Cocaine abuse and addiction continues to be a problem that plagues
our nation. In 1997, for example, an estimated 1.5 million Americans
age 12 and older were chronic cocaine users. Although this is an
improvement over the 1985 estimate of 5.7 million users, we still
have a substantial distance to go in reducing the use of this addictive
stimulant. Science is helping. We now know more about where and
how cocaine acts in the brain, including how the drug produces its
pleasurable effects and why it is so addictive.
Through the use of sophisticated technology, scientists can actually
see the dynamic changes that occur in the brain as an individual
takes the drug. They can observe the different brain changes that
occur as a person experiences the "rush," the "high,"
and, finally, the craving of cocaine. They can also identify parts
of the brain that become active when a cocaine addict sees or hears
environmental stimuli that trigger the craving for cocaine. Because
these types of studies pinpoint specific brain regions, they are
critical to identifying targets for developing medications to treat
Cocaine is a powerfully addictive stimulant that directly affects
the brain. Cocaine has been labeled the drug of the 1980's and 1990's,
because of its extensive popularity and use during this period.
However, cocaine is not a new drug. In fact, it is one of the oldest
known drugs. The pure chemical, cocaine hydrochloride, has been
an abused substance for more than 100 years, and coca leaves, the
source of cocaine, have been ingested for thousands of years.
Pure cocaine was first extracted from the leaf of the coca bush,
which grows primarily in Peru and Bolivia, in the mid-19th century.
In the early 1900's, it became the main stimulant drug used in most
of the tonics/elixirs that were developed to treat a wide variety
of illnesses. Today, cocaine is a Schedule II drug, meaning that
it has high potential for abuse, but it can be administered by a
doctor for legitimate medical uses, such as a local anesthetic for
some eye, ear, and throat surgeries.
There are basically two chemical forms of cocaine: the hydrochloride
salt and the "freebase." The hydrochloride salt, or powdered
form of cocaine, dissolves in water and, when abused, can be taken
intravenously (by vein) or intranasally (in the nose). Freebase
refers to a compound that has not been neutralized by an acid to
make the hydrochloride salt. The freebase form of cocaine is smokable.
Cocaine is generally sold on the street as a fine, white, crystalline
powder, known as "coke," "C," "snow,"
"flake," or "blow." Street dealers generally
dilute it with such inert substances as cornstarch, talcum powder,
and/or sugar, or with such active drugs as procaine (a chemically-related
local anesthetic) or with other stimulants such as amphetamines.
Crack is the street name given to the freebase form of cocaine
that has been processed from the powdered cocaine hydrochloride
form to a smokable substance. The term "crack" refers
to the crackling sound heard when the mixture is smoked. Crack cocaine
is processed with ammonia or sodium bicarbonate (baking soda) and
water, and heated to remove the hydrochloride.
Because crack is smoked, the user experiences a high in less than
10 seconds. This immediate and euphoric effect is one of the reasons
that crack became enormously popular in the mid 1980's. Another
reason is that crack is inexpensive both to produce and to buy.
In 1997, an estimated 1.5 million Americans (0.7 percent of those
age 12 and older) were current cocaine users, according to the 1997
National Household Survey on Drug Abuse (NHSDA). This number has
not changed significantly since 1992, although it is a dramatic
decrease from the 1985 peak of 5.7 million cocaine users (3 percent
of the population). Based upon additional data sources that take
into account users underrepresented in the NHSDA, the Office of
National Drug Control Policy estimates the number of chronic cocaine
users at 3.6 million.
Crack cocaine remains a serious problem in the United States. The
NHSDA estimated the number of current crack users to be about 604,000
in 1997, which does not reflect any significant change since 1988.
Adults 18 to 25 years old have a higher rate of current cocaine
use than those in any other age group. Overall, men have a higher
rate of current cocaine use than do women.
The 1998 Monitoring the Future Survey, which annually surveys teen
attitudes and recent drug use, reports that lifetime and past-year
use of crack increased among eighth graders to its highest levels
since 1991, the first year data was available for this grade. The
percentage of eighth graders reporting crack use at least once in
their lives increased from 2.7 percent in 1997 to 3.2 percent in
1998. Past-year use of crack also rose slightly among this group,
although no changes were found for other grades.
