Cocaine is a powerfully addictive stimulant drug. The powdered
hydrochloride salt form of cocaine can be snorted or dissolved in water
and injected. Crack is cocaine base that has not been neutralized by an
acid to make the hydrochloride salt. This form of cocaine comes in a
rock crystal that is heated to produce vapors, which are smoked. The
term “crack” refers to the crackling sound produced by the rock as it
is heated.
How is Cocaine Abused?
Three routes of
administration are commonly used for cocaine: snorting, injecting, and
smoking. Snorting is the process of inhaling cocaine powder through the
nose, where it is absorbed into the bloodstream through the nasal
tissues. Injecting is the use of a needle to release the drug directly
into the bloodstream. Smoking involves inhaling cocaine vapor or smoke
into the lungs, where absorption into the bloodstream is as rapid as by
injection. All three methods of cocaine abuse can lead to addiction and
other severe health problems, including increasing the risk of
contracting HIV and infectious diseases.
The intensity and
duration of cocaine’s effects, which include increased energy, reduced
fatigue, and mental alertness, depend on the route of drug
administration. The faster cocaine is absorbed into the bloodstream and
delivered to the brain, the more intense the high. Injecting or smoking
cocaine produces a quicker, stronger high than snorting. On the other
hand, faster absorption usually means shorter duration of action. The
high from snorting cocaine may last 15 to 30 minutes, but the high from
smoking may last only 5 to 10 minutes. In order to sustain the high, a
cocaine abuser has to administer the drug again. For this reason,
cocaine is sometimes abused in binges—taken repeatedly within a
relatively short period of time, at increasingly high doses.
How Does Cocaine Affect the Brain?
Cocaine
is a strong central nervous system stimulant that increases levels of
dopamine, a brain chemical associated with pleasure and movement, in
the brain’s reward circuit. Certain brain cells, or neurons, use
dopamine to communicate. Normally, dopamine is released by a neuron in
response to a pleasurable signal (e.g., the smell of good food), and
then recycled back into the cell that released it, shutting off the
signal between neurons. Cocaine acts by preventing the dopamine from
being recycled, causing excessive amounts of dopamine to build up,
amplifying the message, and ultimately disrupting normal communication.
It is this excess of dopamine that is responsible for cocaine’s
euphoric effects. With repeated use, cocaine can cause long-term
changes in the brain’s reward system and in other brain systems as
well, which may eventually lead to addiction. With repeated use,
tolerance to the cocaine high also often develops. Many cocaine abusers
report that they seek but fail to achieve as much pleasure as they did
from their first exposure. Some users will increase their dose in an
attempt to intensify and prolong the euphoria, but this can also
increase the risk of adverse psychological or physiological effects.
What Adverse Effects Does Cocaine Have on Health?
Abusing
cocaine has a variety of adverse effects on the body. For example,
cocaine constricts blood vessels, dilates pupils, and increases body
temperature, heart rate, and blood pressure. It can also cause
headaches and gastrointestinal complications such as abdominal pain and
nausea. Because cocaine tends to decrease appetite, chronic users can
become malnourished as well.
Different methods of taking cocaine
can produce different adverse effects. Regularly snorting cocaine, for
example, can lead to loss of the sense of smell, nosebleeds, problems
with swallowing, hoarseness, and a chronically runny nose. Ingesting
cocaine can cause severe bowel gangrene as a result of reduced blood
flow. Injecting cocaine can bring about severe allergic reactions and
increased risk for contracting HIV and other blood-borne diseases.
Binge patterns of use may lead to irritability, restlessness, anxiety,
and paranoia. Cocaine abusers can suffer a temporary state of
full-blown paranoid psychosis, in which they lose touch with reality
and experience auditory hallucinations.
Regardless of how or how
frequently cocaine is used, a user can experience acute cardiovascular
or cerebrovascular emergencies, such as a heart attack or stroke, which
may cause sudden death. Cocaine-related deaths are often a result of
cardiac arrest or seizure followed by respiratory arrest.
Added Danger: Cocaethylene
When
people consume cocaine and alcohol together, they compound the danger
each drug poses and unknowingly perform a complex chemical experiment
within their bodies. Researchers have found that the human liver
combines cocaine and alcohol to produce a third substance,
cocaethylene, which intensifies cocaine’s euphoric effects.
Cocaethylene is associated with a greater risk of sudden death than
cocaine alone.1
What Treatment Options Exist?
Behavioral
interventions—particularly, cognitive-behavioral therapy—have been
shown to be effective for decreasing cocaine use and preventing
relapse. Treatment must be tailored to the individual patient’s needs
in order to optimize outcomes—this often involves a combination of
treatment, social supports, and other services.
Currently, there
are no medications for treating cocaine addiction, so this remains one
of NIDA’s top research priorities. Researchers are looking for
medications that help alleviate the severe craving experienced by
people in treatment for cocaine addiction, as well as medications to
counteract other triggers of relapse, such as stress. Several compounds
are currently being investigated for their safety and efficacy,
including a vaccine that would sequester cocaine in the bloodstream and
prevent it from reaching the brain. Research so far suggests that
addiction medications are most effective when used as a part of a
comprehensive treatment program.
How Widespread is Cocaine Abuse?
Monitoring the Future Survey*
According
to the 2007 Monitoring the Future survey—a national survey of 8th-,
10th-, and 12th-graders—cocaine use among students did not increase
significantly, though it remained at unacceptably high levels: 3.1
percent of 8th-graders, 5.3 percent of 10th-graders, and 7.8 percent of
12th-graders have tried cocaine; 0.9 percent of 8th-graders, 1.3
percent of 10th-graders, and 2.0 percent of 12th-graders were current
(past-month) cocaine users.
Use of Cocaine in Any Form by Students
2007 Monitoring the Future Survey
| |
8th-Graders |
10th-Graders |
12th-Graders |
| Lifetime** |
3.1% |
5.3% |
7.8% |
| Past Year |
2.0 |
3.4 |
5.2 |
| Past Month |
0.9 |
1.3 |
2.0 |
|
2007 Monitoring the Future Survey
| |
8th-Graders |
10th-Graders |
12th-Graders |
| Lifetime** |
2.1% |
2.3% |
3.2% |
| Past Year |
1.3 |
1.3 |
1.9 |
| Past Month |
0.6 |
0.5 |
0.9 |
|
National Survey on Drug Use and Health (NSDUH)***
According
to the 2006 National Survey on Drug Use and Health, 35.3 million
Americans aged 12 and older reported having used cocaine, and 8.5
million reported having used crack. An estimated 2.4 million Americans
were current (past-month) users of cocaine; 702,000 were current users
of crack. There were an estimated 977,000 new users of cocaine in
2006—most were 18 or older when they first used cocaine. Among young
adults aged 18 to 25, the past-year use rate was 6.9 percent, showing
no significant difference from the previous year.
Source: National Institute of Drug Abuse
Dr. Jeffrey Speller
Dr. Tanya Korkosz
Psychopharmacology Associates of New England
www.psychopharmassociates.com
