Cocaine
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Origins: The Coca Leaf
Cocaine is a psycho-stimulant derived from the leaves of the coca plant, a South American shrub (Erythroxylon coca), which is indigenous to Colombia, Peru and Bolivia. Coca grows abundantly in the lower altitudes of the Andes. It is also easily replanted and cultivated to other areas with a suitable climate such as northern Chile, Ecuador, the Amazon basin, Java, Sri Lanka and Taiwan.
The coca leaf has a rich and varied history. The coca leaf was considered a divine plant by the Incans, for example, which used it in traditional spiritual ceremonies. There are still indigenous peoples of South America, particularly on the western coast, who consider coca an essential part of religious practices. Used as a masticatory in Bolivia, coca is viewed as a means of honoring, invoking and communing with the earth mother, Pachamama. There is evidence that coca has also been an integral part of shamanic practices in South America. For example, the coca leaf has been used by shamans to enhance meditation, induce trance and facilitate communion with supernatural powers. Coca is also used by high attitude miners in South America for stamina and endurance as well as spiritual protection. Miners offer coca in various forms to the Tio, the devil of the mines, to appease the supernatural being while in the dangerous depths of the mines.
Coca is also considered to have many health benefits and is widely used in South America in such forms as infusions or teas. Coca used in these forms, and in other legal products such as food and candies, are considered to be without cocaine (cocaine was never extracted when used in the product) or to have been de-cocainized (the extracted cocaine was removed before making the product). As a source of nutrition coca leaves have been found to provide:
• Calories • Proteins • Fats • Carbohydrates • Calcium • Phosphorous • Iron • Vitamin A • Vitamin B1 • Vitamin PP • Vitamin C • Vitamin B2
Coca Chewing or Mastication
The extraction of cocaine from coca leaves requires the presence of an alkaloid such as lime, ash, baking soda, certain plants or other chemical compounds and processes. The traditional mastication (chewing) of coca leaves involves the use of the leaves in combination with another substance (alkaline in nature) which will extract the stimulant properties of the coca leaf when placed in the mouth between the teeth and cheek. This traditional use of the coca leaf is called acullico. The cocaine released in acullico is absorbed through the mucous membranes of the mouth and gastrointestinal system. It is stimulating, provides a sense of well-being, suppresses hunger, thirst and fatigue and compensates for the low oxygen content of high altitudes by providing respiratory stimulation. It is thought that coca leaves have been used for thousands of years and many modern natives of the Andes highlands are said to still use coca leaves daily, and throughout the day, for various purposes including acclimation to the altitude, overall health benefits, spirituality, nutrition and medicinal purposes.
Alkaloids of the Coca Leaf
Chemically, the psychoactive properties of the coca leaf are derived from the presence of tropane alkaloids within the coca leaf. The psychoactive chemical Benzoylmethylecgonine, one of these alkaloids, is commonly known as the cocaine alkaloid. It is classified as a tropane alkaloid which is found in the botanical families of Erythroxylaceae and Solanaceae. These plants include the coca leaf and some well known toxic plants including mandrake, datura and belladonna. Tropane alkaloids do have pharmacological uses including anticholinergic uses; however, at higher doses they are fatal. Symptoms of tropane alkaloid toxicity include:
• Ataxia
• Thirst
• Confusion, delirium
• Hallucinations
• Convulsions
• Coma
Along with Benzoylmethylecgonine, the cocaine alkaloid, other alkaloids have been isolated from the coca leaf. These include:
• benzoylecgonine
• benzoyltropine
• cinnamyl-cocaine
• cuscohygrine
• dihydroxy tropane | • hygrine
• hygroline
• methyl cocaine
• methyl ecgonidine
• nicotine
• tropa cocaine
• A- and B-truxilline
The Medicalization of Cocaine
In their South American colonization efforts, the Spanish conquistadors discovered the coca leaf and its many properties. The conquistadors found coca useful in suppressing the hunger and fatigue of indigenous people who were forced to work in the fields and mines of South America to further the colonization efforts of the Spaniards. As a result of its discovery by the conquistadors, the coca leaf was introduced to Europe in the 1500s by the returning Spaniards. Botanical information about the coca leaf, and the indigenous practices of South America involving the coca leaf, were chronicled by Nicolas Monardes, a Spanish botanist, in Seville in 1569. His work, Joyfull Newes out of the New Found Worlde, presented one of the first illustrations of the coca leaf seen outside of South America.