Trends in 30-day prevalence of cocaine abuse among eighth, tenth
and twelfth graders. 1991-1998
The principal routes of cocaine administration are oral, intranasal,
intravenous, and inhalation. The slang terms for these routes are,
respectively, "chewing," "snorting," "mainlining,"
"injecting," and "smoking" (including freebase
and crack cocaine). Snorting is the process of inhaling cocaine
powder through the nostrils, where it is absorbed into the bloodstream
through the nasal tissues. Injecting releases the drug directly
into the bloodstream and heightens the intensity of its effects.
Smoking involves the inhalation of cocaine vapor or smoke into the
lungs, where absorption into the bloodstream is as rapid as by injection.
The drug can also be rubbed onto mucous tissues. Some users combine
cocaine powder or crack with heroin in a "speedball."
Cocaine use ranges from occasional use to repeated or compulsive
use, with a variety of patterns between these extremes. There is
no safe way to use cocaine. Any route of administration can lead
to absorption of toxic amounts of cocaine, leading to acute cardiovascular
or cerebrovascular emergencies that could result in sudden death.
Repeated cocaine use by any route of administration can produce
addiction and other adverse health consequences.
A great amount of research has been devoted to understanding the
way cocaine produces its pleasurable effects and the reasons it
is so addictive. One mechanism is through its effects on structures
deep in the brain. Scientists have discovered regions within the
brain that, when stimulated, produce feelings of pleasure. One neural
system that appears to be most affected by cocaine originates in
a region located deep within the brain, called the ventral tegmental
area (VTA). Nerve cells originating in the VTA extend to the region
of the brain known as the nucleus accumbens, one of the brain's
key pleasure centers. In studies using animals, for example, all
types of pleasurable stimuli, such as food, water, sex, and many
drugs of abuse, cause increased activity in the nucleus accumbens.
Researchers have discovered that when a pleasurable event is occurring,
it is accompanied by a large increase in the amounts of dopamine
released in the nucleus accumbens by neurons originating in the
VTA. In the normal communication process, dopamine is released by
a neuron into the synapse (the small gap between two neurons), where
it binds with specialized proteins (called dopamine receptors) on
the neighboring neuron, thereby sending a signal to that neuron.
Drugs of abuse are able to interfere with this normal communication
process. For example, scientists have discovered that cocaine blocks
the removal of dopamine from the synapse, resulting in an accumulation
of dopamine. This buildup of dopamine causes continuous stimulation
of receiving neurons, probably resulting in the euphoria commonly
reported by cocaine abusers.
As cocaine abuse continues, tolerance often develops. This means
that higher doses and more frequent use of cocaine are required
for the brain to register the same level of pleasure experienced
during initial use. Recent studies have shown that, during periods
of abstinence from cocaine use, the memory of the euphoria associated
with cocaine use, or mere exposure to cues associated with drug
use can trigger tremendous craving and relapse to drug use, even
after long periods of abstinence.
Reaping the benefits of treatment begins by recognizing the signs
of cocaine addiction. The next step is to be evaluated by a qualified
professional. Although cocaine addiction can be diagnosed by primary
care physicians, most often the physician will refer the patient
to a psychiatrist, psychologist, clinical social worker, or other
professionals specializing in addictions. Treatment is a partnership
between the patient and the health care provider. It is important
that informed consumers understand their treatment options and discuss
all concerns with a treatment provider as they arise. Cocaine addiction
represents a challenge to treatment professionals.
Cocaine addicts are more prone to relapse and are often the most
difficult clients to treat effectively because of their many problems.
Dual diagnosis patients require a comprehensive treatment approach
that recognizes their special needs and provides integrated treatment
for the multiple disorders identified.
Serenity Lane is a total care facility for treating the whole person.
We directly address the physical and psychological elements of dependency
disorders, as well as the defeating beliefs that accompany addiction.
Thirty years of experience has provided us with an expertise to
treat patients who are suffering from addictions and those complicated
by a psychiatric disorder.
Cocaine's effects appear almost immediately after a single dose
and disappear within a few minutes or hours. Taken in small amounts
(up to 100 mg), cocaine usually makes the user feel euphoric, energetic,
talkative, and mentally alert, especially to the sensations of sight,
sound, and touch. It can also temporarily decrease the need for
food and sleep. Some users find that the drug helps them to perform
simple physical and intellectual tasks more quickly, while others
can experience the opposite effect.
The duration of cocaine's immediate euphoric effects depends upon
the route of administration. The faster the absorption, the more
intense the high. Also, the faster the absorption, the shorter the
duration of action. The high from snorting is relatively slow in
onset and may last 15 to 30 minutes, while that from smoking may
last 5 to 10 minutes.
