Cocaine & Crack: Abuse & Treatment
Cocaine is a powerfully addictive stimulant directly affecting the brain and is estimated to be abused by around 3.6 million Americans.
Cocaine is one of the oldest known drugs. While pure cocaine hydrochloride has only been abused for around 100 years, coca leaves, the source of cocaine, have been ingested for thousands of years.
In the mid-19th century, pure cocaine was first extracted from the leaf of the Erythroxylon coca bush, which grows primarily in Peru and Bolivia. In the early 1900s, cocaine became the main stimulant drug used in most of the tonics and elixirs that were developed to treat many illnesses.
Today, cocaine is classified as a Schedule II drug – its high potential for abuse is recognized but it can be administered by a doctor for legitimate medical uses such as for local anesthetic in some eye, ear, and throat surgeries.
Cocaine on the Street
Essentially two forms of cocaine are abused on the street: hydrochloride salt and freebase. The hydrochloride salt refers to the powdered form of cocaine, which dissolves in water and is usually injected into the vein or snorted into the nose. Freebase is the form of cocaine that is smokable (crack). The acid that neutralizes hydrochloride salt is removed to make crack cocaine.
Cocaine is generally sold on the street as a fine, white, crystalline powder and called coke, C, snow, flake, or blow. Street dealers generally dilute it with substances like cornstarch, talcum powder, and/or sugar. It is also sometimes manufactured with active drugs like procaine (a chemically-related local anesthetic) or other stimulants like amphetamines. Some users combine cocaine powder or crack with heroin to create a “speedball.”
How Cocaine is Used
The 4 main ways cocaine is taken and the corresponding slang terms are:
- Orally (chewing)
- Intranasally (snorting – inhaling cocaine powder through the nostrils, where it is absorbed into the bloodstream through the nasal tissues)
- Intravenously (mainlining, injecting – releases the drug directly into the bloodstream and heightening the intensity of its effects)
- Inhalation (smoking, including freebase and crack cocaine – inhalation of the vapor or smoke into the lungs causes absorption into the bloodstream as rapidly as injection)
There is no safe way to use cocaine. Although levels of use range from occasional through repeated or compulsive use, each time cocaine is taken there is a risk of absorption of toxic amounts of cocaine, leading to acute cardiovascular or cerebrovascular emergencies that could result in sudden death.
Repeated cocaine abuse by any means can lead to addiction and other adverse health consequences.
Crack Cocaine – One of the Street’s Most Addictive Drugs
Crack is the street name for the freebase form of cocaine that is smokable. The term “crack” comes from the crackling sound heard when the mixture is smoked. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water and heated to remove the hydrochloride.
When crack is smoked, the user experiences a high in less than 10 seconds. The immediate euphoric effect helped make crack popular in the mid 1980s, along with its low cost.
Crack cocaine is much more potent than other forms of cocaine. By removing the hydrochloride, crack cocaine is cooked into a more concentrated version. Crack cocaine is smoked, usually through a glass pipe or aluminum can.
Crack cocaine is one of the most addictive street drugs available. Crack users cannot stop, even when they want to.
Crack cocaine was originally thought of as used mainly in ghettos. But it has now become popular among younger and more affluent crowds, due to its low cost and short, powerfully euphoric high.
The euphoric feeling crack cocaine produces is short lived. After the high fades, a crack user can be left with side effects like:
- Harsh mood swings
Regular use will lead to addiction. Once addicted, crack cocaine users become desperate for their next fix. They’ll lie, cheat, and steal to get it.
Intense craving can only be satisfied by more and more crack cocaine. As a crack addict develops physical and psychological dependence, they feel they need it to function. Tolerance often develops. This means that higher doses and more frequent use of cocaine are required for the brain to register the same level of pleasure.
Recent studies have shown that when a user abstains from cocaine use, the memory of the euphoria from cocaine use, or just exposure to cues associated with cocaine use, can trigger tremendous craving and relapse, even after long periods of abstinence.
Long-term crack cocaine effects include:
- Constant or compulsive restlessness
- Severe depression
- Heart and respiratory problems
- Heart attack
How Cocaine Produces its Effects
Cocaine’s pleasurable effects are produced by its effects on structures deep in the brain that, when stimulated, produce feelings of pleasure. One neural system that appears to be most affected by cocaine originates in a region called the ventral tegmental area (VTA). Nerve cells in the VTA extend to the region of the brain known as the nucleus accumbens, one of the brain’s key pleasure centers.
Normally, dopamine is released by a neuron into the synapse, where it can bind with dopamine receptors on neighboring neurons. Then dopamine is recycled back into the transmitting neuron by a specialized protein called the dopamine transporter.
