Cocaine is no stranger to pop culture.

Many people associate cocaine use with successful business moguls like the Jordan Belfort (The Wolf of Wall Street), John Belushi, and Hunter S. Thompson.

If these successful people are taking it, why is cocaine such a problem?

In this article, we’re going to explore the devastation this highly addictive drug has on the body.

Cocaine directly hijacks the reward circuit in the brain, causing the body to crave the drug — eventually relying on it just to function.

Here, we’ll go over cocaine addiction and abuse, discuss how cocaine works, why it’s so addictive, and what the treatment options are for yourself or anybody you might know who’s become addicted to cocaine.

What is Cocaine?

Cocaine is the active alkaloid from the coca plant (Erythroxylum coca). It’s chemically related to caffeine and nicotine but has very different effects on the body.

The coca plant has been used by traditional cultures in South America where it grows naturally for centuries. It was used to boost energy levels and manage many of the side-effects of altitude sickness. The plant in its raw form isn’t very dangerous. The concentration of pure cocaine is so low that addiction problems are uncommon.

Cocaine is a concentrated extract of the active alkaloid — far more potent than the raw plant could ever produce. This concentrated form of the plant is highly addictive and comes with a variety of short-term and long-term side-effects.

The US government classifies cocaine as a schedule II drug — which means it has a high potential for abuse and addiction but has some isolated medicinal uses. Most of the medical uses involve its analgesic effects for eye, ear, and throat surgery.

How Does Cocaine Work?

Cocaine is a central nervous system stimulant — its effects work to increase activity in the central nervous system of the spinal cord and brain.

Specifically, cocaine increases dopamine concentrations by preventing the body from breaking dopamine down naturally. As dopamine levels rise, it gives us a feeling of improved focus, concentration, and energy levels. This is also the cause of cocaine’s long list of negative side-effects.

Cocaine is usually snorted. The active alkaloid is absorbed through the microcapillaries lining the nasal activity where they enter the bloodstream and exert their effects on the brain and other areas such as the heart, kidneys, lungs, and liver.

Side-Effects of Cocaine Use:

• Anxiety or panic attacks
• Euphoria
• Changes in mood
• Behavioral changes
• Paranoia
• Restlessness
• Insomnia
• False sense of confidence
• Addiction and abuse
• Overdose and death

How to Tell if Someone is High on Cocaine

Cocaine use comes with some characteristic effects that make it easy to tell if someone is under the influence of the drug.

Key Signs of Active Cocaine Use:

• Agitation
• Disinhibition
• Excessive enthusiasm
• Hyperactivity
• Fidgeting
• Runny nose or nosebleeds
• Muscle tics
• Inability to concentrate or hyper-concentration
• Dilated pupils
• Loss of appetite
• Financial problems
• Irritability
• Depression
• Over-excitement
• Overconfidence

Cocaine Addiction

Cocaine is highly addictive; even one dose can be enough to hook someone onto the effects of the drug. In 2014, an estimated 1.5 million Americans were addicted to cocaine according to the National Institute of Health. That works out to be about 0.6% of the American population.

What Makes Cocaine so Addictive?

Cocaine is addictive for two Main reasons:

1. It’s habit forming — causing routines around its use socially
2. It’s physically addictive — producing changes in the brain that make us rely on the drug to function normally

At first, cocaine use may appear to lack any negative effects on our health. It helps us focus on our work, it wards off fatigue and lets us stay out partying much later than we would normally be able to.

Most cocaine addictions start out like this. We only take the drug when we’re going out partying for the night or when we’re with certain friends or colleagues. We feel as though we could stop at any moment… if we wanted too.

Eventually, after taking cocaine this way for a few days, weeks, or months — it becomes normal. We take the drug out of habit more than out of any real need or desire to take it.

This is when cocaine addiction enters what we call a behavioral addiction.

Over several weeks or months of this, physical changes in the brain develop — leading to an even more serious form of addiction.

Here’s how it works.

Tolerance Formation

Our body constantly tries to maintain a specific balance. Everything from blood pressure, to hormone levels, are closely regulated by the brain and central nervous system. With regular cocaine use, some of these systems are pushed out of balance.

