• Cocaine Use Disorder

    (Cocaine Abuse; Cocaine Dependence)

    Definition

    Cocaine use disorder is when the use of cocaine harms a person’s health or social functioning, or when a person becomes dependent on cocaine. The powdered form of cocaine can be snorted or dissolved in water and injected. Crack is cocaine in a rock crystal form. It can be heated so its vapors can be smoked.
    Cocaine use disorder is treatable, but it takes hard work.

    Causes

    Cocaine stimulates the brain to release large amounts of the hormone dopamine. Dopamine results in the euphoria commonly reported by cocaine abusers. As a person continues to use cocaine, a tolerance is developed. This means that higher doses and more frequent use are needed to maintain the euphoria.
    Release of Dopamine in the Brain
    neurotransmitter
    The dopamine connecting to the receptors causes a euphoric feeling. This occurs naturally, but cocaine causes an exaggerated response that can lead to addiction.
    Copyright © Nucleus Medical Media, Inc.
    When a cocaine user stops using abruptly, a crash or withdrawal occurs. This results in an extremely strong craving for more cocaine. It also results in fatigue, loss of pleasure in life, depression, anxiety, irritability, suicidal thoughts, and sometimes paranoia. These withdrawal symptoms often prompt the user to seek more cocaine.

    Risk Factors

    Cocaine use disorder is more common in young men and in those aged 18-25 years. However, cocaine use disorder can occur in anyone at any age.

    Symptoms

    Symptoms associated with cocaine use disorder include:
      Short-term effects include:
      • Euphoria
      • Increase in energy
      • Excessive talking
      • Being mentally alert
      • Decreased need for food and sleep
      • Dilated pupils
      • Increased temperature
      • Increased heart rate
      • Increased blood pressure
      • Bizarre, erratic, or violent behavior
      • Vertigo
      • Muscle twitches
      • Paranoia
      • Restlessness, irritability, and anxiety
      • Heart attack
      • Seizures
      • Sudden death
      Long-term effects include:
      • Cravings that cannot be controlled or predicted
      • Increased tolerance
      • Increased dosing
      • Use of cocaine in a binge
      • Increased irritability, restlessness, and paranoia
      • Paranoid psychosis
      • Hearing sounds that are not there
      Medical complications include:

    Diagnosis

    The doctor will ask about symptoms and medical history. A physical exam will be done. The doctor will ask specific questions about cocaine use. Questions will include the length and frequency of use.

    Treatment

    Treatment programs may be inpatient or outpatient and may:
    • Require that cocaine use has been stopped
    • Involve a detoxification program

    Medications

    There are currently no medications to specifically treat cocaine use disorder. Treatment with medication focuses on the symptoms of euphoria and craving. Medications that have shown some promise include:
    • Modafinil—wakefulness-promoting agent
    • N-acetylcysteine
    • Topiramate—seizure medication
    • Disulfiram
    • Agonist replacement therapy
    • Baclofen
    • Antidepressants—may be helpful for people in the early stages of stopping cocaine use

    Behavioral Therapy

    Behavioral therapies to help people quit using cocaine are often the only available, effective treatment for cocaine use disorder. Therapies include contingency management. With this program, people receive positive rewards for staying in treatment and remaining cocaine-free. Also, cognitive behavioral therapy helps people to learn how to abstain and remain abstinent from cocaine.

    Rehabilitation Programs

    In rehab programs, people with cocaine use disorder stay in a controlled environment for 6-12 months. During this time, they may receive vocational rehab and other support to prepare them to return to society.

    Prevention

    The best way to prevent cocaine use disorder is to never use cocaine. It is highly addictive and illegal.

    RESOURCES

    Cocaine Anonymous http://www.ca.org

    National Institute on Drug Abuse https://www.drugabuse.gov

    CANADIAN RESOURCES

    Cocaine Anonymous of Southern Ontario http://ca-on.org

    Native Alcohol and Drug Abuse Counseling Association of Nova Scotia http://nadaca.ca

    References

    Amato L, Minozzi S, et al. Dopamine agonists for the treatment of cocaine dependence. Cochrane Database Syst Rev. 2011;(12):CD003352.

    Carson-DeWitt R, ed. Encyclopedia of Drugs, Alcohol, and Addictive Behavior. 2nd ed. New York, NY: MacMillan Reference Books; 2000.

    Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet. 2012;379(9810):55-70.

    DrugFacts: Cocaine. National Institute on Drug Abuse website. Available at: https://www.drugabuse.gov/publications/drugfacts/cocaine. Accessed. Updated March 2010. Accessed February 20, 2013.

    Karila L, Reynaud M. Therapeutic approaches to cocaine addiction. Rev Prat. 2009;59(6):830-834.

    Opioid abuse or dependence. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 15, 2013. Accessed February 20, 2013.

    Research report series: Cocaine. National Institute on Drug Abuse website. Available at: http://www.drugabuse.gov/publications/research-reports/cocaine/letter-director. Updated September 2010. Accessed February 20, 2013.

    Revision Information

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