In 1609, Padre Blas Valera wrote of the medicinal properties of cocaine:
Coca protects the body from many ailments, and our doctors use it in powdered form to reduce the swelling of wounds, to strengthen broken bones, to expel cold from the body or prevent it from entering, and to cure rotten wounds or sores that are full of maggots. And if it does so much for outward ailments, will not its singular virtue have even greater effect in the entrails of those who eat it?
The chemical isolation of cocaine from coca leaves was done for the first time in 1855 by Friedrich Gaedcke, a German chemist. Gaedcke published his account of the process in the scientific journal, Archiv der Pharmagie. Although coca leaves and their effects had been known outside South America since the 16th century, the extraction of cocaine from the coca leaf did not occur for almost 200 years. This appears partially related to the difficulty in transporting coca leaves intact from South America. Additionally, the chemical processes required for the isolation of cocaine were not available for many years after the discovery of the coca leaf by the Spanish conquistadors.
Soon after its chemical isolation 1855, others began to research the coca leaf, its derivatives and potential uses in Europe. Albert Niemann, a student at the University of Gottingen in Germany, further improved the alkaloid isolation process in 1860 and is credited with having coined the term “cocaine”. The chemical isolation of cocaine soon led to the medicalization of cocaine with such uses as a spinal, ophthalmic, respiratory, nerve-block, and peridural anesthetic. Some 19th century researchers in the first medical uses of cocaine were:
• Vassili von Anrep who researched the analgesic properties of cocaine, 1879
• Carl Koller who used cocaine in ophthalmics, 1884
• Jellinek who used cocaine as a respiratory anesthesia, 1884
• Sigmund Freud research the psychiatric value of cocaine, 1885
• William Halsted used cocaine as a nerve-block anesthesia, 1885
• James Corning who used cocaine as a peridural anesthesia, 1885
• Heinrich Quincke who used cocaine as a spinal anesthesia, 1898
Introduction of Cocaine into the Popular Culture of the United States and Europe
In the 19th century, not long after the isolation process for cocaine was created, products containing cocaine were marketed in the United States and Europe. In 1863, for example, Angelo Mariarni created cocawine sold as Vin Mariani in which coca leaves were combined with ethanol to extract cocaine from the coca leaf.
In 1885, cocaine was sold by the Park-Davis Pharmaceutical Company in cigarettes, powder and an injectible form packaged along with a syringe and needle.
In 1885 John Stith Pemberton, a druggist living in Atlanta, created and marketed Pemberton's French Wine Coca, a drink advertised as an beverage for the intellect and brain as well as an aid to overcoming morphine addiction. This beverage was alcohol-based and problematic in light of the growing temperance movement in the United States. Consequently, Pemberton produced a non-alcoholic beverage, Coca-Cola, in 1886. At that time, Coca-Cola was considered a patent medicine and advertised as treatment for several maladies including headaches, neuralgia, hysteria and melancholy. It was made with the use of fresh coca leaves, but a negative public opinion about cocaine just after the turn of the century led the manufacturers of Coca-Cola to use de-cocainized coca leaves. The manufacturers also stopped advertising Coca-Cola as medicinal and began to promote it as a beverage.
At the turn of the 20th century, cocaine was available in the United States in some drugstores as powder and tablets marketed as a stimulant. There were other cocaine products sold with curative claims during that time such as those marketed as health tonics, toothache remedies, antidepressants and hay fever and catarrh remedies.
