Let us first mention that cocaine (as well as amphetamines) ranks among the agents called stimulants of the central nervous system . While much of the information presented here also applies to alcohol and other drug dependence, there is some data specifically relevant to this family of chemical agents.
Substance abuse occurs when the user repeatedly fails to meet his obligations at work, at school or at home. Or that he uses the substance despite physical danger, judicial problems, or that it leads to social or interpersonal problems.
The dependence is characterized by tolerance, that is to say that the quantity of product necessary to obtain the same effect increases; withdrawal symptoms during cessation of consumption, escalation in the amounts and frequency of use. The user devotes much of his time to consumer-related activities and continues despite significant negative consequences.
Addiction is the pursuit of consuming a substance compulsively without regard to the negative consequences (social, psychological and physiological) of this consumption. Dependence seems to develop when repeated use of the substance changes certain neurons (nerve cells) of the brain. Neurons are known to release neurotransmitters (various chemical substances) to communicate with each other; each neuron can release neurotransmitters and receive them (by means of receptors). It is believed that these stimulants cause a physiological change in some neuron receptors, affecting their overall functioning. These can never recover completely, even when stopping consumption. Furthermore, dopamine, norepinephrine and serotonin.
Dopamine. It is normally released by neurons to activate reflexes of satisfaction and reward. Dopamine seems to be the main neurotransmitter related to the problem of dependence, because satisfaction reflexes are no longer normally triggered in the brain by cocaine users.
Norepinephrine. Normally released in response to stress, it causes an increase in heart rate, elevated blood pressure and other symptoms resembling those of hypertension. The subject experiences an increase in motor activity, with slight tremor in the extremities.
Serotonin. Serotonin helps regulate mood, appetite and sleep. It has a calming effect on the body.
Recent research indicates that addictive drugs impair brain function in a way that persists after the person has stopped using. The health, social and labor difficulties that often accompany the abuse of these substances do not necessarily end at the cessation of consumption. Specialists see addiction as a chronic problem. It seems that cocaine is the drug that presents a greater risk of dependence, and this, because of its powerful euphoric effect and its speed of action.
Origin of cocaine
The leaves of Erythroxylon coca, a plant native to Peru and Bolivia, were chewed by Amerindian peoples and by conquistadors who appreciated its tonic effect. This plant also helped to reduce the feeling of hunger and thirst. It was only towards the middle of the XIX century that is extracted pure cocaine this plant. At that time, doctors used it as a tonic substance in many remedies. The harmful consequences were not known. Thomas Edison and Sigmund Freud are two famous users. Its presence as an ingredient in the original drink “Coca-Cola” is probably the best known (the drink has been free for several years).
Forms of cocaine
People who abuse cocaine use it in one of two forms: cocaine hydrochloride and crack (freebase). Cocaine hydrochloride is a white powder that can be sniffed, smoked or dissolved in water and then injected intravenously. The crack is obtained by a chemical transformation of cocaine hydrochloride to obtain a hard paste that is smoked.
Prevalence of dependency
The National Institute on Drug Abuse of the United States (NIDA) states that the total number of cocaine and crack use has declined for ten years. Overdose of cocaine is the most important cause of drug-related admissions in hospitals in the United States and Europe. According to Canadian survey data, the prevalence of cocaine use in the Canadian population in 1997 was 0.7%, the same rate as in the United States. This is down from 3% in 1985, which was the highest rate reported. According to these same surveys, men are twice as likely to report using cocaine as women.
The symptoms of cocaine addiction
The physiological and psychological signs associated with the use of cocaine are attributable to its powerful stimulating effects on the nervous, cardiovascular, gastrointestinal and respiratory systems of the body.
- Particular signs related to the use of cocaine:
– a feeling of euphoria;
– a state of contemplation;
– an energy boost;
– an acceleration of speech;
– reducing the need to sleep and eat;
– sometimes, a facility to perform intellectual and physical tasks, but with a loss of judgment;
– accelerated heart rate;
– elevation of blood pressure;
– faster breathing;
– dry mouth.
|The effects of cocaine increase with the dose. The feeling of euphoria can intensify and create strong agitation, anxiety and, in some cases, paranoia. Large doses can cause serious harm and life.|
Health risks of long-term use
- Risks to the consumer:
– certain allergic reactions;
– loss of appetite and weight;
– damage to the cells of the liver and lungs;
– problems with the respiratory tract (chronic nasal congestion, permanent damage to the nasal septum cartilage, loss of sense of smell, difficulty in swallowing);
– cardiovascular problems (increased blood pressure, irregular heartbeat, ventricular fibrillation, convulsions, coma, cardiac arrest with sudden death, with as little as a single dose of 20 mg);
– pulmonary problems (chest pain, respiratory arrest);
– neurological problems (headaches, excitability, deep depression, suicidal thoughts);
– gastrointestinal problems (abdominal pain, nausea);
– Hepatitis C due to the exchange of needles;
– HIV infection (cocaine users are more likely to engage in risky behaviors, such as needle exchange and unprotected sex).
