Last year, almost a million in the UK people snorted, dabbed, smoked or injected cocaine, making it the second most popular drug in the country, after cannabis. To many it may seem relatively harmless, for others it becomes a more regular habit. Research shows that up to 1/5 of all cocaine users develop an addiction.
Consultant Psychiatrist and Group Medical Adviser for UK Addiction Treatment Centres Dr Mateen Durrani, based at Sanctuary Lodge, Halstead Essex, explains how the champagne drug of the world has less than glamourous effects on physical and mental health.
Dr Durrani said:
Cocaine increases energy levels and alertness, and rushes the brain with feelings of pleasure. It affects the centre of the brain in a place called the Ventral Tegmental Area (VTA). This is the part of the brain responsible for basic tasks such as eating, fighting and reproducing. Crucially, it is also responsible for pleasure, through the brain’s ‘reward system’. Powered by a chemical called dopamine, this is released in response to potential rewards, such as the smell of good food, and then recycled back into the cell from which it came.
Cocaine disrupts this pattern in two ways. First, it travels through the bloodstream and into the brain, where it causes the release of a particularly large dose of dopamine. But rather than being recycled back into the brain cells, the dopamine stays and causes excessive amounts of the chemical to build up. This means that cocaine can give the user far greater feelings of pleasure than they may ever feel from natural measures.
When dopamine levels are boosted by taking cocaine the brain registers this as a new necessity. In response, it starts to change shape to accommodate these new, higher levels of dopamine. Once the brain adapts, the natural amounts of dopamine barely register and the amount of pleasure created naturally by activities diminishes. The only thing that can give you pleasure, or even make you feel normal, is more cocaine.
The signs that someone is currently under the influence of cocaine can be easy to spot. They include dilated pupils, runny or congested nose, anxiety or panic, increased energy, extremely talkative, short attention span, restlessness, feelings of superiority, irritability and muscle twitches.
Dr Durrani continues:
Although cocaine addiction may start in the brain, there are factors that can make someone more likely to become a cocaine addict. Research suggests that it is most likely that a mixture of genetic, environmental and psychological factors work together to lead to addiction.
Certain inherited genetic traits can greatly increase the chances of becoming an addict. Scientists believe that genetics contribute to 50% of the risk of developing an addiction (https://www.ncadd.org/about-addiction/family-history-and-genetics). There is no specific gene which is responsible for addiction, but rather a series of genetic variations that make some individuals more vulnerable to addiction than others.
Genetics do not work alone, and often they can be very hard to tell apart from environmental and family influences. Individuals who have come from unstable home environments may be at a higher risk of addiction than those with a stable family background. This is especially true if someone has grown up around drug abuse, as they may believe these activities are normal or even harmless. These influences can come from family, friends, colleagues or partners.
Cocaine can make the user feel invincible, as if they have nothing to fear. As such, it is often used as an antidote to social anxiety. This can lead to a reliance on the drug and a belief that without it, it would be impossible to relax and ‘be themselves’ in social situations. Mental health issues are higher among cocaine addicts than the general population, as it is often used as a form of self-medication and as a coping method.
Addiction to cocaine can cause health issues. Cocaine causes blood vessels to tighten, the heart rate to quicken and blood pressure to suddenly rise. This puts the heart at risk, as all of these effects can deprive the heart of oxygen. It puts the user at great risk of heart attack or stroke. In the US, every year half a million people present themselves at the emergency department with cocaine associated problems, of which chest pain is the most common.
Long term cocaine use can cause irreversible damage to the heart muscle and can make the heart beat dangerously irregular, which also leads to heart attacks. Despite its reputation as an aphrodisiac, cocaine can impair sexual performance. For men, over time cocaine increasingly affects their ability to maintain an erection and ejaculate, while woman may have problems reaching orgasm.
Cocaine can severely damage the appearance and function of the nose. Snorting the drug causes restriction of blood flow to the septum and creating a hole in the centre of the nose. Long term abuse can start to alter the biochemistry of the brain causing psychological disorders such as anxiety, depression, insomnia and irritability. Over time cocaine can impair the function of the brain, leading to memory loss, confusion and decreased intellect.
According to the Advisory Council on the Misuse of Drugs up to 88% of cocaine users seeking treatment demonstrate psychotic symptoms, such as hallucinations, delusions and a lack of self-awareness. In general, these symptoms are transitory, passing after a short time. However, psychosis may be more permanent among some users who have either been dependent for many years, or use cocaine with other drugs or alcohol.
Eytan Alexander, founder of UK Addiction Treatment Centres added:
Cocaine differs from other drugs, such as heroin or alcohol, as it generally does not cause physical withdrawal symptoms. However, the psychological symptoms caused by withdrawal from cocaine can be severe, sometimes causing depression, agitated delirium and a condition known as toxic paranoid psychosis, in which the user’s ability to distinguish reality from fiction is impaired.
Effective treatment should focus on supporting the patient through the psychological effects of withdrawal, if necessary with the help of medication. Behavioural and group therapy will help the patient revaluate their approach to the drug.
One form of therapy which has proved to be particularly useful in treating cocaine dependence and preventing relapse is Cognitive Behavioural Therapy (CBT). The user’s brain adapts to the drug and creates new cognitive pathways which alter the way they think about it. The learning process can be harnessed in a positive way and used to help support abstinence form the drug.
Group therapy can be extremely effective in helping the patient come to understand some of the essential truths about their addiction, as members of the group work together to overcome the same issues. In the group, members exchange stories, coping strategies, hopes and difficulties. With the structure of the 12 steps program, these groups can help patients work through the process of recovery in an atmosphere of mutual respect and support.