Cocaine Addiction, Treatment, and Recovery
You are more than your cocaine addiction. Get the help you need to reclaim your life.
You might be afraid that, without cocaine, you won't feel good. You might feel completely isolated in your addiction. You might not be able to imagine your future with or without drugs. But, ultimately, you know that something needs to change. That's why you're here.
Recovery from cocaine addiction is a journey that you need to take one day at a time. It's a journey that requires help from knowledgeable and compassionate professionals who understand your struggle. You can recover. Besides, no other high is better than the one you feel when you know that you've taken back your life.
The Dangers of Cocaine and the Reasons for Hope
Cocaine abuse and addiction have devastating consequences for users and their loved ones. Cocaine addiction is often described by loved ones as an obviously life-endangering condition. The toll of cocaine addiction to a user's physical and mental health is visible—often tragically so. The obsession with cocaine, and the powerful compulsion to use it, leave addicts and loved ones with overwhelming feelings of helplessness and hopelessness. The costs are high for addicts and those who love them. It is costly for the community as well, including the costs involved with treatment, the legal system, emergency room and hospital care, and child protection.
If you or a loved one is addicted to cocaine, there is a great deal of hope for recovery despite the desperation and hopelessness you feel. Many have recovered and many as you read this are beginning recovery today. There are a great number of resources for cocaine addiction recovery, including rehab programs staffed with trained professionals who understand the special needs of cocaine addicts. These include inpatient, residential, and outpatient programs. There are also community self-help groups and recovery-oriented programs that help addicts transition from treatment into a productive and cocaine-free life.
If you or a loved one is addicted to cocaine, there is a great deal of hope for recovery despite the desperation and hopelessness you feel. Many have recovered, and many as you read this are beginning recovery today.
What Is Cocaine?
Cocaine, often referred to as "coke," is a stimulant that increases energy, physical stamina, alertness, and wakefulness. It creates a sense of well-being, euphoria, excitement, confidence, self-esteem, and a sense of having skills and talents that are enhanced. Cocaine also increases social ease and makes one talkative and outgoing. It increases a sense of sexual ability and heightens senses (Daigle, Clark, & Landry, 1988).
Cocaine is made from the coca leaf that is native to South America. It is most commonly available in powder form that is white and crystalline. The second most available form of cocaine is crack. Crack is derived from cocaine powder and comes in the form of small smokable "rocks" that are usually white to yellow in color (Foundation for a Drug Free World, 2014). Its use is illegal in the US and Canada without being administered by a physician.
Cocaine is classified as a Schedule II drug in the U.S., and it's a controlled substance in the majority of the world (U.S. Department of Justice, 2014). This means:
- There is a high potential for abuse.
- Use can lead to severe psychological or physical dependence.
- It may have legal and medical uses but its use is governed by strict policies.
- The drug must be administered by a physician (i.e., cocaine is sometimes used in medicine as a local anesthesia).
- There are laws governing its use, possession, and trafficking.
How Is Cocaine Used?
"As soon as cocaine enters your bloodstream it goes to work (Wagner & Triggle, 2003)." This is true, but there is more to the story: the sooner the bloodstream gets cocaine to the brain, the faster cocaine effects can be felt. There are three methods by which cocaine is commonly introduced into the bloodstream and finally to the brain. These are snorting powder cocaine (sniffing it into the nose), smoking powder derivatives (freebase and crack), and injecting (dissolving powder into a liquid solution for use with a syringe). These methods of use have somewhat different immediate effects—how quickly one becomes intoxicated, for example, and how long the high lasts. This is due to the different rates of absorption for each method, determining how quickly the drug enters the brain.
- Snorting (Intranasal Use)—When sniffed into the nose, cocaine is absorbed by the mucous membrane in the nasal cavity. From there it travels a long route through the blood vessels, heart, lungs, and finally, the brain. It takes approximately 3-5 minutes for the cocaine to be fully absorbed into the brain and for the user to get high.
- Smoking—Crack cocaine is the most common form used for smoking. It is typically smoked with a pipe and enters the bloodstream and brain more quickly than any other method—in about 10-15 seconds. Because crack acts so rapidly, its high is more intense than with other methods. This is why crack is considered one of the most addictive substances, if not the most addictive available today (Wallace, 2012).
- Injection—Cocaine powder is dissolved into a liquid to make an injectible solution. It is typically injected into a vein (IV or intravenous use). Cocaine injection takes about 15-30 seconds to produce the desired effects.
