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Cocaine Withdrawal

While opioids claim more lives than any other illicit drug, cocaine has consistently been reported as the second highest killer in overdoses among drug users. Conflicting reports state that cocaine use has been down recently, but The New York Times outlines how cocaine prices have fallen, making it easier to obtain in the United States. 

Of course, the opioid epidemic is a serious one that requires attention and funding. However, treatment for cocaine use becomes harder to access. Unlike opioid addiction, there are no medications approved for use in curbing cravings or reducing withdrawal symptoms of cocaine use. 

Treatment for someone in active cocaine addiction will depend on the access to resources in his or her community. Other factors include the quality of the clinical and medical staff at the facility where they seek treatment and their ability to cover the costs. As you will see, cocaine withdrawal is not fatal, but continued use of it can be. 

What Is Cocaine?

Cocaine is a central nervous system (CNS) stimulant derived from the coca plant native to South America. When it’s used in powder form, users either snort it or add it to a liquid, heating and injecting it. “Crack” is cocaine that has been mixed with a solution of baking soda. The water evaporates, leaving crystal-like rocks behind, which are then heated, and the vapors smoked. 

Cocaine was used for thousands of years by indigenous people in South America, particularly in Peru. They chewed the leaves of the Erythroxylon coca plant for strength and energy. It was used for medicinal purposes up through the 19th century. It was used as an analgesic, a numbing agent, toothache medication, and as an anesthetic. 

However, it’s clear addictive potential caused people to realize that it could also be abused and potentially dangerous. In the U.S., it’s considered a Schedule II drug.

Cocaine works in a way that’s similar to other stimulants. It alters your brain chemistry by interacting with dopamine, a naturally occurring brain chemical that’s closely tied to reward, motivation, and feelings of excitement. Cocaine blocks a process called reuptake, where excess chemicals are removed from your system and recycled. 

Cocaine blocks the reuptake of dopamine and serotonin (to a lesser extent). This causes a build-up of the chemical to bind to more dopamine receptors, leading to intense feelings of euphoria, excitement, energy, and alertness. 

The euphoric effects of the dopamine flooding your brain can also affect your reward system. The reward system of your brain is designed to pick up on healthy activities and encourage you to repeat them. It’s closely tied to dopamine, and cocaine can cause your brain to mistake it for a life-sustaining activity which leads to addiction. 

How Cocaine Affects the Brain

Everything we do affects the central nervous system. The foods we eat, how much sleep we get, the quality of the air and water we ingest, and even things like stress and unseen toxins in cleaning products will have some kind of an effect. 

The effects of cocaine, crack, and other amphetamines are relatively similar, with variations in duration of effects and length of time to recover from withdrawal symptoms. Cocaine acts mainly by blocking the reuptake of dopamine. This leaves more of the feel-good dopamine in the synapses and leads to feelings of elation or euphoria. 

Cocaine can also act as an anesthetic, and in fact, this was one of the first uses by modern medicine toward the turn of the 20th century. Sigmund Freud was famous for using cocaine for a variety of ailments, as well as prescribing it to patients and colleagues. Additionally famous was the fact that the Coca-Cola company included cocaine in its ingredients until around 1906. 

Whether the cocaine is snorted, injected, or smoked, some signs or symptoms to be aware of are:

  • Changes in heart rhythm
  • Elevated mood
  • Anxiety or irritation
  • Increased alertness, or confidence
  • Decreased need for food, sleep
  • Dilated pupils
  • Elevated or lowered blood pressure
  • Sweating or chills
  • Nausea or vomiting
  • Psychomotor agitation
  • Chest pain or respiratory depression
  • Confusion, paranoia or seizures

What You Can Expect from Cocaine Withdrawal

Cocaine withdrawal is not considered life-threatening. Symptoms will depend upon the type, severity, and frequency of use, but will typically include depression, the onset of which can be within hours up to several days after the last use. It also will include the need for extended sleep and food to compensate for the time spent with diminished appetite and sleep while actively using. 

The following may also be present during a withdrawal period for cocaine:

  • Vivid, unpleasant dreams
  • Insomnia or hypersomnia
  • Psychomotor agitation, or retardation
  • Disruptions in cognitive performance
  • Decreased ability to focus
  • Paranoia

Cocaine is metabolized relatively quickly, with a half-life of about 40-60 minutes. That means in that time, about half of the substance has been processed, and the effects will begin to diminish. Unfortunately, this is what contributes to the highly addictive properties of cocaine. Because it is processed by the brain and body quickly, the negative side effects are also felt relatively quickly, and this can lead to an individual searching out more and more of the drug to avoid withdrawal symptoms. 

What Are the Steps for Cocaine Withdrawal Treatment?

The withdrawal from cocaine is not considered lethal. However, long-term, chronic use of cocaine is associated with serious symptoms that are the opposite of the initial effects experienced by the user. These can include serious, persistent changes to brain functioning, social and occupational declines, as well as adverse effects on the cardiovascular and respiratory systems. 

Additionally, if the drug is snorted, there can be long-term damage to the soft tissue found in the nasal passages. The potential for addiction is high, as is the necessity for quality care to interrupt the cycle of use, dependence, and addiction.

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Once you have identified that you are in need of help, the next phase of cocaine addiction treatment is entering either an inpatient or outpatient addiction recovery treatment program. A skilled clinician will be able to assess whether you will benefit more from living at a residential treatment facility and having continuous access to medical and therapeutic care, or if you are stable enough to participate in treatment while still living at home. Either way, long-term treatment is essential to avoiding relapse. 

In a recovery treatment program, you will be able to address the physical, psychological, medical, and social aspects of the cocaine addiction, learning through various therapeutic tools how to manage your addictive behaviors effectively and maintain long-term sobriety. This is done through a customized treatment plan, which you will customize with your therapist, and may include some of the following common treatment modalities:

Sources

PBS. (2011, October 17) Cocaine: How 'Miracle Drug' Nearly Destroyed Sigmund Freud, William Halsted. Retrieved from https://www.pbs.org/newshour/show/cocaine-how-miracle-drug-nearly-destroyed-sigmund-freud-william-halsted

DEA Museum & Visitor's Center. (n.d.). Cannabis, Coca, & Poppy: Nature's Addictive Plants. Retrieved from https://www.deamuseum.org/ccp/coca/history.html

New York Times. (2018, March 05). Overshadowed by the Opioid Crisis: A Comeback by Cocaine. Frakt, A. Retrieved from https://www.nytimes.com/2018/03/05/upshot/overshadowed-by-the-opioid-crisis-a-comeback-by-cocaine.html

SAMHSA. (2014, September 30). Stimulants. Lynsen, A.Retrieved from https://www.samhsa.gov/atod/stimulants

National Institute on Drug Abuse. (n.d.). What is the scope of cocaine use in the United States? Retrieved from https://www.drugabuse.gov/publications/research-reports/cocaine/what-scope-cocaine-use-in-united-states

Medscape. (2018, August 01). Stimulants .Retrieved from https://emedicine.medscape.com/article/289007-overview#a3

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