Cocaine is a stimulant drug that interferes with the reabsorption of one of the brain’s natural messengers, or neurotransmitters, dopamine.
Dopamine is partially responsible for feelings of pleasure, mood, and emotional regulation. By blocking the dopamine receptors in the brain, cocaine floods the system with “happy cells,” often leading to an addictive high.
The National Survey on Drug Use and Health (NSDUH) published that 1.5 million Americans over the age of 12 abused cocaine in the month prior to the 2013 survey. The Drug Enforcement Administration (DEA) considers cocaine a Schedule II drug, meaning that it has very limited accepted medicinal uses in the United States and a high potential for abuse, dependency, and addiction.
Cocaine comes from the South American native coca plant, and it is usually sold on the street in a white powder or as crack in small rock-shaped pieces.
Street names for cocaine include:
- Ice Cube
- Gold Dust
- Snow White
Cocaine is usually injected, snorted, or smoked. It creates a high quickly, within a few minutes, when smoked or injected, and it takes a little longer to take effect when snorted. A tolerance to cocaine levels can occur rather quickly, requiring higher and more doses in order to obtain the desired rush. Tolerance may develop into a physical and psychological dependence, and users may crave cocaine after it leaves the bloodstream.
When the cocaine high wears off, a crash occurs, which is indicated by complete mental and physical exhaustion and often depression. While generally not life-threatening, this crash and subsequent withdrawal, may increase the risks for suicide if left untreated. In addition, the health risks associated with cocaine abuse increase the likelihood of mortality in users. A Spanish study published by Science Daily found that cocaine abusers were 5.1 times more likely to die than the general population.
Comprehensive Treatment Models
Addiction is a brain disease that is highly treatable with comprehensive treatment models. Many of these care plans begin with a detoxification, or detox, process. Detox is the process of purging cocaine from the system in a safe and controlled manner. It may be most successfully completed at a specialized detox facility under supervised medical care.
First, a complete and comprehensive assessment must be administered by a medical professional in order to ascertain the correct course of treatment. Several tests may be done during this time, including a potential blood or urinalysis to test for the presence of drugs and to determine which ones are in the system and how much. Mixing cocaine with other drugs or substances can increase potential risks, and all substances that are present need to be identified in order to provide the safest detox program. Cocaine withdrawal symptoms are largely emotional or psychological in nature, while alcohol withdrawal can be physically dangerous and even potentially fatal if not managed properly.
A medical history is also required in order to determine any underlying medical or mental health conditions as well as family history. Mental illness and cocaine abuse often go hand in hand, and 84 percent of the cocaine consumed in the United States is by those who have suffered from some type of mental illness within their lifetime, as reported by the National Bureau of Economic Research (NBER). Additionally, NBER finds that mental illness increases the odds of using cocaine by 27 percent, and a history of mental illness increases the potential for using cocaine by 69 percent over that of the general population.
Substance abuse is often a method of self-medicating an undiagnosed mental disorder in order to provide temporary relief. Unfortunately, substance abuse may actually make mental illness worse, increasing symptoms and interfering with mental health treatment. A comprehensive medical and mental health assessment is vital to determining the best detox and recovery plan for a cocaine abuse or dependency issue.
Restoring Physical Balance
The initial goal during detox is generally physical stabilization. Cocaine is a powerful stimulant that is often used in a binge pattern (i.e., taking repetitive doses in short period of time which can increase the side effects and risk factors). Stimulant drugs increase heart rate, blood pressure, body temperature, and energy levels as well as depress appetite and the need for sleep. Cocaine also impairs judgment, which may cause the user to make poor decisions that involve potentially hazardous situations, including risky sexual behaviors. Injection cocaine abusers may also transmit infectious diseases through the sharing of dirty needles.
Chronic cocaine abuse is hard on the heart, also. When the levels of cocaine in the system reach toxic levels, an overdose may occur. Cocaine was responsible for 40.3 percent of all emergency department (ED) visits related to illicit drug use, according to the Drug and Alcohol Abuse Warning Network (DAWN) report in 2011. Overdose deaths related to cocaine abuse also increased 29 percent from 2001 to 2013, as published by the National Institute on Drug Abuse (NIDA). Overdose deaths are usually due to stroke or heart attack.