Despite how it is used, many short- and long-term cocaine effects are common across the board. The immediate effects of intoxication include excitement, exhilaration, increased energy, decreased need for sleep and food, feelings of well-being, increased stamina, confidence, self-esteem, and pleasure. Increased movement, talkativeness, and restlessness are typically also present when using cocaine. Symptoms of intoxication can also include:
- Rapid or irregular heartbeat
- Dilated pupils
- Dysregulated blood pressure
- Respiratory distress
- Nausea or vomiting
- Muscular weakness
- Involuntary muscle movement
- Coma (American Psychiatric Association, 2000)
Long-term use can lead to addiction, cocaine-induced mental disorders, and physical damage to the body.
Long-Term Effects of Cocaine Use
Long-term cocaine effects can include a tolerance for high doses, which creates the potential for toxicity and overdose. Long-term use can lead to addiction, cocaine-induced mental disorders, and physical damage to the body. Long-term cocaine users are also at risk for infectious disease, including HIV, due to high risk behavior when using. Intravenous users are at risk for abscesses, hepatitis, and HIV.
The environment in which cocaine, especially crack cocaine, is bought and used often puts the user at risk for being victimized, committing violent acts, or witnessing them. The excitability and tendency toward paranoia, impulse, and hostility when using also puts addicts at risk for aggression.
Financial ruin and related issues such as loss of employment can lead to criminal activity and incarceration as a result of illegal use. Family disruption and child protection issues are also risks of long-term addiction and its lifestyle.
Cocaine Use During Pregnancy
There are significant risks for mothers who use during pregnancy, and for their unborn children. Fetuses are vulnerable to birth defects, fetal stroke, miscarriage, stillbirth, and premature delivery when exposed to cocaine. Side effects for exposed children include an increased "risk of lifelong disabilities such as mental retardation and brain damage" (Foundation for a Drug Free World, 2014).
The Effects of Cocaine on the Brain
How does cocaine affect the brain? Cocaine is a stimulant that acts directly upon the brain and central nervous system. It significantly alters brain chemistry particularly by going directly to the reward and pleasure centers of the brain. Cocaine stimulates the brain to flood with dopamine, the brain chemical responsible for pleasure and sense of well-being and satisfaction. After prolonged use, the brain is unable to produce its own dopamine unless cocaine is present. Consequently, cocaine users do not feel pleasure unless they use cocaine. The brain, in a sense, becomes depleted of its "feel-good chemistry" and the user, without cocaine, is depressed, unable to feel good, and at times so depressed that suicide becomes a tenable option.
Longer-term use of cocaine can also result in altered perceptions such as hallucinations and misinterpretations of reality, like events and bodily sensations. For example, the altered functioning of dopamine in the brain can lead to suspiciousness, paranoia, and delusions in which one feels persecuted—which can lead to hostility and aggression. Other altered perceptions due to brain changes include the experience of "coke bugs"—sensations that cause the addict to believe the skin is infested with insects. There is also some evidence of brain lesions caused by prolonged use as well as a phenomenon known as "kindling" in the brain. Kindling occurs when brain pathways become overly sensitive to cocaine; seizure and other intense reactions can occur when cocaine is used (Freye, 2011).
Cocaine is considered one of the most addictive known substances. It creates a rapid and intense psychological dependence.
A Highly Addictive Substance
How addictive is cocaine? It's actually considered one of the most addictive known substances. It creates a rapid and intense psychological dependence because it activates the pleasure centers of the brain so effectively (Gawin, 1991). Having a psychological dependence upon cocaine includes being mentally preoccupied (or obsessed) with the pleasant effects of it, and the desire to use more. These are mental and emotional issues that strongly contribute to one becoming addicted to cocaine.
Those who are dependent in this way feel an overwhelming need for cocaine and look to it for a type of pleasure that they cannot find elsewhere. Also, psychological dependence includes using cocaine to cope with life stress, mental and emotional issues, feelings about the self, and relationship issues. In short, dependency of this sort involves the user looking to cocaine for life solutions and happiness.
Apart from mental and emotional dependencies in cocaine use, the body also comes to rely upon cocaine. Building a tolerance for cocaine happens quickly with users eventually needing more of the drug to get the same high (Hammer, Egilmezb & Emmett-Oglesbyb, 1997). Physical dependence occurs when an increased amount of the drug is needed over time—also referred to as tolerance. A person also has built a tolerance for a drug if there will be withdrawal symptoms when use stops (American Psychiatric Association, 2013).
For many years, it was believed that users only experienced psychological dependency—that is, desiring it, but not physically needing it. However, in recent years—particularly since the advent of crack cocaine and research into cocaine's effects on the brain—we've discovered that the body itself becomes dependent on cocaine (i.e., addicted to it). Withdrawal symptoms are evident in the experience of addicts who reduce the amount they use or stop using cocaine abruptly.