Modern Products Containing Coca Leaf
Products containing the coca leaf are still available today from South America with many online sites offering them. Such products are sold as:
• coca leaf teas
• coca leaf powder
• coca leaf capsules
• coca soap
• coca honey
• coca jam
• liquor
• wine
• shampoo
• Candy
• Cookies
• Noodles
• jewelry
The benefits of such contemporary coca leaf products are listed by marketers as:
• antioxidant • dietary supplement • decreasing fatigue • suppressing appetite • elevating mood • combating altitude sickness
Regulation of Cocaine as a Narcotic
The U.S. Comprehensive Drug Abuse Prevention & Control Act (commonly referred to as the Controlled Substances Act) went into effect in 1970. As a result, cocaine was designated as a Schedule II drug. A Schedule II drug is a substance or therapeutic agent considered to have a high abuse potential or potential for severe psychological and/or physical dependence. These drugs are considered to have legal and appropriate medical uses, however, and can be legally administered by a physician within strict governmental guidelines governing their uses. Cocaine is, for example, sometimes used in medicine as a local anesthesia. Schedule II drugs are described by the U. S. Drug Enforcement Administration DEA as:
Any of the following substances whether produced directly or indirectly by extraction from substances of vegetable origin, or independently by means of chemical synthesis, or by a combination of extraction and chemical synthesis:
(1) Opium and opiate, and any salt, compound, derivative, or preparation of opium or opiate.
(2) Any salt, compound, derivative, or preparation thereof which is chemically equivalent or identical with any of the substances referred to in clause (1), except that these substances shall not include the isoquinoline alkaloids of opium.
(3) Opium poppy and poppy straw.
(4) coca … leaves, except coca leaves and extracts of coca leaves from which cocaine, ecgonine, and derivatives of ecgonine or their salts have been removed; cocaine, its salts, optical and geometric isomers, and salts of isomers; ecgonine, its derivatives, their salts, isomers, and salts of isomers; or any compound, mixture, or preparation which contains any quantity of any of the substances referred to in this paragraph.
While cocaine is addressed by the International Narcotics Control Board it does not meet the common use of the word to describe a drug that “lulls” or induces sleep or stupor. Conversely, cocaine is described by NIDA and the U.S. Drug Enforcement Agency as a stimulant that elevates mood and increases energy and alertness, produces exhilaration, extended wakefulness, and loss of appetite. Cocaine is generally regarded to be in the same class as other stimulants such as methamphetamine and amphetamines as well as the more commonly used nicotine and caffeine.
The importation of coca leaves is addressed and controlled by the Drug Enforcement Administration (DEA) under the U.S. Controlled Substance Act or Title 21, Chapter 13. The Control and Enforcement subsection of the act addresses governmental control and enforcement of scheduled substances.
Since cocaine is derived from the coca leaf which is not native to the U.S., this statue addresses the importation of cocaine and coca leaves to the U.S. The importation of Schedule II substances is prohibited with specific exceptions. Exceptions that relate to cocaine and coca leaves are stated as:
• That “such amounts of…coca leaves as the Attorney General finds to be necessary to provide for medical, scientific, or other legitimate purposes” may be imported (Subsection a).
• Coca leaves
In addition to the amount of coca leaves authorized to be imported into the United States under subsection (a) of this section, the Attorney General may permit the importation of additional amounts of coca leaves. All cocaine and ecgonine (and all salts, derivatives, and preparations from which cocaine or ecgonine may be synthesized or made) contained in such additional amounts of coca leaves imported under this subsection shall be destroyed under the supervision of an authorized representative of the Attorney General (subsection c)”
Crime and Cocaine
U.S. governmental surveys have reported that the distribution and use of cocaine in the United States negatively impacts the country far more than does any other drug. In 2008, for example, most law enforcement agents in the United States reported cocaine to be the primary drug problem in their jurisdictions. These agents identify cocaine as contributing to violent crimes and crimes against property. In the same year, the majority of drug related arrests made by the DEA were cocaine-related.
It was estimated in 2007 that between 545 to 707 metric tons of cocaine left South America destined for the United States market. Shipping off the Pacific coast of South America and Central America, cocaine has been transported by various means including aircraft, boat, semi-submersibles and submersible vessels.
The DEA identifies cocaine trafficking as the primary drug-related threat to the United States. It is believed that the majority of the cocaine entering the United States originates in Colombia, Peru and Bolivia. It is also believed that the majority of cocaine enters the United States through Mexico.
