Cocaine is an intoxicating alkaloid chemical derived from the coca plant.
The drug is most commonly found as a white powder, although crack cocaine comes as brownish-white rocks that are melted down and injected or smoked. Powdered cocaine is typically snorted directly.
Cocaine is one of the most powerful stimulants found in nature, and it can lead to changes in the brain and body over time as it is abused.
What Is Cocaine, and How Is It Abused?
Although cocaine is considered by many to be an addictive substance of abuse, it is actually a Schedule II medication, according to the Drug Enforcement Administration (DEA). Other drugs that fall into Schedule II include oxycodone and hydrocodone, two powerful and addictive narcotic painkillers. Cocaine has some limited medical use, although it also has a high potential for abuse and addiction. In medical settings, it is used to reduce bleeding from the mucous membranes in the throat, nose, and mouth; it is also used as a topical anesthetic for the upper respiratory tract when mixed in an appropriate, low-dose solution.
Most people are familiar with cocaine as a street drug, both as a white powder and as crack cocaine rocks. Cocaine is typically cut with other substances, such as other drugs and substances like cornstarch and talcum powder. It is sometimes abused in combination with other intoxicating substances like alcohol or heroin.
Who Is at Risk for Cocaine Addiction?
Reports suggest about 14 percent of adults in the United States have tried cocaine, and one in 40 of those people used cocaine at least once in the last year.
The people most at risk of developing an addiction to cocaine are young men, between the ages of 18 and 25.
In 2014, about 1.4 percent of young adults, regardless of gender, reported at least one instance of cocaine abuse in the past month, according to the National Institute on Drug Abuse (NIDA).
Among most other groups, cocaine abuse rates are declining. For example, among 8th, 10th, and 12th graders surveyed for past 30-day cocaine use between 2002 and 2015, rates of abuse steeply declined. Peak abuse of cocaine among this age group occurred in the 1990s.
Symptoms and Side Effects of Cocaine Abuse
Cocaine affects the brain by stimulating areas of the mesolimbic dopamine system, which is the reward center of the brain. By preventing the removal of dopamine, cocaine produces amplified signals in the brain, leading to euphoria, elevated mood, and increased energy. However, when dopamine is not removed from the brain, it can also create other mood changes and hallucinations.
The stimulant drug’s effects begin within 15-20 minutes of the first dose when snorted and typically disappear within a few hours. When smoked or injected in the form of crack cocaine, the effects begin as quickly as five minutes after the first dose but wear off within the hour. However, because the brain releases dopamine, which elevates mood, when cocaine is ingested, the system is likely to create a feedback system that leads the person to take another dose as soon as the primary effects wear off. This can quickly lead to abuse, addiction, or overdose. Initial effects of cocaine include:
- Very elevated mood, feeling primarily happy
- High energy
- Mental alertness
- Sensitivity to stimuli, such as light, sound, and tough
Physical side effects of cocaine abuse include:
- Constricted blood vessels, leading to high blood pressure
- Dilated pupils
- Restlessness or mood swings
- Tremors or shaking
- Muscle twitches
- Rapid heartbeat
- Increased body temperature
Risks specifically related to smoking cocaine include:
- Slurred speech
- Confusion and cognitive changes
- Anxiety and psychological changes
- Unpleasant crash after the initial
Long-term abuse of cocaine in any form can lead to tolerance, meaning the body is used to a specific dose and needs more to get the original effects, and dependence, as the body requires the drug to release neurotransmitters like dopamine. Although these effects are not the same thing as addiction, the sensations can reinforce addiction, including cravings and drug-seeking behavior.
- Heart: Consistently raised blood pressure damages the heart, arteries, and veins. A hardened aorta changes rate of blood flow to and from the heart and brain. Other effects include increased risk of blood clots, heart attack, and stroke.
- Brain: Use can lead to a wide range of effects to the brain, such as a loss of gray matter; increased risk of seizures or convulsions; persistent or permanent changes in mood or psychology, including a psychotic break; intense mood swings; headaches; extreme low mood, including suicidal ideation; severe paranoia; insomnia or sleep disturbances; hallucinations, usually auditory; and increased risk of Parkinson’s disease later in life.