The short-term physiological effects of cocaine include constricted
blood vessels, dilated pupils, and increased temperature, heart
rate, and blood pressure. Large amounts (several hundred milligrams
or more) intensify the user's high, but may also lead to bizarre,
erratic, and violent behavior. These users may experience tremors,
vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic
reaction closely resembling amphetamine poisoning. Some users of
cocaine report feelings of restlessness, irritability, and anxiety.
In rare instances, sudden death can occur on the first use of cocaine
or unexpectedly thereafter. Cocaine-related deaths are often a result
of cardiac arrest or seizures followed by respiratory arrest.
Cocaine is a powerfully addictive drug. Once having tried cocaine,
an individual may have difficulty predicting or controlling the
extent to which he or she will continue to use the drug. Cocaine's
stimulant and addictive effects are thought to be primarily a result
of its ability to inhibit the reabsorption of dopamine by nerve
cells. Dopamine is released as part of the brain's reward system
and is either directly or indirectly involved in the addictive properties
of every major drug of abuse.
An appreciable tolerance to cocaine's high may develop, with many
addicts reporting that they seek but fail to achieve as much pleasure
as they did from their first experience. Some users will frequently
increase their doses to intensify and prolong the euphoric effects.
While tolerance to the high can occur, users can also become more
sensitive (sensitization) to cocaine's anesthetic and convulsant
effects, without increasing the dose taken. This increased sensitivity
may explain some deaths occurring after apparently low doses of
Use of cocaine in a binge, during which the drug is taken repeatedly
and at increasingly high doses, leads to a state of increasing irritability,
restlessness, and paranoia. This may result in a full-blown paranoid
psychosis, in which the individual loses touch with reality and
experiences auditory hallucinations.
There are enormous medical complications associated with cocaine
use. Some of the most frequent complications are cardiovascular
effects, including disturbances in heart rhythm and heart attacks;
respiratory effects such as chest pain and respiratory failure;
neurological effects, including strokes, seizures, and headaches;
and gastrointestinal complications, including abdominal pain and
nausea. Cocaine use has been linked to many types of heart disease.
Cocaine has been found to trigger chaotic heart rhythms, called
ventricular fibrillation, accelerated heartbeat and breathing, and
increased blood pressure and body temperature. Physical symptoms
may include chest pain, nausea, blurred vision, fever, muscle spasms,
convulsions and coma.
Different routes of cocaine administration can produce different
adverse effects. Regularly snorting cocaine, for example, can lead
to loss of sense of smell, nosebleeds, problems with swallowing,
hoarseness, and an overall irritation of the nasal septum, which
can lead to a chronically inflamed, runny nose. Ingested cocaine
can cause severe bowel gangrene, due to reduced blood flow. Persons
who inject cocaine have puncture marks and "tracks," most
commonly in their forearms. Intravenous cocaine users may also experience
an allergic reaction, either to the drug or to some additive in
street cocaine, which can result, in severe cases, in death. Because
cocaine has a tendency to decrease food intake, many chronic cocaine
users lose their appetites and can experience significant weight
loss and malnourishment.
Research has revealed a potentially dangerous interaction between
cocaine and alcohol. Taken in combination, the two drugs are converted
by the body to cocaethylene. Cocaethylene has a longer duration
of action in the brain and is more toxic than either drug alone.
It is noteworthy that the mixture of cocaine and alcohol is the
most common two-drug combination that results in drug-related death.
Yes. Cocaine abusers, especially those who inject, are at increased
risk for contracting such infectious diseases as human immunodeficiency
virus (HIV/AIDS) and Hepatitis. In fact, use and abuse of illicit
drugs, including crack cocaine, have become the leading risk factors
for new cases of HIV. Drug abuse-related spread of HIV can result
from direct transmission of the virus through the sharing of contaminated
needles and paraphernalia between injecting drug users. It can also
result from indirect transmission, such as an HIV-infected mother
transmitting the virus perinatally to her child. This is particularly
alarming, given that more than 60 percent of new AIDS cases are
women. Research has also shown that drug use can interfere with
judgment about risk-taking behavior and can potentially lead to
reduced precautions about having sex, the sharing of needles and
injection paraphernalia, and the trading of sex for drugs by both
men and women.
Additionally, Hepatitis C is spreading rapidly among injection
drug users; current estimates indicate infection rates of 65 to
90 percent in this population. At present, there is no vaccine for
the Hepatitis C virus, and the only treatment is expensive, often
unsuccessful, and may have serious side effects.
