Cocaine (benzoylmethylecgonine) is a stimulant processed from the coca plant. The United States Drug Enforcement Administration classifies cocaine as a Schedule II controlled substance, indicating that while it does have some medicinal uses, it is a highly prone drug of abuse and can result in the development of physical dependence.
Cocaine remains one of the most popular drugs of abuse in the United States in a number of different forms, including the powder form, which is typically snorted or injected, and crack cocaine, which is typically smoked. Abuse of cocaine results in a number of devastating consequences for individuals.
Signs of Cocaine Use
Use of cocaine can result in the development of a substance use disorder (the clinical term that includes both the notions of substance abuse and addiction). In terms of a formal diagnosis, an individual with a substance use issue regarding cocaine use would formally be diagnosed with a stimulant use disorder, according to the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) used by the American Psychiatric Association and mental health clinicians.
Signs of an individual with a formal stimulant use disorder as a result of cocaine use are outlined below.
- The person demonstrates a number of issues with controlling their use of the drug that can include:
- Being unable to stop using cocaine despite wanting to do so
- Being unable to cut down their cocaine use despite wanting to do so
- Continuing to use cocaine in situations where it is dangerous to do so
- Repeatedly using cocaine for longer periods of time than originally intended
- Continuing to use cocaine in spite of experiencing negative ramifications directly related to cocaine use, such as issues at work, in their personal relationships, at school, or another important areas of life
- Continuing to use cocaine in spite of knowing that it is causing them to experience issues with their health and/or with their emotional functioning
- The person has repeated cravings to use cocaine.
- The person spends significant amounts of time trying to get cocaine, using cocaine, or recovering from using cocaine.
- The person develops a tolerance to cocaine.
- The person displays withdrawal symptoms when not using cocaine.
- Formal Diagnostic Criteria
Formal diagnostic criteria can only be employed by trained healthcare professionals to determine a diagnosis of a substance use disorder. Some other signs of cocaine use that may occur in individuals but do not specifically relate to the diagnostic criteria include:
- Alternating periods of extreme energy or even hyperactivity followed by periods of lethargy and depression; may include periods of pressured speech, loss of inhibitions, reduced need for sleep, extreme feelings of wellbeing or euphoria, sweating and nervousness, paranoia or psychotic behavior, followed by periods of extreme lethargy, sleepiness, depression, and/or apathy
- Constant runny nose or nosebleeds and redness around the nose
- Increased periods of irritability and agitation
- Increased periods of the person wanting to be isolated or being gone for days at a time
- Involuntary muscle movements, such as tremors or shakiness
- Long-Term Effects
A more obvious sign is finding drug paraphernalia related to cocaine use, such as rolled-up dollar bills, straws, glass or metal pipes, mirrors with residue on them, etc.A number of long-term effects are also associated with cocaine use. These can include:
- Damage to the nasal passages as a result of snorting cocaine
- Damage to the respiratory system as a result of snorting or smoking cocaine
- Advanced tooth decay
- Cardiovascular issues, including high blood pressure, heart rhythm abnormalities, arteriosclerosis, and an increased potential for stroke
- Damage to the liver and/or kidneys
- Increased risk to develop cancer
- Significant neurological damage that can lead to problems with the ability to pay attention, memory, and problem-solving abilities
- A diagnosis of a formal substance use disorder
- The development of other mental health disorders as a result of neurological damage and the ramifications of cocaine use, including issues with anxiety, depression, and a vulnerability to develop other disorders, such as psychotic disorders or trauma- and stress-related disorders
- Withdrawal from Cocaine
- A withdrawal syndrome develops as a result of a person chronically using a drug and developing physical dependence on the drug. Physical dependence consists of having both tolerance (the need to use more of the drug to get effects once achieved at lower doses) and withdrawal symptoms. Tolerance to cocaine develops rapidly in people who use the drug, and withdrawal symptoms can occur in chronic users. The medicinal use of cocaine is rarely prescribed for a long-term basis, and it is typically situational use, such as being used as a mild numbing agent. Because individuals who use cocaine regularly procure the drug illegally and use it for nonmedicinal uses, anyone who has developed physical dependence on cocaine has also developed a stimulant use disorder as a result of their cocaine use. Withdrawal symptoms associated with cocaine include:
- Periods of moderate to severe depression often referred to as the “crash”
- Increased need for sleep
- Increased appetite
- Cravings for cocaine
- Mood swings that can include periods of irritability and anxiety
- Increased body temperature, changes in heart rate, sweating, fever, chills, headache, and mild nausea
- Suspiciousness and, in some cases, hallucinations
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Withdrawal from cocaine is classically described as a three-phase withdrawal process that includes:
- The initial crash: Symptoms in the initial phases are lethargy, drowsiness, appetite increase, and issues with depression. This phase is typically short-lived and may last for hours to a few days.