Cocaine can also lead to complications related to certain health problems if the person is already suffering from them (in particular: liver diseases, Tourette’s syndrome, and hyperthyroidism).
It should also be noted that the cocaine-alcohol combination is the most common cause of drug-related mortality.
- Risks to the fetus:
– death (spontaneous abortion);
– premature birth;
– physiological abnormalities;
– less than normal weight and height;
– in the long term: sleep and behavior problems.
- Risks for the breast fed baby (cocaine passes into breast milk):
– elevation of blood pressure;
– accelerated heart rate;
– respiratory problems;
– unusual irritability.
- Side effects of weaning:
– depression, excessive drowsiness, exhaustion, headache, hunger, irritability and difficulty concentrating;
– in some cases, suicide attempts, paranoia and loss of contact with reality (psychotic delirium).
People at risk
- Current data shows that people showing a lack of self-confidence, emotional addiction or a passive-aggressive attitude are more likely to become addicted to drugs.
- Researchers have not yet found a “gene for addiction”, but believe that a genetic factor may be involved. People who have a genetic deficiency in the dopamine D2 receptor seem more at risk.
Because of its extremely rapid modifying effect on neurons, cocaine can cause very strong physical and psychic dependence after very few or even one use.
Medical treatment of cocaine addiction
According to the National Institute on Drug Abuse (NIDA), a care strategy must take into account all aspects of addiction; consequently, treatments must affect both biology and behavior and the social context. Treatments should be tailored to each individual because no treatment can apply to all people. By the way, according to an article published in the medical journal The Lancet, in 1996: “It is unrealistic to expect cure after treatment, any more than it would be for any chronic illness. Sustained changes in addictive drug use remain after weaning and require ongoing maintenance treatment – whether psychosocial, pharmacological, or both.
The classic approach has two aspects
To achieve weaning, it is obviously necessary first of all to stop consuming and to use the necessary means to no longer be in contact with the substance. If withdrawal leads to serious manifestations (psychotic delirium or depression), it is necessary to consult a doctor. Treatment for addiction includes medications and behavioral interventions.
For the moment, there is no pharmacological treatment of addiction. In contrast, medications have been shown to be effective in treating certain side effects during withdrawal, such as depression or seizures. These include antidepressants, dopamine regulators (amantadine, apomorphine, bromocriptine) and anticonvulsants. Amongst users addicted to both opioids (eg, heroin) and cocaine, studies have shown that methadone can help reduce cocaine consumption.
It is then to find a psychotherapeutic help to prevent relapses.
The cognitive behavioral therapy , also called the approach “behavioral” is based on the idea that learning processes play a key role in the development of maladaptive behavior; therefore, anyone can unlearn one behavior and learn another, better suited (to their current needs). New behaviors learned during counseling allow the individual to use the appropriate strategy (different from one person to another) to:
– avoid contact with the substance;
– cope with cravings;
– recognize the warning signs of a state of lack and find ways to avoid it;
– resist the impulse to consume again.
According to the NIDA, experience shows that the skills acquired during therapies of this type remain accessible to addicts after the end of their treatment. In many cases, counseling with family members and loved ones is also necessary to help them communicate appropriately with and support the addicted person.
NIDA also recommends psychotherapy sessions specifically tailored to the needs of addicts. Emphasis should be placed on the role of drugs in relation to feelings and behaviors, and finding solutions without resorting to drugs. The approach should cover two components:
– support to help people talk about their personal experiences;
– communication skills to help people identify and deal with issues of interpersonal relationships.
Peer support (other addicts who no longer consume) is important in the recovery process. Most support groups use the 12-step approach, developed decades ago for alcoholics and practiced extensively around the world for all kinds of addictions. For cocaine users, the movement is called Narcotics Anonymous (NA). There are more than 350 NA groups in Quebec, and nearly 20,000 around the world, holding meetings at least once a week. The 12-step work includes an analysis of the psychological roots of addiction.
Note. For people who are highly addicted or who have serious psychosocial problems related to their substance abuse, stays in a drug rehabilitation center can combine withdrawal, counseling and support group in the same environment under supervision.