Attempts made by the United States to curb cocaine trafficking have targeted various aspects of the cocaine trade including cocaine production, transportation and distribution. Efforts have been made, for example, to eradicate coca crops in the South America Andean region where coca plants have been sprayed with herbicides as well as destroyed manually in programs funded by the United States. Colombia is considered by the CIA to be the world's leading cultivator of coca leaves, cocaine and coca derivatives. Colombia is also cited as supplying cocaine to all the primary cocaine markets within the United States and internationally. Colombia has experienced aggressive Coca eradication efforts but crops have been replanted in that country continues to lead the world.
Peru is the second largest producer of the coca leaf and cocaine in the world and Bolivia is considered to be the third largest. Coca crop eradication has also been aggressive in these countries, but overall cultivation and production of cocaine has increased.
Additional efforts by the United States to curb cocaine trafficking have been targeting the transportation of cocaine across the border between the United States and Mexico. The United States also employs many counterdrug operations utilizing alliances with other countries, military resources and intelligence operations.
Cocaine as an Illicit Drug
There are two chemical forms of cocaine used illicitly. These are the hydrochloric salt or powder (Benzoylmethylecgonine) which can be used intranasally (snorted or inhaled) or as a soluble which can be injected intravenously and crack cocaine, a freebase substance (heated cocaine in ether or other solvent to extract a precipitant), derived from powder cocaine which is smoked. Both forms of illicitly used cocaine are considered scheduled II controlled substances in the USA.
The effects of cocaine and the duration of effects depend upon the route of administration and how rapidly the cocaine enters the bloodstream. There are three common forms of abuse. These are:
• Intranasal (snorting)
• Smoking (inhalation)
• Injection
Intranasal or Snorting
Cocaine powder is inhaled (snorted) through the nose and is absorbed into the bloodstream through the mucous membranes of the nasal cavity. Effects of intranasal use last from approximately 3-60 minutes. It is estimated that approximately 60 to 80% of the cocaine used is absorbed.
Smoking or Inhalation
Most typically smoked as “crack," cocaine is absorbed into the bloodstream in approximately 10 seconds with its effects lasting approximately 5 to 10 minutes. Cocaine in this form is the most inexpensive to manufacture and use.
Injection
Cocaine powder is dissolved and injected by needle directly into the bloodstream. The effects are similar to intranasal use.
Cocaine Absorption
Cocaine is lipid soluble and consequently can be absorbed by all body tissues. Chronic use can result in central nervous system deposits. Additionally, cocaine crosses the blood brain barrier and the placenta. Laboratory tests can detect cocaine for up to 2 to 5 days in urine and blood and for approximately 90 days in hair samples. The meconium of newborn infants can detect cocaine use in the mother during the last 4 to 5 months of pregnancy.
Effects of Cocaine
The effects of cocaine are dependent upon several factors including individual susceptibility, dosage and route of administration. The typical effects of cocaine intoxication are euphoria, increased energy, decreased need for sleep and suppressed appetite. As a nervous system stimulant, cocaine significantly increases levels within the brain of the neurotransmitter dopamine. The brain's normal dopamine cycle is interrupted by cocaine, allowing excessive amounts of the neurotransmitter to accumulate without its typical rate of re-absorption. Consequently, the regulation of the brain's reward center is adversely affected. This accounts for the intoxicating euphoric effect of cocaine use as well as its strong addictive potential and the eventual decreasing euphoric effects of chronic use.