In order to counteract this, the body makes changes to offset the effects of cocaine. This forms what we refer to as tolerance.

With tolerance, we become resistant to the drug — meaning that we need to take more of it to produce the same level of effects as before. This is why experienced cocaine users require a much larger dose than people trying the drug for the first time.

Becoming Dependant

After tolerance comes dependence and physical addiction. The changes made by the body become so profound that we can’t function properly without having the drug in our system. Whenever the cocaine starts to wear off we become ill — referred to as withdrawal.

The brain starts craving the drug to prevent feelings of withdrawal.

Cocaine Hijacks the Reward System

The reward center controls our urges and habits. Whenever we do something that benefits the body, dopamine is released, triggering a cascade of oxytocin and other neurotransmitters that give us brief feelings of euphoria.

Higher regions of the brain love this feeling of euphoria and will work hard to get another dose of this reward by repeating the activity that caused it. Ideally, this will be triggered by activities that aid in our survival as a species — eating healthy food, having sex (reproduction), seeking safety, or making new social connections.

Cocaine hijacks this system by forcefully boosting dopamine levels in the brain — which lowers the threshold of the reward center. It begins releasing oxytocin much easier than normal — which explains the overwhelming feeling of euphoria produced by cocaine use.

The problem is that while this happens more often, other triggers of the reward center no longer work. We can no longer activate this system without the drug — causing higher regions of the brain to dedicate all resources to obtain more of the drug instead of other important things like eating or seeking genuine social interaction with friends and family.

When cocaine takes over this system, the desire to take more cocaine becomes stronger than all other desires or habits — including eating sex.

This can be seen through two of the most common side-effects of cocaine addiction — loss of libido and appetite.

Here’s a short video about the effect of cocaine’s interaction with dopamine:

 

The Cost of Cocaine Addiction

Cocaine addiction has a high-cost financially and on the well-being of those affected. A gram of cocaine can cost users anywhere from $40 to $350 depending on its purity and how available the drug is in the region.

This can become a real cost burden on those affected when you consider the fact that the drug’s effects only last about 2-4 hours. Often times, cocaine addicts are forced to turn to crack instead of cocaine in order to afford their addiction.

Combine this with the cost of healthcare for drug-induced injuries, loss of productivity, and job loss that are also common with people addicted to cocaine.

The Risks of Cocaine Addiction Include:

• Cardiomyopathy
• Aortic aneurysm
• Chronic inflammatory diseases
• Kidney damage
• Contraction of HIV or hepatitis C infection (mainly from injecting crack cocaine)
• Psychosis
• Depression

1. Cocaine’s Effect on The Heart

One of the most debilitating and dangerous side-effects of cocaine use is heart damage.

Cocaine triggers inflammation in the heart muscle, which causes it to enlarge over time. Eventually, the cells comprising the heart muscle begin to die off — it’s a condition called cardiomyopathy and it’s very dangerous.

As the heart enlarges, and the cells begin to die, issues with maintaining normal heart rhythms begin to form.

2. Cocaine’s Effect on The Kidneys

The kidneys are also heavily affected by cocaine use.

These organs contain a network of tiny blood vessels used to filter particles out of the bloodstream. Any problems with the kidneys can result in systemic side-effects, including high blood pressure, mood changes, blood pH changes, and death.

Cocaine causes inflammation in the microcapillaries of the kidneys, which makes it harder for them to do their job in the short term, and results in widespread cell death with long-term inflammation.

This is a similar problem faced by diabetics who don’t control their blood sugar levels effectively. The organ becomes inflamed and eventually fails.

3. Cocaine’s Effect on The Brain

Cocaine changes the balance of neurotransmitters in the brain.

Over prolonged use, these changes start to manifest more permanently and affect a wider range of neurotransmitters within the brain.

Changes in the Brain May Include:

• Psychosis
• Formation of ADHD
• Erratic behavior
• Depression
• Lowered ability to control body movements

Cocaine Withdrawals

Cocaine addiction, like many other drug addictions, induces withdrawals whenever drug use is stopped.

