Cocaine Drug Addict Case Study

Cocaine Abuse

Authored By Diedre O'Donnell, M.S., Neuropharmacology

  1. Overview of Cocaine Abuse
  2. Signs and Symptoms
  3. Cocaine Abuse Treatment
  4. Am I Addicted?
  5. Statistics on Cocaine Abuse
  6. Teen Cocaine Abuse
  7. Resources, Articles, and More Information

Overview of Cocaine Abuse

Cocaine is a type of drug that functions to increase the availability of the neurotransmitter dopamine in the brain. Dopamine is associated with the generation of 'euphoric' emotions, the regulation of movement, and the processing of reward cues. However, it is also associated with a considerable potential for dependence and abuse. Cocaine abuse is related to an increased risk of:

Cocaine is attractive as a recreational substance due to the perceived positive effects on mood, motivation, and energy. Someone abusing cocaine may smoke, snort, or take it intravenously (via injection).


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Signs and Symptoms

Typical signs and symptoms of current cocaine use include:

  • Increased agitation.

  • Effusive enthusiasm.

  • Disinhibition.

  • Increased movement (i.e. hyperactivity).

  • Increased common cold-like symptoms and/or nosebleeds.

  • Signs of involuntary movements (i.e. muscle tics).

  • Changes in concentration and focus.

Other Adverse Effects

One of the most serious effects of cocaine abuse is heart muscle damage. Cocaine may cause damage by inducing cell death in the muscles of the heart (cardiomyopathy). Intravenous cocaine use can lead to inflammation of the inner tissues of the organ (endocarditis).

These cellular effects of cocaine cumulate into serious conditions such as heart attacks and cardiac arrhythmias, which may be fatal. Other symptoms of cocaine-induced cardiotoxicity include:

  • Inflammation of heart muscle.

  • Rupture of the aorta, the major artery leading from the heart.

  • Severe declines in health and life quality due to reductions in cardiac function or severe blood loss.

Cocaine-induced heart failure or damage may also increase the risk of stroke, or brain damage resulting from interruptions in the blood supply available to the brain.

The abuse of this drug is also associated with kidney damage. The prolonged use of cocaine is thought to be related to the inflammation of important microstructures within this organ.

Even users who regard their use as 'recreational' may be at risk of neurological changes that affect their lives. 'Recreational' use is associated with the decreased ability to regulate and control behavior, leading to reduced abilities to control movements, react to environmental stimuli and carry out daily activities. Long-term  use is also associated with deficits in cognitive performance, attention, and decision-making abilities.

Other risks stemming from abuse include bloodborne infectious conditions such as HIV or hepatitis C (HCV). These risks are related to the injection of cocaine, and the adverse effects of irresponsible and non-sterile needle use.


Video: 10 Facts About Cocaine

The following video shows 10 alarming facts you may not know.



Credit: 10List


Cocaine Abuse Treatment

There are many treatment options available for cocaine dependence and abuse. These may be delivered in inpatient facilities, which accommodate the treatment-seeker for the duration of their therapy.

Alternatively, the patient may make regular appointments at a center or clinic to receive treatment (i.e. outpatient treatment).

The nature of these treatments may be both behavioral and pharmacological.

Behavioral Therapies

Behavioral therapies are psychosocial treatments that address the reasons, motivations and possible underlying psychological issues associated with a person's substance abuse.

Current research indicates that behavioral therapy techniques are particularly effective in patients affected by cocaine abuse and dependence.

An example of behavioral treatment associated with effective abstinence from cocaine use is contingency management (CM). This treatment is based on incentives (e.g. prizes or cash) for abstinence, or other positive parameters, such as improved social interactions. This treatment has demonstrated promising in-treatment results, but the long-term effects are less certain, as it appears to lose efficacy over time.

Another form of behavioral treatment, cognitive behavioral therapy (CBT) may be used. This type of treatment addresses the reasons behind the substance abuse, and helps to alter maladaptive ways of thinking and acting that may be contributing to the cocaine abuse issue.

Pharmacological Therapies

Pharmacological (or drug-based) therapies refers to medications administered to treat cocaine dependence by physiological means.

