Cocaine is a highly addictive central nervous system stimulant found in the leaves of the coca plant, Erythroxylon coca.
Though most cocaine is used recreationally and illegally, it has legitimate medical uses as a potent local, topical anesthetic for the eye, ear drum, and mucous membranes of the nose, mouth, and respiratory system.
Street names for powdered cocaine include: “coke,” “blow,” “C,” “flake,” “snow” “nose candy,” “basa,” “smack,” “powder,” and “toot.”
Cocaine can be sniffed or “snorted” through the nose, dissolved in water and injected intravenously, and smoked in a pipe and inhaled through the lungs.
Crack cocaine is the form that is smoked. Crack gets its name from the crackling sound made as cocaine powder is cooked with baking soda. The off-white, cooked product is broken into small pieces called “rocks,” or “kibbles & bits.”
Both cocaine and crack are sometimes mixed with other substances, like methcathinone, or “cat.” A mixture of crack and marijuana is known as a “woolah.” Either cocaine or crack, used together with heroin, is called a “speedball.” Alcohol, frequently used together with cocaine, is the most common fatal two-drug combination.
Cocaine's effects include loss of fatigue, mental alertness, and increased energy. Their intensity and duration depend on how the drug is used. The more rapidly it reaches the brain, the faster its effects are felt and the quicker they dissipate. Intravenous injection and smoking produce faster and more intense effects.
Coca leaves were chewed by the Incas and other inhabitants of the Andean region of South America for thousands of years as a stimulant, to combat altitude sickness, and to suppress appetite.
Late in the nineteenth century, cocaine hydrochloride, coca's psychoactive ingredient, was extracted from the leaves and soon found its way into many patent medicines and other popular products, like colas. The drug's negative effects soon became apparent and in 1914, the Harrison Act banned the use of cocaine in non-prescription products. Its use subsequently declined substantially.
The drug culture of the 1960s sparked renewed interest in cocaine and, with the advent of crack cocaine in the 1980s, cocaine abuse once again become a national problem. Its use declined in the early 1990s, but remains a significant problem in certain age groups and geographic areas. A mid-1990s government report stated that Americans spend more money on cocaine than on all other illegal drugs combined.
Causes and symptoms
Like other addictions, cocaine abuse results from complex combinations of factors like genetic predisposition, family history, stress, and other environmental issues. As many as three to four million people are estimated to be chronic cocaine users.
Cocaine increases the brain's levels of dopamine by preventing it from being recycled back into brain cells.
Dopamine is responsible for feelings of pleasure; the higher the dopamine levels, the greater the sensations of pleasure. With repeated drug use, tolerance develops and more frequent use produces diminishing sensations of pleasure.
The short-term effects of cocaine can include:
- rapid heartbeat
- constricted blood vessels
- dilated pupils
- increased temperature
- increased energy
- reduced appetite
- increased sense of alertness
- sudden death due to overdose, heart attack, or stroke
The long-term effects of cocaine and crack use include:
- dependence, addiction
- mood swings
- weight loss and malnutrition
- auditory hallucinations
- loss of sense of smell
- ruptured nasal septum
- chronic runny nose
- hoarse voice
- bowel gangrene
- increased risk of contracting HIV and other blood-borne diseases
The rise in the use of cocaine and crack in the 1980s raised fears about their effects on developing fetuses. But researchers have not been able to conclusively demonstrate consistent, adverse effects. Experts nowadays believe that the lack of good prenatal care, along with alcohol and tobacco use in cocaine users who are pregnant, are more important factors in premature delivery, low birth weight, and fetal and neonatal death.
The Centers for Disease Control and Prevention (CDC), however, reports that mothers who use cocaine early in pregnancy are five times more likely to have babies with malformed urinary tracts than mothers who do not use the drug.
Thus, cocaine use, especially in the early weeks of pregnancy, is inadvisable.
Discouraging pregnant women from using cocaine, tobacco, and alcohol are important tasks for all healthcaregivers.