Symptoms of cocaine intoxication given by the Diagnostic and Statistical Manual (DSM-IV) include:
• rapid or irregular heartbeat
• dilation of pupils
• dysregulation of blood pressure
• agitation
• respiratory distress
• sweating
• nausea or vomiting
• muscular weakness
• dystonia
• involuntary muscle movement
• confusion
• seizure
• coma
Symptoms of cocaine withdrawal are typically considered to occur with a reduction or cessation of cocaine after significant and prolonged use. Symptoms can include:
• fatigue
• irritability
• restlessness
• sleep disturbance
• depressed mood
• lethargy
• agitation
• increased appetite
Effects of Prolonged Cocaine Use
Prolonged cocaine use has many potential adverse effects including physiological, psychological, legal, financial and social consequences. Chief among the adverse physiological effects of cocaine is the potential for users to develop the addictive disorders of Cocaine Abuse and Cocaine Dependence. The symptoms of these disorders and the lifestyle accompanying abuse and dependence affect individual functioning across all realms. Cocaine use remains illegal in the United States and cocaine users routinely run the risk of legal sanctions. Financial and social consequences of cocaine use can be catastrophic for individuals and families due to the strength of obsession and compulsion involved in cocaine dependence.
Cocaine Abuse and Dependence
Cocaine abuse and dependence are described in the DSM-IV as frequently occurring even with limited exposure due to the powerful euphoric effects and short half-life of cocaine. Individuals who use cocaine habitually require frequent dosing in order to maintain euphoria because its effects quickly dissipate. Psychological factors involved in abuse and dependence include effects of cocaine intoxication that gives its user feelings of increased confidence, competence, mental clarity, enhanced sexual abilities, enhanced social ease, and a sense of well-being, elevated mood and endurance. The psychological effects of cocaine enhance the obsession with and the compulsion to use the substance.
Cocaine Abuse is considered a Substance Disorder and to be the first phase of Cocaine Dependence. Cocaine abuse is the phase of cocaine use in which use has become problematic. It is considered a medical type diagnosis. The diagnostic criteria for Cocaine Abuse involves a pattern of cocaine use over a 12 month period that leads to significant impairment or distress as indicated by the presence of at least one of the following:
• recurring use of cocaine that results in the neglect of major obligations
• recurring use of cocaine and potentially hazardous situations such as when driving
• recurring use of cocaine related legal problems
• recurring use of cocaine despite cocaine-related social or relationship problems
Cocaine Dependence
Prolonged use of cocaine results in another form of a Cocaine Disorder called Cocaine Dependence or more commonly, cocaine addiction. Cocaine Dependence is considered to be a disease process in which physiological dependence has been activated by cocaine use.
The diagnostic criteria for Cocaine Dependence involves a pattern of cocaine use over a 12 month period that leads to significant impairment or distress as indicated the presence of at least three of the following cocaine-related symptoms:
• physiological tolerance
• withdrawal symptoms
• use of progressively larger amounts
• use of cocaine over progressively extended periods
• a persistent desire for use
• a persistent desire to control or stop the use
• unsuccessful efforts to control or stop the use
• time spent obtaining, using a recovery from use of cocaine
• forgoing social, occupational or recreational activities because of cocaine use
• continuing to use cocaine despite cocaine related problems
Psychiatric Complications of Cocaine Use
Psychiatric complications can occur with cocaine use, abuse and dependence. These may involve clinically significant levels of conditions such as depression and psychosis. These conditions vary in severity and at times such complications require psychiatric treatment and/or hospitalization. Some of the psychiatric symptoms associated with prolonged cocaine use include:
• extreme anxiety
• paranoia
• hallucinations
• delusions
• severe agitation
• insomnia
• depression
• suicidality
• aggression
Additionally, there are specific and distinct psychiatric disorders that are reactive to cocaine use. These include:
• Cocaine Intoxication Delirium
• Cocaine-Induced Psychotic Disorder
• Cocaine-Induced Anxiety Disorder
• Cocaine-Induced Sexual Dysfunction
• Cocaine-Induced Sleep Disorder
Cocaine Intoxication Delirium
Cocaine Intoxication Delirium occurs during cocaine intoxication that has resulted from ingestion of high doses of the substance. This diagnosis is given when there is evidence of cocaine intoxication and cognitive impairments during intoxication. The cognitive impairments experienced in Cocaine Intoxication Delirium are significantly more pronounced than are expected in cocaine intoxication. The symptoms of
Cocaine Intoxication Delirium include:
• reduced mental processes such as the ability to maintain focus, attention and concentration
• reduced awareness of the environment
• confusion
• disorientation
• disturbance in language abilities
• memory loss
Cocaine Intoxication Delirium typically resolves as intoxication subsides, however, a person experiencing this disorder may require therapeutic support and assistance for personal safety.
