abused today. Cocaine abuse is common in the U.S and abroad, with an estimated 4.7 million Americans having used cocaine in 2012 alone.1 Cocaine is so addictive due to its close interaction with dopamine production in the brain. Cocaine remains one of the most deadly recreational drugs found today due to its potency, frequency of being cut with dangerous and toxic additives, negative physiological effects, and how easy it is to build a tolerance to it. Overdoses on cocaine are relatively common, with cocaine accounting for 7,000 deaths due to overdose in 2015.2

However, death from cocaine abuse is more common in its sustained damage to the cardiovascular system. Cocaine exhibits short-term effects similar to other stimulants including alertness, euphoria, decreased appetite, and mood shifts. Long term abuse of cocaine can lead to a variety of physiological and mental ailments including infections, body deterioration, cardiovascular problems, and respiratory damage. There are currently no effective pharmaceutical treatments for cocaine addiction, but many breakthroughs are being made in developing medications that can be used in recovery, and rehabilitation facilities offer extensive resources for recovering from cocaine addiction in a safe, stable, and comfortable manner.

What is Cocaine?

Cocaine is one of the most powerful and addictive stimulants available today. Cocaine holds a reputation for its short-lasting intense feelings of energy and euphoria as well as its potent addictiveness. Stimulants are a class of drugs that include dangerous street drugs like cocaine, common prescription drugs such as Adderall, and even your ordinary cup of coffee. Cocaine is synthesized from leaves of the coca plant, a common cash crop found all across South America. The abundance of coca plants and the high demand of cocaine have created a massive drug trade that runs throughout all of South America to supply the worldwide cocaine addiction.

This drug trade has devastated many central and south American countries, particularly Colombia where 495 metric tons of pure cocaine had been manufactured in 2015 alone, resulting in thousands of deaths every year to maintain constant supply of the drug. Although there was a decline in number of deaths attributed to cocaine from 2007 to 2012, it has since been on the rise once again, and the National Institute of Drug Abuse estimates around 7,000 deaths attributed to cocaine in 2015 alone. Deaths from cocaine can come in the form of overdosing, particularly in those with a hypersensitivity to cocaine, or long-term users who have built up a tolerance to the drug. Deaths from damage to the central nervous system and the circulatory system from use of cocaine are also common. Cocaine is classified as a Schedule II drug by the Controlled Substances Act (CSA), meaning that cocaine has some accepted medical usage under severe restriction, but is not considered safe for use either due to its high potential for abuse.

How Does Cocaine Addiction Work?

Cocaine’s deadly addictiveness can be attributed primarily to its effectiveness at blocking dopamine transporters in the brain, which traps already released dopamine in the synapse and allows it to bind over and over to dopamine receptors in the synapse, overstimulating the receptors and causing permanent damage to the cell. Dopamine is a neurotransmitter that is colloquially known as the ‘happiness drug’ due to its purpose in producing feelings of well-being and pleasure when released into the brain. When the body is hurt, the brain produces natural opiates that allow dopamine to be released in the areas of the brain commonly responsible for feelings of pain and stress, which works to reduce overall feelings of pain. However, once dopamine has done its job, it must be taken back out of the synapse to avoid overstimulating the cell. Cocaine disables this preventative measure in the brain.

Because the brain isn’t capable of handling such frequent binding of dopamine, dopamine receptors become damaged and make it more difficult to feel pleasure, leading users to use more and more cocaine to chase the fleeting euphoria it once offered them. Cocaine is particular addictive because, once ingested, it concentrates in the area of the brain known as the reward pathway, as well as areas controlling movement. These numerous issues compound to create a strong addiction potential for cocaine, which becomes more and more difficult to feed the more it is abused. This deadly self-feeding cycle of addiction is at the root of cocaine’s effectiveness at becoming addictive.

Short and Long Term Effects

Cocaine is most often snorted, but can also be taken via injection, orally, or smoked in the form of crack cocaine. Onset of effects varies with the method used to take it, ranging from a few seconds when injected to around one minute when snorted.

Users report short-term mental effects such as feelings of:

  • Euphoria
  • Sexual stimulation
  • Mental stimulation
  • Rapid mood shifts

And physical effects such as:

  • Numbness
  • Lowered appetite
  • Increased heart rate
  • Shaking

Repeated long-term use of cocaine leads to physical side effects such as:

  • Diminished cardiovascular health – Cocaine drastically increases heart rate, putting a great deal of strain on the heart with long term use, which can lead to problems such as tachycardia and heart arrhythmia, and can increase risk of heart attack.
  • Nasal damage – Frequent insufflation of cocaine can cause severe damage to the nasal cavity as well as the throat. The sensitive mucus membrane is damaged both mechanically and chemically from the act of snorting cocaine, and the additives and byproducts of cocaine that are usually present cause further damage. This can lead to frequent infections of the nose and throat as the damaged mucus membrane is unable to effectively fight off infection. Other side effects include loss of smell, difficulty swallowing, frequent nosebleeds, and cocaine-induced midline destructive lesions (CIMDL).
  • Respiratory damage – The smoke from cocaine can cause severe damage to the lungs, particularly when in the form of crack. Chronic coughing is a common side effect, and can develop into dangerous respiratory ailments such as bronchitis.
  • Decay in health of skin, teeth, and hair – Frequent injection of cocaine can lead to open sores and abscesses on the skin, in the lining of the gum, and even inside the body. This makes the user susceptible to infection and may lead to further complications such as blood poisoning.
  • Insomnia – Due to cocaine’s stimulating effect, a general decay in personal health, as well as frequent interruptions in ordinary circadian activity, cocaine users often experience worsening sleeping problems that can develop into insomnia.