This type of treatment uses medications that may mimic the substance of abuse in question, but to a reduced or different extent. The doses of these medications are reduced (or 'tapered') over time, thus 'weaning' the patient off drug dependence and allowing them to work on abstinence and recovery from addiction.

An emerging form of pharmacotherapy for dependence is methylphenidate treatment. This medication is prescribed to treat ADHD, and is similar to cocaine in terms of neurological effects. However, the stimulant effects of methylphenidate act on the brain for a longer duration, but elicit less extreme reactions, compared to cocaine. The hope is to alleviate the 'need' for it, and thus dependence, over time.

It is important to not that medically assisted treatment of any type is very program specific, and not offered universally.


Am I Addicted?

If you're worried about your use of cocaine, there is a strong likelihood you are addicted to the substance. However, you can take our short assessment to determine the severity of the problem by clicking below.


Statistics on Cocaine Abuse

According to the 2015 National Survey on Drug Use and Health:

  • Cocaine was the most common illicit substance involved in emergency department visits in 2011, found in more than 40% of cases.

  • Almost 5 million people reported using cocaine at some point in 2015, and nearly million reported use at some point in their life.

  • Approximately 1.75 times more men than women abused cocaine in 2015.

Additionally, in 2011, the Drug Abuse Warning Network found that cocaine was the most common illicit substance involved in emergency department visits in 2011, found in more than 40% of cases.

To learn more, visit our article, Cocaine History and Statistics.


Teen Cocaine Abuse

Drug abuse is relatively common among adolescents. Almost 2% of 8th graders, 3% of 10th graders, and 4% of 12th graders reported use of the drug at some point in their life, per the National Institute on Drug Abuse's Monitoring the Future Study.

Initiating use at a younger age is one way to increase one's risk of dependency. It is also thought to be related to increased risks of legal and psychiatric problems in later life, and is associated with reduced responses to treatment.

To prevent drug abuse in your teen, it's important to talk to him or her about substance abuse at a young age and continue the conversation. Make sure they understand the dangers of both illicit and prescription drugs, and monitor their behavior, friends, and habits for sudden changes.


Resources, Articles, and More Information

For more information, see the following articles:

You can also join the conversation on cocaine abuse and addiction by visiting our Forum today.


Sources:

  • Dürsteler KM, Berger E-M, Strasser J, et al. Clinical potential of methylphenidate in the treatment of cocaine addiction: a review of the current evidence. Substance Abuse and Rehabilitation. 2015;6:61-74.

  • Maraj S, Figueredo VM, Lynn Morris D. Cocaine and the heart. Clin Cardiol. 2010;33(5):264-269.

  • Qureshi AI, Chaudhry SA, Suri MFK. Cocaine use and the likelihood of cardiovascular and all-cause mortality: data from the Third National Health and Nutrition Examination Survey Mortality Follow-up Study. Journal of Vascular and Interventional Neurology. 2014;7(1):76-82.

  • Jaffe JA, Kimmel PL. Chronic nephropathies of cocaine and heroin abuse: a critical review. Clin J Am Soc Nephrol. 2006;1(4):655-667.

  • Hellem T, Shi X, Latendresse G, Renshaw PF. The Utility of Magnetic Resonance Spectroscopy for Understanding Substance Use Disorders: A Systematic Review of the Literature. J Am Psychiatr Nurses Assoc. 2015;21(4):244-275.

  • Weiss LM, Petry NM. Substance abuse treatment patients with early onset cocaine use respond as well to contingency management interventions as those with later onset cocaine use. Journal of substance abuse treatment. 2014;47(2):146-150.

  • Barrio G, Molist G, de la Fuente L, et al. Mortality in a cohort of young primary cocaine users: controlling the effect of the riskiest drug-use behaviors. Addict Behav. 2013;38(3):1601-1604.

  • Colzato LS, van den Wildenberg WP, Hommel B. Impaired inhibitory control in recreational cocaine users. PLoS One. 2007;2(11):e1143.

  • Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.

  • Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

  • National Institute on Drug Abuse. Monitoring the Future Study: Trends in Prevalence of Various Drugs.

Cocaine and Changes in the Brain

Cocaine abuse is also associated with changes in brain chemistry over time. These changes are associated with the increased 'need' for cocaine over time, as well as behavioral abnormalities that may result from taking cocaine. These behavioral anomalies associated with its effects may include:

  • Unusually erratic behavior (which may even result in unintentional trauma incurred during accidents).