Cocaine-Induced Psychotic Disorder
The physiological effects of cocaine may cause a Cocaine-Induced Psychotic Disorder in which an individual experiences hallucinations or delusions as a direct result of cocaine use. This disorder may mimic other psychotic disorders such as schizophrenia that occurs without the presence of such a severe mental illness. Cocaine-Induced Psychotic Disorder is categorized by the subtypes of Cocaine-Induced Psychotic Disorder with Delusions or Cocaine-Induced Psychotic Disorder with Hallucinations. Psychotic symptoms may occur during cocaine intoxication, acute cocaine withdrawal or the post-acute withdrawal phase of cocaine use for up to one month after last use. Diagnostic specifiers are used to indicate whether these psychotic symptoms have occurred during intoxication or during withdrawal from cocaine use. Individuals are typically not given this diagnosis if psychotic symptoms have existed prior to cocaine use.
Treatment can involve the use of a therapeutic environment to protect the safety of an individual with this disorder as well as the use of psychotropic medications to resolve the psychotic symptoms.
Cocaine-Induced Anxiety Disorder
The direct physiological effects of cocaine use may cause a Cocaine-Induced Anxiety Disorder during which an individual experiences the following:
• clinically significant anxiety
• panic attacks
• obsessions
• compulsions
This diagnosis is given if an individual has used cocaine within one month prior to the onset of symptoms and if there has not been another pre-existing anxiety disorder. The subtypes of a Cocaine-Induced Anxiety Disorder are:
• Cocaine-Induced Anxiety Disorder with Generalized Anxiety
• Cocaine-Induced Anxiety Disorder with Panic Attacks
• Cocaine-Induced Anxiety Disorder with Obsessive-Compulsive Symptoms
• Cocaine-Induced Anxiety Disorder with Phobic Symptoms
This disorder is specified in type by indication of when the cocaine-induced anxiety symptoms began: With Onset During Intoxication or With Onset During Withdrawal.
Treatment of cocaine-induced anxiety disorder can require hospitalization if the anxiety symptoms are severe enough to impair daily functioning; however, these disorders can be treated in outpatient psychiatric settings with counseling and psychotropic medications.
Cocaine-Induced Sexual Dysfunction
Cocaine-Induced Sexual Dysfunction is a disorder directly caused by the physiological effects of cocaine in which there is significant sexual dysfunction that causes distress or interpersonal difficulty. This diagnosis is given if there has been cocaine use within one month of the presenting symptoms and there is not a pre-existing Sexual Dysfunction Disorder. The onset of Cocaine-Induced Sexual Dysfunction Disorder, however, is commonly during intoxication and may include symptoms of impaired sexual desire, arousal and orgasm as well as the experience of pain during sex.
The subtypes of Cocaine-Induced Sexual Dysfunction Disorder are specified as:
• Cocaine-Induced Sexual Dysfunction with Impaired Desire
• Cocaine-Induced Sexual Dysfunction with Impaired Arousal
• Cocaine Induced Sexual Dysfunction with Impaired Orgasm
• Cocaine-Induced Sexual Dysfunction or Sexual Pain
Cocaine-Induced Sleep Disorder
The Cocaine-Induced Sleep Disorder is a condition in which there is a clinically significant disturbance in sleep as a direct result of the use of cocaine, intoxication with cocaine, acute withdrawal or post-acute withdrawal. This diagnosis is given if there has been cocaine use within one month of the onset of symptoms, if there is not the presence of another Sleep Disorder and if the symptoms are not what are to be expected during intoxication or withdrawal from cocaine. The subtypes of Cocaine-Induced Sleep Disorder are:
• Cocaine-Induced Sleep Disorder, Insomnia Type (inadequate sleep)
• Cocaine-Induced Sleep Disorder, Hypersomnia Type (excessive sleeping)
• Cocaine-Induced Sleep Disorder, Parasomnia Type (experience of abnormal movement or activity during sleep such as nightmares, night terrors and sleepwalking)
• Cocaine-Induced Sleep Disorder, Mixed Type (more than one type of sleep disturbance is present)
Cocaine Use in Pregnancy
The use of cocaine by pregnant women poses significant health risk to both mother and unborn child. Because cocaine crosses the placenta, an unborn child is exposed to cocaine use by the mother. There are potentially severe and profound medical risks of cocaine use by pregnant women. Some of these are:
