Facing the Cocaine Problem: Medication for Cocaine Addiction

What Is Cocaine?

Cocaine hydrochloride (coke) is an illegal stimulant drug with extremely addictive properties. It is classified as a CNS (central nervous system) stimulant and a local anesthetic.

Cocaine causes alertness, heightened energy, intense happiness, and, sometimes, anxiety. Abusing cocaine can also temporarily decrease the desire to eat or sleep.

Crack vs Cocaine

Crack is the freebase form of cocaine. Users typically smoke crack cocaine, experiencing a high in less than 10 seconds.

Other street names include:

• Blow
• Crack (freebase form)
• Snow
• C
• Rock
• Powder

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Why Is Cocaine Addictive?

A 2014 study found that 1.5 million people (12 and older) were past-month cocaine users—about 0.6 percent of the U.S. population.

Cocaine is addictive because it inhibits dopamine's reabsorption via nerve cells, creating a sense of euphoria. Its properties make it classified as a Schedule II drug with a high potential for abuse.

The more a person uses an addictive substance, the more at risk they are of developing an addiction. Over time, a person has to keep increasing their cocaine dose to achieve the same high. The substance also changes your brain chemistry and shrinks brain cells, creating dependence.

Risk Factors of Cocaine Abuse

A person is more likely to engage in repeated cocaine use for the following reasons:

• They are genetically predisposed to cocaine use
• They demonstrate narcissistic personality traits and are more vulnerable to the idea of cocaine use
• They use more cocaine over time
• They’ve experienced Adverse Childhood Effects (ACEs)

Adverse Childhood Effects

People with adverse childhood effects experience traumatic events in their youth, which can be physical, psychological, or social. This leads to a higher risk of developing mental or substance use disorders (SUDs) later in life.

Some ACEs include:

• Dealing with physical and emotional neglect
• Living with a family member addicted to substances
• Living with a family member with mental illnesses
• Having a broken home (divorce, separation, or incarceration)
• Experiencing racism

Symptoms of Cocaine Abuse

The signs of cocaine use disorder (CUD) are often difficult to recognize. Since many people abuse cocaine at parties or social events, they may not know they are addicted. However, an individual tolerating the drug will experience withdrawal symptoms after stopping use.

Physical symptoms of cocaine abuse include:

• Decreased appetite
• Dilated pupils
• Constricted blood vessels
• Extreme weight loss
• Blurred vision
• High blood pressure
• Frequent nosebleeds
• Headaches or migraines
• Sensitivity to sound, sight, and touch
• Changes in eating and sleeping patterns
• Poor hygiene
• Weak immune system (getting sick often)

Psychosocial consequences of cocaine use  include:

• Loss of interest in previously enjoyable activities
• Isolation from other people
• Money difficulties or stealing money
• Participating in risky behaviors
• Extreme mood swings

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Signs of Cocaine Dependency

Between 2018 and 2019, about 69,000 people died of a drug overdose. Cocaine overdoses comprised 23 percent (more than 1 in 5) of these deaths.

If you or a loved one experiences any of the following symptoms, you may be at increased risk of cocaine dependency:

• Uncontrollable cravings for the substance
• Not wanting to use the drug, but doing so anyway
• Ignoring the possible consequences and risk factors

How Long Does it Take to Feel the Effects of Cocaine?

Manufacturers produce cocaine from the coca plant, native to South America. Coke is typically available in powdered form that is commonly snorted, inhaled, or dissolved and injected.

How long it takes to feel cocaine effects depends on the method of use:

• Snorting: 3-5 minutes and last up to 20 minutes
• Smoking: 5-10 seconds and lasts up to 20 minutes
• Injecting: 5-10 seconds and lasts up to 20 minutes
• Oral ingestion: 10-30 minutes and last up to 90 minutes

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Long-Term Side Effects of Abuse

People often feel cocaine’s effects immediately after snorting, inhaling, or injecting the substance. Depending on the dose, its adverse effects fade after a few minutes to an hour. Besides these effects after use, cocaine’s long-term effects lead to some severe and permanent consequences.

Possible severe and long-term adverse effects of abuse include:

• Drastic changes in mood, such as extreme excitability followed by depression after the high wears off
• Risk of health complications, such as heart disease, stroke, heart attacks, seizures, lung damage, Hepatitis C, and HIV (through injection)
• Irritability, anxiety, and paranoia, which can result in a mental health disorder
• Loss of smell and trouble swallowing
• Permanent changes to brain chemistry and thought process

What Happens During Cocaine Withdrawal?