Diagnosing cocaine addiction can be difficult. Many of the signs of short-term cocaine use are not obvious. Since cocaine users often also use other drugs, it may not be easy to distinguish the effects of one drug from another.
Cocaine use has been documented in significant numbers of eighth graders as well as older teens. Over all age groups, more men than women use the drug. The highest rate of cocaine use is found among adults 18–25 years old.
Cocaine has been linked to several serious health problems, including:
- heart attacks
- chest pain
- respiratory failure
Other complications may vary depending on how the drug is administered. Prolonged snorting, for example, can irritate the nasal septum, producing nosebleeds, chronic runny nose and ruptured nasal septum, and other problems. Intravenous users face an increased risk of infectious diseases such as HIV/AIDS and hepatitis.
Urine testing for cocaine can be useful in diagnosing cocaine abuse and monitoring adherence to drug-abuse treatment programs.
The last two decades have seen a dramatic rise in the number of cocaine addicts seeking treatment. There are no specific, targeted treatments for cocaine abuse or addiction. Most programs combine cognitive-behavioral therapy with social support.
There are no specific medications for treating cocaine addiction.
A wide range of behavioral interventions have successfully treated cocaine addiction. Approaches must be tailored to individuals' specific needs and available resources. Tailored programs with negotiated contingency rewards for drug avoidance, confirmed by urine testing, can work.
In cognitive-behavioral therapy, users learn to recognize, manage and avoid situations most likely to lead to cocaine use and develop healthy ways to cope with stressful situations.
Residential programs/therapeutic communities may also be helpful, particularly in more severe cases. Patients typically spend 6–12 months in such programs, which may also include vocational retraining.
Various alternative or complementary approaches, often combined with conventional therapies, have been used in treating cocaine addiction. In Japan, the herb acorus has been traditionally used both to assist earlystage cocaine withdrawal and in later recovery stages. Other herbs sometimes used to treat drug addictions of various kinds include kola nut, guarana seed and yohimbe (to boost short-term energy), and valerian root, hops leaf, scullcap leaf, and chamomile (to calm the patient). The amino acids phenylalanine and tyrosine have been used to reduce cocaine addicts’ craving for the drug. Vitamin therapy may be used to help strengthen the patient. Gentle massage has been used to help infants born with congenital cocaine addiction. Other techniques, such as acupuncture, EEG biofeedback, and visualization, may also be useful in treating addiction.
Addiction is a complex disorder, and prospects for individual addicts vary widely. A 2004 study found that recovering drug addicts continue to crave the high and rush that they initially received from using the drug. However, research also has consistently shown that treatment can significantly reduce both drug abuse and subsequent criminal activity. The comprehensive Services Research Outcomes Study (1998) found a 45% drop in cocaine use five years after treatment, compared to use during the five years before treatment. The study also found that females generally respond better to treatment Page 867 | Top of Articlethan males, and older patients tend to reduce their drug use more than younger patients.
Research supports the ability of 12-step programs, along with other approaches, to improve addiction treatment outcomes. One study in outpatient drug-treatment programs found that participation in a 12-step program nearly doubled the chances of remaining drug-free.
Despite significant variation over time, cocaine addiction has proven to be a persistent public health problem. Interdiction and source control are expensive and have failed to eliminate the problem. Some law enforcement officials recommend more emphasis on demand reduction through education and other measures to address the causes of cocaine addiction.
“Craving for Cocaine May Last for Years after Recovery.” Health & Medicine Week April 19, 2004: 846.
“Treating Cocaine Addiction with Viruses.” Ascribe Health News Service June 21, 2004.
Cocaine Anonymous, 21720 S. Wilmington Ave., Ste. 304, Long Beach, CA 90810-1641, (310) 559-5833, Fax: (310) 559-2554, firstname.lastname@example.org, http://www.ca.org .
Nar-Anon Family Group Headquarters, 22527 Crenshaw Blvd., Suite 200B, Torrance, CA 90505, (310) 534-8188, (800) 477-6291, email@example.com, http://www.naranon.org/Nar-Anon .
James Waun, MD, RPh