  • Psychotic symptoms.

  • New-onset Attention Deficit Hyperactivity Disorder (ADHD).

Finding Treatment for Cocaine Addiction

Seeking treatment for substance addiction is the first step to true recovery. This may require thorough research to find a program best suited to the treatment needs and preferences of the individual patient. In addition, a patient may have to find answers to questions such as:

  • Will insurance cover treatment?

  • What methods of funding can I use for treatment?

  • How long the program will last?

  • Will my treatment program accommodate any special needs?

What quality of aftercare (a program of post-treatment activities or lifestyle modifications that may enhance abstinence and recovery) will be available upon completion of a program.

What does cocaine look and smell like?

Maybe you are concerned that your teen is abusing cocaine, but don't know what to look for. Most often found in white powder form, cocaine does not emit a specific odor but can be recognized by the burning smell typically associated with smoking the drug.

Cocaine is the most potent natural stimulant available to man. It is found in the leaves of the erythroxylon coca plant in the Andean highlands, and has been used for centuries as a soothing and energizing tea by natives of Peru and Bolivia. It was first isolated by German chemist Albert Niemann in the early 1800s. Its early uses were in surgery to numb nose and throat areas. It was useful in these areas specifically because it constricts blood vessels and helps stop blood flow as well as acting as an anesthetic. Cocaine was also studied by Sigmund Freud who proposed using it as a treatment for depression, alcoholism, and morphine addiction. It was sold in pharmacies in Canada as a tonic until around 1911 when it was outlawed and did not return to popularity until the 1960s.

Cocaine is sold on the street illicitly as a white crystalline powder or in off-white chunks. Before final sale, it is usually diluted (i.e. cut) with fillers to increase the volume, and thereby the final profits. It is rarely smoked, but is most often injected, for a high within 15-30 seconds, or snorted, for a high within 3-5 minutes. The crack form of cocaine can be smoked for an almost immediate high.[1] The physiological effects of cocaine depend upon the amount of cocaine ingested, ingestion method, and prior drug use. Usual effects of the drug are feelings of euphoria, extra energy, and alertness. Negative effects of the drug include contemplativeness, accelerated heartbeat, high blood pressure, seizures, respiratory failure, stroke, and heart failure. Repeated use leads to restlessness, excitability, insomnia, paranoia, hallucinations, and symptoms similar to schizophrenia. Repeated use can cause mood swings, loss of sexual desire, weight loss, and insomnia.[1,2] It is estimated that 1.3 million people in the United States use cocaine every month. Occasional usage is down to 3 million from the 1985 usage high of 8.5 million. Weekly usage has remained relatively constant at 500,000 since 1985.[1]

Addiction to cocaine occurs when the structure of the brain is permanently changed by use of the drug. Cocaine alters the circuits in the brain which are involved in emotions and free will. Cocaine works by altering the behavior of a neurotransmitter called dopamine. Dopamine is responsible for feelings of happiness, body movement, judgment, and motivation. Cocaine utilizes the same receptor in the brain as dopamine does, so when cocaine is present there is an excess of dopamine with no site to bind to.[3] This causes feelings of pleasure and encourages drug use. The dopamine effect and the constricting of arteries and blood vessels shows a cumulative effect that correlates to the length and intensity of drug use.[4] Cocaine-induced binges are also understood via the biochemistry of dopamine. Dopamine controls impulses for eating, drinking, sleeping, and sex. When dopamine pathways are disturbed, the impulse to stop a behavior is hindered. Thus, when cocaine is present, the dopamine is ineffective in its effort to tell the body when it has had enough. The craving for cocaine continues because of the lack of the cessation impulse.[3] It has been found that drug users do not become tolerant to cocaine or need to increase their dosage. They actually become more sensitive to the drug as their brains are further changed by extended use. The dependence on cocaine is therefore more psychological than it is physical. Cocaine is central to the thoughts, emotions, and activities of the user and this emotional dependence is what causes cravings. Abstinence from cocaine in a regular user can cause insomnia, eating disorders, depression, anxiety, and cravings.[2]

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