- Formal withdrawal: Any of the above listed symptoms can occur during the withdrawal phase. Symptoms will vary from patient to patient. In some rare cases, there are instances of patients having seizures and even heart attacks in the early and middle phases of withdrawal from cocaine. This phase can last from days to weeks, depending on the patient.
- Extinction: During the final phase, the patient may still experience a number of low-level emotional symptoms, including irritability, mild depression, issues with anxiety, etc. They may also continue to experience intermittent cravings for the drug, especially in situations that remind them of their drug use. This phase can last indefinitely in some patients. Many sources describe lengthy extinction periods as a post-acute withdrawal syndrome or protracted withdrawal syndrome.
Even though the above model is often still referenced in clinical sources, more recent research has suggested that these phases are not quite as well-defined as originally believed. Patients may experience acute symptoms associated with the crash for several days and then move on to more low-level symptoms that are associated with extinction, or patients may experience symptoms associated with the withdrawal phase and not experience a significant crash. Most sources agree that, in general, withdrawal from cocaine is not physically dangerous and that the majority of symptoms are psychological or emotional in nature. However, some patients may be vulnerable to issues with poor judgment, accidents, or even suicidality during extreme periods of withdrawal, depending on the symptoms they experience.
- Treatment for Addiction Involving Cocaine
- Many people will attempt to discontinue cocaine on their own and use a “cold turkey” approach. Because relapse rates are extremely high during the early phases of withdrawal, this is not a sound approach for individuals who are serious about recovery. It is much more prudent for people to seek the assistance of professional mental health workers, such as addiction medicine physicians and therapists, when they are in the early stages of recovery. Treatment should include:
- Some form of a medically assisted withdrawal management program: Addiction medicine physicians can administer a number of medications to deal with issues concerning mood, cravings, and lethargy as the person undergoes the withdrawal syndrome. Physicians are usually able to adjust these interventions based on the needs of the specific patient. Withdrawal management can be performed on an inpatient or outpatient basis. The decision to use inpatient versus outpatient treatment depends on the needs of the individual and the specific situation. This should be thoroughly discussed with one’s treatment providers.
- Treatment for identified co-occurring disorders: This should be initiated along with treatment for the substance use disorder. Medical management of any existing issues should also be continued.
- Therapy: Clients should engage in some formal form of substance use disorder therapy in order to address issues that led them to use cocaine, develop a sound plan of relapse prevention, learn effective stress management techniques, and address any other psychological symptoms. Therapy can be delivered on an individual basis or in a group setting.
- Social support: Support from friends and family is crucial in recovery. In addition, participating in social support groups, such as 12-Step groups (e.g., Cocaine Anonymous), can be particularly useful.
Hope in Recovery
Cocaine is a highly addictive drug. Chronic use of cocaine can result in the development of a serious substance use disorder and the potential for a number of ill effects to health, relationships, and in other important areas of the person’s life. Treatment for a stimulant use disorder as a result of cocaine abuse should be undertaken with the assistance of professional mental healthcare personnel who are trained in addiction recovery.