The full extent of the effects of prenatal drug exposure on a child
is not completely known, but many scientific studies have documented
that babies born to mothers who abuse cocaine during pregnancy are
often prematurely delivered, have low birth weights and smaller
head circumferences, and are often shorter in length.
Estimating the full extent of the consequences of maternal drug
abuse is difficult, and determining the specific hazard of a particular
drug to the unborn child is even more problematic, given that, typically,
more than one substance is abused. Such factors as the amount and
number of all drugs abused, inadequate prenatal care; abuse and
neglect of the children due to the mother's lifestyle, socioeconomic
status, poor maternal nutrition and other health problems are just
some examples of the difficulty in determining the direct impact
of cocaine use.
Many may recall that "crack babies," or babies born to
mothers who used cocaine while pregnant, were written off a decade
ago as a lost generation. They were predicted to suffer from severe,
irreversible damage, including reduced intelligence and social skills.
It was later found that this was a gross exaggeration. Most crack-exposed
babies appear to recover quite well. However, the fact that most
of these children appear normal should not be interpreted as a positive
sign. Using sophisticated technologies, scientists are now finding
that exposure to cocaine during fetal development may lead to subtle,
but significant, deficits later, especially with behaviors that
are crucial to success in the classroom, such as blocking out distractions
and concentrating for long periods of time.
There has been an enormous increase in the number of people seeking
treatment for cocaine addiction during the 1980s and 1990s. Treatment
providers in most areas of the country report that cocaine is the
most commonly cited drug of abuse among their clients. The majority
of individuals seeking treatment smoke crack and are likely to be
poly-drug users, or users of more than one substance. The widespread
abuse of cocaine has stimulated extensive efforts to develop treatment
programs for this type of drug abuse. Cocaine abuse and addiction
is a complex problem involving biological changes in the brain as
well as a myriad of social, familial, and environmental factors.
Therefore, treatment of cocaine addiction is complex and must address
a variety of problems. Like any good treatment plan, cocaine treatment
strategies need to assess the psychological, social, and pharmacological
aspects of the patient's drug abuse.
There are no medications currently available to treat cocaine addiction
specifically. Consequently, the National Institute on Drug Abuse
(NIDA) is pursuing the identification and testing of new cocaine
treatment medications. Several newly emerging compounds are being
investigated to assess their safety and efficacy in treating cocaine
addiction. For example, one of the most promising anti-cocaine drug
medications to date, selegeline, was taken into multi-site phase
III clinical trials in 1999. These trials evaluated two innovative
routes of selegeline administration: a transdermal patch and a time-released
pill, to determine which was most beneficial. Disulfiram, a medication
that has been used to treat alcoholism, has also been shown in clinical
studies to be effective in reducing cocaine abuse. Because of mood
changes experienced during the early stages of cocaine abstinence,
antidepressant drugs have been shown to be of some benefit.
Many behavioral treatments have been found to be effective for
cocaine addiction, including both residential and outpatient approaches.
Indeed, behavioral therapies are often the only available, effective
treatment approaches to many drug problems, including cocaine addiction,
for which there is, as yet, no viable medication. However, integration
of both types of treatments is ultimately the most effective approach
for treating addiction.
It is important to match the best treatment regimen to the needs
of the patient. This may include adding to or removing from an individual's
treatment regimen a number of different components or elements.
For example, if an individual is prone to relapses, a relapse component
should be added to the program.
Cognitive-behavioral therapy is another approach. Cognitive-behavioral
coping skills treatment, for example, is a short-term, focused approach
to helping cocaine-addicted individuals become abstinent from cocaine
and other substances.
The underlying assumption is that learning processes play an important
role in the development and continuation of cocaine abuse and dependence.
The same learning processes can be employed to help individuals
reduce drug use. This approach attempts to help patients to recognize,
avoid, and cope; i.e., recognize the situations in which they are
most likely to use cocaine, avoid these situations when appropriate,
and cope more effectively with a range of problems and problematic
behaviors associated with drug abuse.
Longer term halfway house programs with planned lengths of stay
of 6 to 12 months offer another alternative to those in need of
treatment for cocaine addiction. Therapeutic communities are often
comprehensive, in that they focus on the resocialization of the
individual to society and can include on-site vocational rehabilitation
and other supportive services.
For further information on Serenity Lane's treatment of cocaine
addiction, call (541) 687-1110 or toll free 1-800-543-9905