Long-term use of cocaine also carries several mental side effects including:

  • Severe addiction – Because of cocaine’s addictiveness, both mental and physical addiction are developed very quickly, leading to a complete dependency on the drug.
  • Depression – Due to overstimulation of dopamine receptors, cocaine frequently leads to depression due to the brain’s inability to utilize dopamine effectively.
  • Anxiety – Anxiety is a frequent symptom of drug abuse in general, and is common in meth abuse due to internal factors from the psychological and physical effect of the drug itself, as well as external factors such as pressure family, friends, and work that may all be affected by addiction. This can compound and develop into chronic paranoia.

Other risks posed by cocaine abuse include:

  • Increased risk of HIV – Cocaine has been proven to speed up and assist in the progression of HIV infections, which may also be obtained through misuse of needles when injecting cocaine. Because cocaine weakens immune response as well as impairs cell functioning, both HIV and Hepatitis infections are allowed to progress much more rapidly than in a healthy individual.
  • Risk of overdose – Cocaine overdose is a sometimes understated but dangerously frequent occurrence. Because cocaine tolerance is so volatile, and potency can differ between different batches, it is very easy to misjudge the amount you can handle and overdose. Death by heart failure is common, and survival rates of overdoses are low.
  • Additives – Cocaine purchased on the street is often cut with additives to maximize profits, including many dangerous and toxic additives. Cocaine is often created through the use of cheap toxic additives such as gasoline and deadly drugs such as the livestock de-wormer Levamisole.
  • Pregnancy – Cocaine can lead to a wide variety of difficulties with pregnancy. This includes issues in the mother such as migraines and seizures as well as both fatal and nonfatal birth defects, premature birth, membrane ruptures, stillbirths, Sudden Infant Death Syndrome, Neonatal Abstinence Syndrome, and various other dangerous abnormalities.

Cocaine withdrawal can be a very difficult process to go through, and includes withdrawal symptoms such as:

  • Increased appetite
  • Fatigue
  • Restlessness
  • Depression
  • Loss of concentration
  • Tremors, muscle aches and cramps
  • Insomnia

Methods of Treatment

Pharmacological:

Unfortunately there are currently no accepted forms of pharmaceutical treatment for cocaine addiction that are accepted by the FDA for use in the United States. However, research into potential treatments that work on dopamine, GABA, serotonin, and adrenaline is promising. These treatments focus on receptors found in the reward pathway of the brain in order to directly combat cocaine’s effect on the reward pathway. Although no medications specifically for cocaine addiction treatment are available, treatment through other medications has shown some benefit, such as the use of disulfiram, a drug traditionally used to treat alcohol addiction. Some breakthroughs are also being made in the application of vaccine technology to cocaine addiction, which may be used to aid the immune system in reducing cocaine’s effectiveness on the brain.

Therapeutic:

Other forms of treatment for beer addiction come in the form of psychological and behavioral therapies. These treatments focus on the behaviors and habits that led to addiction in the first place in an attempt to remove the root of addiction. Amongst these forms of treatment, Cognitive Behavioral Therapy (CBT) is one of the most common, and is growing in support from the scientific and clinical communities all the time. Cognitive Behavioral Therapy sees substance abuse such as beer addict as a symptom of a greater psychological issue, and not a cause in and of itself. By utilizing reflective and analytic techniques, an addict is better able to understand what led them to addiction in the first place, change bad habits, and avoid behaviors that may trigger cravings.

The twelve-step program is also available as a longestablished method of treating drug and alcohol addiction. The twelve-step program works as a gradual method of guiding principles and pragmatic steps that can be taken to go from the depths of addiction and unhealthy habits to sobriety. These twelve steps are aimed at effectively recovering from compulsive and addictive behaviors, and addressing mental and behavioral problems that led to addiction in the first place. These twelve steps include both internal and external actions aimed at making amends for past mistakes, accepting responsibility for the actions that led to addiction, and moving forward to establish healthy habits and a positive mindset.

Rehabilitation

There are two main types of rehabilitation: inpatient and outpatient. Inpatient rehabilitation refers to programs that require patients to check themselves into a facility where they will undergo all rehabilitation treatment. Although inpatient rehabilitation requires a greater level of commitment, the facilities, environment, and support offered by these facilities are conducive to a stable and effective recovery. Inpatient facilities generally offer services such as psychiatrists, counselors, group therapy, and all of the living facilities necessary for a comfortable stay. The extensive support offered by these facilities, combined with an environment that is focused on self-improvement and wellness is a great combination for providing the motivation to push through the difficulties of withdrawal and to establish good healthy habits to prevent relapsing once you leave. This form of rehabilitation is effective for those who would benefit from a stricter more scheduled recovery in which the outside distractions and temptations of life won’t get in the way of focusing on recovery.

Outpatient rehabilitation is based on the principle of spending only part of your time in recovery programs while offering you the freedom to continue daily living on your own. Generally these programs will require ten to twelve hours of commitment per week spent in a treatment facility participating in similar activities to those done in an inpatient facility such as group therapy, counseling, and even detox. While this does offer easier access to drugs, some may find being able to maintain their normal daily schedule more beneficial. This form of rehabilitation is effective for those who require more freedom and contact with friends and family.

Both forms of rehabilitation are effective solutions at combatting cocaine addiction, and there is a variety of different types of both inpatient and outpatient rehabilitation to suit the personal needs of each individual.

 

 

References

  1. Bureau for International Narcotics and Law Enforcement Affairs. International Narcotics Control Strategy Report. Vol. 1, The Bureau, 2017, www.state.gov/documents/organization/268025.pdf.
  2. “Overdose Death Rates.” NIDA, National Institute on Drug Abuse, 6 Jan. 2017, www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.