People addicted to cocaine who suddenly stop using it will experience an initial crash or withdrawal. Cocaine withdrawal can be intense and challenging due to cravings and uncomfortable side effects.

Effects of cocaine withdrawal include:

• Fatigue
• Hostility
• Paranoia
• Anxiety
• Agitation and aggression
• Sleep issues
• Depression
• Increased appetite

Cocaine withdrawal can cause intense discomfort and induce strong feelings to take the drug again. Even when cocaine withdrawal symptoms have lessened, sudden cravings are common.

How Long Does Cocaine Stay in Your System?

Cocaine has a half-life of only one hour. However, repeated exposure leads to longer elimination times. In addition, how long cocaine remains detectable depends on the testing method:

• Blood: Up to 2 days
• Saliva: Up to 2 days
• Urine: Up to 3 days for light users, up to 2 weeks for extended drug use
• Hair: Months to years

Factors that influence how long cocaine affects a person include the following:

• Dosage
• Frequency of use
• When an individual last engaged in cocaine use
• Body mass
• Whether an individual uses other substances 
• Pre-existing medical conditions

Drug Interactions: Cocaine, Alcohol, and Heroin

Using multiple drugs at once is called polysubstance abuse and can occasionally occur unintentionally when a drug is laced with another drug.

Since cocaine rewires your brain with continued use, quitting the drug without professional treatment is challenging. In some cases, cocaine addiction can be the first of several substances a person may misuse. If you are addicted to a drug and alcohol simultaneously, this is called a co-occurring disorder.

Of all the people admitted to emergency rooms for a cocaine overdose, 68% have more than one drug in their system—often alcohol and heroin. Taking cocaine with alcohol increases the risk of cardiac arrest, respiratory failure, and brain damage.

Mixing cocaine and heroin is known as a “speedball,” an extremely deadly combination when injected. 

Another drug commonly combined with cocaine is fentanyl, which is 50 times more potent than heroin and 100 times more potent than morphine. Using fentanyl significantly increases a person’s risk of cocaine overdose.

Risk Factors of “Street” Cocaine

Drug dealers commonly dilute (cut) street cocaine with other substances. They do so to increase profits, but the consequences of “cutting” coke can be deadly.

Common substances used to dilute the drug may include:

• Cornstarch
• Talcum powder
• Flour
• Baking soda
• Other drugs, such as fentanyl or another stimulant (amphetamine)

Treatment for Cocaine Addiction

Pharmacological and behavioral treatments are the most effective options for cocaine addiction. Outpatient treatment, inpatient treatment, medications, behavioral therapy, or a combination can help you sober up.

For example, common medications used to treat cocaine addiction may include:

• Propranolol: A beta-blocker that may help some patients with severe withdrawal symptoms
• Disulfiram: A medication to treat alcohol dependence and reduce a patient’s risk for cocaine relapse
• Baclofen: A muscle relaxant that reduces the amount of dopamine released; can decrease cocaine cravings and prevent relapse
• Tiagabine: A drug to treat seizures; can improve cocaine abstinence and prevent relapse

Behavioral Therapy

Behavioral therapies aim to address the reasons why someone might abuse cocaine. It also studies the mental disorders associated with substance abuse. Therapy methods common in substance abuse treatment include the following:

• Cognitive behavioral therapy (CBT): This addiction treatment aims to uncover the motivations behind cocaine abuse and replace associated maladaptive thinking with positive behavior and productive responses.
• Contingency management: This treatment program provides incentives for abstinence and other positive parameters, such as maintaining a job or improving social interactions.

Support Groups

People with SUD may benefit from 12-step programs in group settings to encourage recovery. These interactions promote a sense of community where members can hold one another accountable.

Support groups for cocaine addiction include Narcotics Anonymous (NA), Cocaine Anonymous, SMART Recovery, and Celebrate Recovery.

Summary

Cocaine is a stimulant drug that induces alertness, heightened energy, and intense happiness. It’s a highly addictive and illegal drug with severe health risks.

Cocaine use disorder (CUD) naturally develops over long-term use of cocaine. It can lead to severe withdrawal symptoms, requiring more of the drug to avoid its uncomfortable effects.

Support systems (including friends, family, treatment centers, and other people recovering from cocaine addiction) can help you through your recovery. Contact professional addiction specialists to get the proper treatment for your condition.

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