The body becomes dependant on having the drug in the system. If serum (blood) levels of the drug drop too low, the body falls out of balance again — triggering higher regions in the brain to crave the drug.

The symptoms of cocaine withdrawal can be severe — often requiring the careful watch of medical professionals to monitor heart rate and blood pressure.

The first sign of cocaine withdrawal is a complete crash in energy levels. The effects of cocaine cause profound changes in neurostimulation. Part of tolerance formation relies on the upregulation of sedative neurotransmitters in an attempt to offset the effects of the cocaine.

When the drug is no longer in the body, the brain is overwhelmed with the sedative effects of these neurotransmitters.

There are also other side-effects of cocaine withdrawal, some of them can be very serious.

Symptoms of Cocaine Withdrawal Syndrome

• Agitation
• Anxiety
• Cravings for cocaine
• Irritability
• Overwhelming fatigue
• Paranoia
• Psychotic symptoms
• Severe apathy
• Sleepiness

Treatment Options for Cocaine Abuse

Cocaine addiction is treatable. The sooner you seek help for yourself, or loved ones addicted to cocaine, the more effective treatment will be.

Many of the most serious side-effects of cocaine addiction can take a long time to reach the point of being irreversible.

1. Behavioral Therapy

Behavioral therapy is effective for cocaine addiction because cocaine is a drug of habit. It hijacks the reward circuit in the brain which is used to control our habits and motivations for doing the things we do.

By helping users change the triggers to use cocaine, and managing underlying psychological conditions associated with the cocaine abuse, the user can gradually escape the grasp cocaine has on the brain.

There are a few different philosophies around behavioral therapy. There isn’t one that’s better than the others — it depends on the individual. Some people respond better to more rigid therapy involving rules, separation from their regular lifestyle and habits — others find success in a more passive approach. It really depends on the individual undergoing the therapy.

Behavioral therapy philosophies may include:

A) Contingency Management

Contingency Management (CM) involves incentives like cash or prizes to reward abstinence from the drug. It may also reward other improvements such as social interactions, signs of self-discipline, or other metrics of success.

This philosophy makes sense from a biochemical point of view because it aims to retrain the brain to develop new habits using the same reward system affected by cocaine.

When they do something deemed as an improvement regarding therapy, they’re rewarded, triggering a dopamine release and activation of the reward circuit.

This method tends to work very well in the early days of treatment, but loses its effectiveness over time, so treatment needs to be adaptive and evolve when this happens.

B) Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a more systematic, individualized approach. It involves targeting the underlying reasons for drug abuse, including psychological disorders, social factors, and ill-disposed way of thinking.

CBT is often lead by psychologists and can range from intensive, around the clock therapy to more passive, weekly visits.

2. Drug Therapy

Drug therapy is another common method of treating addiction but is usually done in a hospital setting or a rehabilitation center. This allows doctors and nurses to oversee the patients and make sure their dosing schedules are both effective, and not taken advantage of.

Many of the drugs used to treat cocaine addiction can also be abused. They tend to work on the same pathways in the brain and are used to taper the user off of the drugs slowly over time. This helps ease the user into sobriety and offsets many of the common side effects of cocaine withdrawal.

This form of treatment is not standardized, and every user will need to be assessed individually by a trained professional before a drug is prescribed as a tool for treatment.

The length of treatment can also vary a lot, but the goal is always to wean them off the drug as soon as possible.

Recovering from Cocaine Addiction

Recovering from any addiction is difficult, to say the least.

Drugs like cocaine have a profound impact on our motivations, desires, and ability to perform self-discipline. It conditions our brain to think about nothing except the next hit of the drug, despite widespread and often debilitating side effects.

Recovering from addiction successfully and safely relies on a few important considerations. It’s a multifaceted approach, requiring widespread and consistent changes in the habits, lifestyle, diets, and social interactions of those affected.

Changing only one factor is not enough to escape the addiction. This is why institutions like rehab centers are so effective — they forcibly remove all stimuli surrounding the habit, and use methods such as cognitive behavioral therapy, contingency management, drug therapy, support groups, dietary changes, and removal from the triggers for drug use.