- Lungs: Effects include changes to breathing rate; increased risk of lung infections; damage to lung tissue; damage to the nose and throat; and chronic nosebleeds.
- Stomach: Effects include pain in the stomach or gastrointestinal system; extreme weight loss; and malnourishment from lack of eating.
- Liver and kidneys: Cocaine use may lead to rhabdomyolysis, or the sudden and overwhelming failure of the kidneys, which releases toxins that destroy muscle mass.
- Cocaine Withdrawal
Cocaine withdrawal is typically not dangerous, but it can be very uncomfortable. Many people who experience withdrawal without medical help and social support can relapse due to intense cravings. Symptoms of cocaine withdrawal include:
- Sickness and vomiting
- Hunger and overeating
- Extreme mood swings
- Exhaustion and fatigue
- Physical weakness
- Muscle or joint pain
- Sleep disturbances
- Suicidal ideation
- Trouble concentrating
- Slowed thinking
- Chills or tremors
Withdrawal from cocaine is rarely dangerous, although suicidal thoughts should be monitored closely by therapists and physicians. Continued abuse of cocaine causes many serious, long-lasting effects that can dramatically shorten life, if it doesn’t lead to overdose and death. As a result, it is important to get help to safely overcome cocaine addiction as soon as possible.
When a person ingests too much cocaine, they experience cocaine overdose, also sometimes called acute cocaine toxicity. Medical professionals report three phases of this condition. It is important to call 911 immediately for a person in any of these stages. There are no drugs that can reverse a cocaine overdose, so the only way to improve a person’s chances of survival is to get immediate medical attention.
The first phase of cocaine toxicity includes:
- Pupil dilation
- Grinding teeth
- Nausea and vomiting or heaving
- Tremor or twitching
- Pre-convulsive movements
- Increased blood pressure and/or slowed heart rate
- Increased breathing rate and depth
- Raised body temperature
- Euphoria, elation, or talking without making sense or completing thoughts
- Talking about impending doom
Many of these symptoms are very similar or slightly more extreme versions of the cocaine high. However, in the second phase of cocaine toxicity, symptoms change to:
- Hypertension that begins to affect the brain (malignant or hypertensive encephalopathy)
- Decreased responsiveness to stimuli
- Increased tendon reflexes
- Bluish tinge to the fingers, lips, and tip of the nose
- Weak, rapid pulse
- Hyperthermia, or extremely elevated body temperature
The third phase is the most extreme, and it can quickly lead to death. Symptoms include:
- Cardiac arrest
- Respiratory failure
Treatment for Cocaine Abuse
A combination of detox, medications, long-term psychotherapy, and social support is the typical treatment when a person works to overcome cocaine addiction. In order to enter some rehabilitation programs, the individual is required to successfully detox from the drug; some rehabilitation programs offer in-house detox programs. Once the individual has detoxed, they should continue into a comprehensive rehabilitation program so they can begin the bulk of addiction treatment.
There are no specific medications used to treat cocaine withdrawal or to help overcome the addiction. Some medications may be prescribed on an off-label basis, such as:
- Disulfiram, which is normally a prescription treatment for alcohol addiction
- Modanifil, which is typically prescribed to treat narcolepsy
- Lorcaserin, which is usually part of obesity treatment
A supervising physician or psychiatrist may also prescribe mood-stabilizing medications, including anti-anxiety or antidepressant drugs. These can help ease psychological tension as the individual enters therapy, and in some instances, they can also help overcome cravings for the drug.
The most common forms of therapy to help a person overcome cocaine addiction include:
- Cognitive Behavioral Therapy, which helps the person develop new, healthier coping mechanisms to manage stress or triggers
- Contingency Management, which provides non-drug rewards for people who maintain a drug-free lifestyle
- Group therapy, to help the person learn from others who have been through the same situation
The Road to Recovery
There are several inpatient and outpatient rehabilitation programs that offer significant help for people overcoming cocaine addiction. These programs typically offer therapy for individuals, groups, and families, as well as other forms of support. Some rehabilitation programs offer job and life skills training, while others include offerings of alternative or complementary therapies.