After-Effects of Cocaine: Withdrawal Symptoms
Known as the cocaine "crash," withdrawal occurs after a binge of use or after longer-term use. Its symptoms can include:
- Increased appetite
- Disrupted sleep or excessive sleeping
- Vivid and unpleasant dreaming
- Fatigue, listlessness, and lethargy
- Mood swings
- Anger, hostility, anxiety (Gray, 2011)
A diagnosis of cocaine use disorder is given whenever an individual has at least 2 of the symptoms listed below. The symptoms that follow are typically those that most people think of as characteristics of addiction. The disorder can range from a mild to severe form (APA, 2013). It is widely accepted that if cocaine use (or other drug use) includes the symptoms below, that the user should be considered to have a medical illness (Flynn, 1993).
Cocaine use disorder symptoms include the following:
- Continuing to use cocaine despite negative personal consequences
- Being repeatedly unable to carry out major obligations at work, school, or home due to cocaine use
- Recurrently using cocaine in physically hazardous situations
- Continuing to use despite persistent or recurring social or interpersonal problems caused or made worse by cocaine use
- Having a tolerance for cocaine—a need for markedly increased amounts to achieve the desired effect, or a markedly diminished effect with continued use of the same amount
- Experiencing withdrawal or using to avoid withdrawal
- Using greater amounts or using over a longer time period than intended
- Having a persistent desire to use or unsuccessful efforts to cut down or control use
- Spending a lot of time obtaining, using, or recovering from use
- Stopping or reducing important social, occupational, or recreational activities due to cocaine use
- Consistently using cocaine despite awareness of persistent or recurrent physical or psychological difficulties from using cocaine
- Craving or having a strong desire to use cocaine (American Psychiatric Association, 2013)
The severity of the disorder is determined by how many of the symptoms above are present. The range is:
- Mild—2-3 symptoms are present
- Moderate—4-5 symptoms are present
- Severe—6 or more symptoms are present (Gorski, 2014)
Cocaine use, even after drug use has stopped for some time, can cause significant anxiety that interferes with daily life.
Other Cocaine-Related Disorders
Along with a cocaine use disorder there may be other conditions directly related to cocaine use. These are cocaine-induced disorders that require treatment along with the addiction.
Cocaine-Induced Psychotic Disorder
The toxic and harmful effects of cocaine use can produce psychosis in which there are hallucinations (hearing, seeing, feeling, smelling, or tasting things that are not present) and delusions (having false beliefs of being watched, persecuted, etc.). Some people are misdiagnosed with other severe forms of mental illness such as schizophrenia when having this cocaine-related condition.
Cocaine-Induced Mood Disorders
Cocaine use, even in recovery, can cause huge shifts in mood—from happy, to angry, sad, and afraid. Many times these mood swings are quite intense and painful for those who experience them. They often cause individuals to have trouble in daily functioning. Such mood problems are also often misdiagnosed as other mental conditions that so not stem from drug use, such as bipolar disorder.
Cocaine-Induced Anxiety Disorder
Cocaine use, even after drug use has stopped for some time, can cause significant anxiety that interferes with daily life. This can take the form of generalized uneasiness, excessive worry, obsessions, compulsions, anxiety attacks, panic attacks and even phobias.
Cocaine-Induced Sleep Disorder
Cocaine use can disrupt sleep, causing one to have insomnia or to sleep too much. Other forms of cocaine-related sleep problems include experiencing excessive movement when sleeping, nightmares, or sleepwalking.
Cocaine-Induced Sexual Dysfunction
Sexual dysfunction can be caused by cocaine use and continue after stopping cocaine, but it is typically related to cocaine intoxication. Sexual problems can include no sex drive, difficulty becoming aroused, excessive sexual drive without orgasm, and pain experienced during sex.
Cocaine-Induced Neurocognitive Disorders
These disorders include problems with cognitive functioning and performance caused by cocaine use. They include, for example, such problems as comprehensive, decision-making, attention, problem-solving, memory and language. These issues can appear similar to dementia, amnesia and other such conditions. Cocaine Delirium is a condition that occurs when intoxicated. Its symptoms can include the above mentioned as well as disorientation and confusion.
Signs That Someone You Love Is Using Cocaine
Signs of cocaine addiction can be categorized into different aspects such as physical signs, moods, habits, and routines. Keep in mind that changes from the usual are important. Here are some tips if you suspect your loved one has a cocaine problem:
Physical effects of cocaine abuse
- They may lose weight, have no appetite at times, and feel starved other times.