• stillbirth
• spontaneous abortion-- miscarriage
• fetal stroke
• premature birth
• placental abruption -- the placenta detaches prematurely from the uterine wall
• low birth weight
• birth defects
Cocaine-related birth defects present in children exposed to cocaine in utero can be severe, debilitating and even life-threatening. Some of these can include malformations of the:
skull • face • brain • heart • arms and legs • intestines • urinary tract • genitals
Unborn babies exposed to cocaine in utero may become cocaine dependent and experience cocaine withdrawal at birth. Some of the symptoms of a newborn’s cocaine withdrawal are:
• unresponsiveness
• poor sleep
• restlessness
• tremors
• unusual crying
• feeding problems
• diarrhea
• muscle spasms
• abnormal reflexes
• vomiting
• seizures
Course of Cocaine Abuse and Cocaine Dependence
Cocaine use in the disorders of Cocaine Abuse and Cocaine Dependence can range from daily to episodic use. Some individuals, for example, use continuously throughout the day over long periods of time, while others may use continuously throughout the day during an episode of use. The stimulant effects of cocaine typically result in binging in which there is high and/or frequent dosing followed by periods of non-use and recovery from use, however, some individuals use cocaine daily with increasing tolerance over a period of time.
All individuals who use cocaine over a prolonged period of time will experience increased tolerance for the substance. It is common for cocaine use during an episode to stop only when the supply of the substance is exhausted. The route of administration is directly linked to the speed of the progression of addictive illness. Smoked and injectible cocaine users progress more rapidly into dependence than those who use intranasally, but all cocaine users do progress to cocaine dependence with prolonged use.
Treatment of Cocaine Abuse and Cocaine Dependence
Cocaine Abuse and Cocaine Dependence are often treated in inpatient settings such as a drug rehab that treats Substance Use Disorders. These treatment programs typically facilitate withdrawal and detoxification, psychoeducation about the substance, course of recovery, relapse prevention planning and identification of resources in the community to maintain recovery efforts after discharge. Counseling (individual, group and family) and behavioral interventions are often used to help individuals identify the dynamics of cocaine-related behaviors, cocaine-related thinking patterns and emotional responses along with alternate coping strategies that support continued abstinence from cocaine.
There are medications that may be useful in reducing the craving for cocaine, but none are widely used as a best medical practice in the treatment of cocaine use disorders. Some medications that have been used to reduce cocaine craving are:
• baclofen
Cocaine Detoxification
Detoxification from cocaine is considered a medical procedure. Individuals in the acute phase of withdrawal are monitored for such medical issues as hypertension and seizure as well as psychiatric issues such as clinical depression and suicidality. Mood disturbance and anxiety, palpitations and sweating are common withdrawal symptoms for which medications are sometimes used. Antidepressants and tranquilizers as well as antidyskinetics (such as amantadine) can be used to alleviate withdrawal symptoms and such complications.
12-Step Programs
Self-help efforts such as the use of a 12-step program like Cocaine Anonymous are commonly considered to be beneficial to those recovering from cocaine disorders. Cocaine Anonymous was formed in Los Angeles, California in 1982 and utilizes the principles of Alcoholics Anonymous. It provides literature specific to cocaine addiction and recovery such as Hope, Faith and Courage: Stories from the Fellowship of Cocaine Anonymous and various pamphlets about cocaine and recovery.
Narcotics Anonymous is another 12-step program in which individuals with cocaine disorders may find support for recovery efforts. Also based on the principles of Alcoholics Anonymous, Narcotics Anonymous was founded in the 1950s in Los Angeles, California. The Narcotics Anonymous, Basic Text and other literature provide information about recovery from addiction to all drugs including cocaine.