Cocaine makes chemical changes in the brain that may take time to reverse. A safe and secure environment monitored around the clock by staff members may provide the smoothest possible detox. Physically, the body may need to stabilize. Cocaine suppresses appetite and may cause unhealthy weight loss, for example. A balanced diet plan can help restore a healthy body weight. Physical exercise is also beneficial during detox as it releases natural endorphins as well as increases physical strength and stamina, boosting self-esteem and confidence levels. Yoga and meditation have been proven to help reduce stress, and increase energy and focus naturally.
Cocaine has a short half-life, and it is usually completely out of the bloodstream in as little as 90 minutes, which can lead to the onset of withdrawal symptoms. The duration and severity of these symptoms is dependent on the amount of drug abused, type of drug (crack cocaine or powdered cocaine), method of abuse, duration of abuse, and level of physical dependency. Some genetic and physiological factors such as metabolism may also play a role in the withdrawal process.
Cocaine withdrawal usually occurs in three phases: the initial crash, withdrawal period, and extinction. Each phase may need to be managed differently during detox. For example, during the crash phase, users may require more sleep than usual as well as have an increased appetite. Fatigue, irritability, depression, anxiety, and dysphoria, or the inability to feel pleasure, are also present during the crash period. Providing healthy meal options and set sleep schedules can help regulate the body during this time.
The middle phase generally includes drug cravings, trouble concentrating as well as prolonged irritability, depression, and lethargy. Relapse prevention methods and psychotherapy are important during this phase. Extinction is considered the last phase, and intermittent drug cravings may be managed with therapy, counseling, and support groups.
Use of Medications
There are currently no medications approved for the treatment of cocaine addiction; however, several adjunct medications may be useful during detox in order to promote stability. Antidepressants are a useful tool for moderating suicidal thoughts and behaviors. Other mood stabilizers may be useful during withdrawal to help moderate the levels of dopamine that have been depleted by cocaine abuse. Cocaine interferes with the brain’s natural reward pathways and dopamine production, and if used long-term, these changes may take some time to restore. The brain will try to regain balance, causing withdrawal symptoms; however, this may take some time. In the meantime, dopamine levels may be very low. Without dopamine, it is easy to feel depressed, and the user may find it difficult to feel any pleasure. Medications may be useful to stimulate dopamine production temporarily as the brain works to produce it at natural levels again.
Benzodiazepines may also be used short-term for the management of acute anxiety present during withdrawal at times. As a stimulant, cocaine may cause severe sleep deprivation, which hinders the healing process, and in some cases, an insomnia medication may be necessary at least for a short period of time.
After a period of physical stabilization, it is important to address the emotional components related to cocaine abuse and dependency. Therapies and counseling sessions both in groups and individually are important during recovery. Contingency management (CM), or motivational incentives, is one approach that can be effective in treating cocaine addiction. CM is used during detox and recovery, motivating users to stay sober as they earn chips, vouchers, or points for each drug-free urine test provided. These vouchers, points, or chips can then be traded in for prizes or cash. One study published in the Journal of Substance Abuse Treatment found that significant cash incentives for clean drug tests greatly improved abstinence and retention in an addiction treatment program.
Behavioral therapies, such as Cognitive Behavioral Therapy (CBT), are also effective tools used in addiction treatment and recovery. Healthy lifestyle changes, coping mechanisms, and new life skills are taught with CBT. Potential stressors can be identified, and self-destructive behaviors like substance abuse are addressed and modified into more positive behavior patterns. CBT works to improve self-esteem and negative self-images. Since cocaine is a psychologically addictive substance, therapies and counseling, sometimes coupled with pharmacology, may be the most effective methods for completely detoxing and recovering from abuse and dependency.
Ongoing support is vital during recovery, and peer and family support groups as well as 12-Step programs may provide the necessary positive environment that is conducive for long-term recovery and the prevention of relapse. Learn as much as possible about the disease of addiction, particularly stimulant addiction, in order to better understand what to expect.
If you suffer from co-occurring disorders such as a substance abuse disorder and a mental health disorder, a dual diagnosis treatment plan offers the highest rate of success, providing a comprehensive and integrated care model that treats both disorders simultaneously with medical professionals who work closely together to produce positive results.
Detox is best performed under direct medical supervision with the assistance of consulting physicians, in a peaceful setting, such as the one offered here at Black Bear Lodge. Detox is not the same for everyone, and our highly trained professional staff members are sensitive to each individual’s needs. Admissions coordinators are standing by to give you a free and confidential assessment to determine what level of care is right for you. Give us a call at 706-914-2327 today