- Their grooming and personal attention to appearance may decline
- They may have bloodshot eyes
- There may be burnt marks on their fingers or lips or needle marks on their arms
- They may cough, have sores, sniffles or complain of itching
Behavioral effects of cocaine abuse
- They may become vague about their activities
- Changes in habits and routines are common
- Changes in friends are common and new friends will have signs of use
- They will need money frequently
- They may stay away longer than expected
- They may seem overly focused on getting things done, and neglectful at other times
- They will be talkative at times and withdrawn at others
- They may get into debt, steal, lie, miss or quit work, get fired
Personality and mood effects of cocaine abuse
- There may be angry outbursts, irritability, impatience and defensiveness
- There may be suspiciousness that seems excessive, even paranoia
- Usual interests are discarded
- There seems to be intense enjoyment, energy, and passion at times and then a shift to depression, boredom, and disinterest
What to Do If Someone You Love Is Using Cocaine
Gathering information about cocaine use (including what cocaine does to users) and available resources for help is critical. Also, equipping yourself with knowledge about the drug, including side effects of cocaine abuse, consequences of addiction, and treatment options will prepare you for talking with your loved one about getting help. Research and education about what you and your loved one are facing will help you approach the issues more calmly and without shaming or judgment. Contact addiction treatment professionals in your area for advice and information about treatment options.
Keep in mind that despite their sometimes euphoric appearance, your loved one is struggling with an overwhelmingly powerful substance and has many moments of deep despair and regret about using. Approach your loved one during quieter, more lethargic and depressed moments when he or she is not likely to be under the influence and is more in touch with the bad feelings and bad consequences of their use.
Talk openly about the drug use and your concerns for your loved one. Express love, support, and concern, as well as the willingness to help them get help and support them in recovery. Present the information that you have gathered regarding cocaine addiction treatment options, and suggest going now. If they agree, promptly follow through. If not, you have to consider what you will and will not do for your loved one who continues to use. As use continues and your loved one's situation deteriorates, you may have to set difficult limits to protect yourself and others that you love. However, you can be ready whenever your loved one is to help them get to treatment. In the meanwhile, seek help for yourself as you deal with your loved one's continuing addiction.
Express love, support, and concern, as well as the willingness to help them get help and support them in recovery.
Treatment for Cocaine Addiction
When it comes to the abuse of cocaine, treatment options are mostly centered on behavioral interventions that are known to be effective. That's because no medications have yet been approved by the U.S. Food and Drug Administration (FDA) for treating cocaine dependence. As a result, the most common forms of help that you're likely to find include:
- Cocaine detoxification at inpatient facilities—This option is good for people who may not have much outside support or may experience severe cocaine withdrawal. Treatment of this kind begins with a detox process in which medical professionals supervise and assist you during your withdrawal. After detox, most inpatient cocaine rehab programs provide group or individual therapy as well as guidance about how to live and cope without using drugs.
- Contingency management (CM)—Motivational incentives is another term for this type of cocaine addiction help. It involves being part of a program in which you earn chips, points, or vouchers for staying sober. As you keep earning those prizes, they can be exchanged for tangible rewards like movie tickets, fitness memberships, and restaurant gift cards.
- Cognitive-behavioral therapy (CBT)—For abusers of cocaine, treatments of this variety are often effective, especially when combined with other approaches. With CBT, you learn how to develop practical coping skills that can help you overcome any cocaine cravings you may have now or in the future. The therapy also aims to help you recognize and avoid situations in which you are likely to feel the urge to use.
- Various outpatient programs—From individual, family, or group therapy to educational sessions, many types of programs exist that don't require you to be admitted to a facility. In fact, a lot of counseling professionals and rehab centers offer appointment-based cocaine addiction treatments and recovery programs.
- Sober-living residences—Also known as therapeutic communities (TCs), these facilities offer recovering addicts the chance to live among people who've had similar experiences and benefit from a supportive environment. Residents in drug-free homes aim to help each other identify, understand, and modify their addictive behaviors. Many residences also provide onsite services to help people in recovery with issues like employment.
- Self-help or community-based groups—These options tend to be the most helpful for people who are in the recovery stage after an addiction and are trying to maintain their sobriety. For example, a 12-step program like Cocaine Anonymous can provide you with the continuing support and fellowship of people who are going through the same kinds of challenges.
A lot of ongoing research is geared toward finding safe and effective medical treatments for cocaine addiction. And there are good reasons for staying hopeful that such options will eventually become available outside of clinical trials. For example, a cocaine vaccine has been developed and shown to be safe, but researchers are still trying to improve its effectiveness before they seek approval for wider use. In addition, other researchers are testing various medications that act on certain chemical receptors or neurotransmitters in parts of the brain that are responsible for emotions, rewards, excitation, and inhibition.
Find Help for Cocaine Addiction Today
Start getting your life back right now. With the care and support of well-trained addiction specialists, you'll have the chance to make many positive and important changes.
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