1. Removing Habit Triggers

Research on the rate of relapse tends to vary from one study to the next. Depending on the study, it can be as low as 25% of recovering cocaine users [1], or as high as 90% by some reports.

What most researchers involved in these studies agree with, however, is that the environment the recovering addict is living in has a major impact on this. If the user attends a rehabilitation program and achieves success with sobriety, only to return to the same environment, patterns, and social circles associated with the cocaine use — they are at serious risk of relapsing.

One of the main tools for maintaining this success is to change the environment of the ex-user completely. Moving to a new neighborhood, city, or even country is a method used by many users to avoid relapse long-term until new habits are cemented in the reward circuit in the place of cocaine.

2. Dietary Changes

This is often overlooked by people during the recovery process but is crucial to the success of the treatment program.

Cocaine alters our brain chemistry, promotes widespread inflammation throughout the body, and shuts off our desire to eat and care for our body’s. Over long periods of time, this often results in malnutrition.

In order to recover effectively, we need all the essential nutrients used to build neurotransmitters, lower inflammation, and repair damage within the body.

Key Nutrients to Consume While Recovering from Cocaine Abuse

• Magnesium
• Zinc
• Selenium
• B vitamins
• Vitamin C
• Vitamin D
• Protein (especially L-tyrosine and L-tryptophan)

3. Support Groups

Support groups are another important tool for maintaining the success of the treatment.

There are many support group options for recovering addicts depending on location, and preference.

There are sport-oriented groups, religious groups, clubs, and organizations modeled after Alcoholics Anonymous. The best type or structure of support groups will depend highly on the individual.

It’s always a good idea to find one of these groups and stick with it for as long as possible.

Overdosing on Cocaine

Cocaine overdose is common and deadly. Cocaine is the third most common cause of overdose deaths in America. It affects novice users and experienced users alike.

The high potency of this substance makes it easy to take too much if you don’t know how much you can take. Just one dose of cocaine could result in overdose.

Experienced users are also at high risk of overdose because of tolerance formation. As users become tolerant to the drug, the dose they need to take rises substantially — eventually reaching toxic levels.

The effects of overdose come on quickly — one minute you feel fine, the next minute you’re on the ground with ringing in your ears, severe nausea, and a heart rate so fast your heart feels like it could beat straight out of your chest.

It’s a terrible feeling.

Potential Causes of Death From Cocaine Overdose:

• Cardiac failure
• Cardiac arrhythmias
• Stroke
• Convulsions

Signs & Symptoms of Cocaine Overdose

• Unaware of surroundings
• Cyanosis (blue-colored skin)
• Apnea (difficulty breathing)
• Loss of bladder control
• Irregular heart rhythm
• Fever
• Rapid or irregular breathing
• High blood pressure
• Seizures
• Unconsciousness

What to do if Someone is Overdosing on Cocaine

Cocaine overdose is extremely hard to treat and those affected need immediate medical attention so that doctors can administer drugs to try and offset the effects of the cocaine long enough for the effects to wear off.

The best form of treatment for cocaine overdose is prevention — seek help as soon as possible to detox and treat cocaine addiction before an overdose occurs.

If you find someone overdosing on cocaine it’s important to stay with them and try to keep them calm. Call emergency services and stay with them while you wait. If they go unconscious, place them into the recovery position to make sure they don’t get any vomit in their mouth, which can suffocate them.

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References

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2. Gawin, F. H., & Ellinwood Jr, E. H. (1988). Cocaine and other stimulants. New England Journal of Medicine, 318(18), 1173-1182.
3. Ritz, M. C., Lamb, R. J., & Kuhar, M. J. (1987). Cocaine receptors on dopamine transporters are related to self-administration of cocaine. Science, 237(4819), 1219-1223.
4. Staley, J. K., Hearn, W. L., Ruttenber, A. J., Wetli, C. V., & Mash, D. C. (1994). High-affinity cocaine recognition sites on the dopamine transporter are elevated in fatal cocaine overdose victims. Journal of Pharmacology and Experimental Therapeutics, 271(3), 1678-1685.
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