Researchers have discovered that pleasurable events lead to a large increase in dopamine released in the nucleus accumbens by neurons originating in the VTA. When cocaine is present, it attaches to the dopamine transporter and blocks the normal recycling process, resulting in the dopamine building up in the synapse. This contributes to the pleasurable effects of cocaine.
Effects of Cocaine and Crack
Cocaine is extremely detrimental to the body – the consequences can be permanent damage, addiction, and death. While each person who uses cocaine reacts to it differently, the short-term effects and long-term effects of cocaine can be devastating.
Short-Term Cocaine Effects
Short-term effects can be experienced after only one use. They effects are felt immediately. Although not always damaging, they can cause serious bodily damage and death. Deaths related to cocaine effects are often a result of cardiac arrest or seizures and respiratory failure.
The method used affects the rate of absorption and the intensity of the high. Effects are normally felt immediately, although the high from snorting is a little slower in onset. The high may last only a few minutes – or up to a couple hours. Smoking crack cocaine produces a short, intense high lasting 5 to 10 minutes.
In doses up to 100 mg, cocaine makes a user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. The cocaine user may not feel the need to eat or sleep. Cocaine also makes users feel they can perform some physical and intellectual tasks faster, although others report it makes them perform more slowly.
A summary of short-term physiological effects of cocaine abuse includes:
- Increased energy
- Decreased appetite
- Mental alertness
- Constricted blood vessels
- Increased temperature, heart rate, and blood pressure
- Dilated pupils
Large amounts of cocaine (several hundred milligrams or more) intensify the high, and may also lead to:
- Bizarre, erratic, and violent behavior
- Muscle twitches
- Toxic reaction closely resembling amphetamine poisoning
Some cocaine users feel restless, irritable, and anxious. Rarely, sudden death occurs on the first use of cocaine or soon after with no warning. Usually, cocaine-related deaths result from cardiac arrest or seizures followed by respiratory arrest.
The Attraction of Cocaine
Many people who try cocaine find the increased energy very attractive. The quick, sustained energetic feeling hooks those who are looking to be more productive in their jobs and other areas of their lives. In the beginning, the perceived benefits can draw in a cocaine user. But increased tolerance and resulting poor life choices become more and more common as the user continues to use cocaine for energy.
Appetite suppression is a dangerously popular effect for those who are trying to lose or maintain their weight, such as fashion models. Cocaine users may go days without eating, becoming addicted to cocaine use to sustain them.
Long-Term Effects of Cocaine
Long-term effects develop after increased periods of cocaine use. The severity of the long-term effects depends on the amount and length of cocaine use.
In addition to serious medical complications, long-term cocaine effects include:
- Auditory hallucinations
- Mood disturbances
Cocaine is powerfully addictive. Even after trying cocaine one time, it may be too powerful for the individual to maintain control over the draw to use cocaine again, leading to more intense, more frequent use regardless of the original intention.
Tolerance to the high from cocaine develops. Cocaine and crack addicts say they can never derive as much pleasure from it as they did the first time. They usually take more and more crack and cocaine to try to reach more intense and longer lasting euphoric effects.
Some cocaine users do not take more of the drug, but seem to become sensitized to certain effects, especially the anesthetic and convulsant effects. Because of the increased sensitivity, cocaine users may die from doses that are considered quite low.
A cocaine user sometimes binges by taking the drug over and over, usually increasing the dose each time. This causes increasing irritability, restlessness, and paranoia. It can lead to full-blown paranoid psychosis, as the individual loses touch with reality and experiences auditory hallucinations.
Negative behavior can become pervasive as the cocaine habit grows. The lifestyle of the cocaine addict is often characterized by:
- Missing days at work
- Denying the use of cocaine
Long-Term Medical Consequences of Cocaine Abuse
Since cocaine is a highly addictive drug, it can lead to major medical complications and health problems.
Some of the most frequent cocaine complications are cardiovascular effects, including disturbances in heart rhythm and heart attacks; respiratory effects like chest pain and respiratory failure; neurological effects including strokes, seizure, and headaches; and gastrointestinal complications, including abdominal pain and nausea. Other physical symptoms include convulsions, nausea, blurred vision, fever, muscle spasms, and coma. Malnourishment and serious weight loss can also occur due to the neglect of nutrition while using cocaine.
Cardiovascular effects of cocaine:
- Disturbances in heart rhythm
- Heart attacks and heart disease
Respiratory effects of cocaine:
- Chest pain
- Respiratory failure
Neurological effects of cocaine:
- Seizures and convulsions
Gastrointestinal complications from cocaine:
- Abdominal pain
Effects from Different Methods of Cocaine Abuse
Snorting cocaine regularly may lead to:
- The loss of sense of smell
- Problems with swallowing
- Irritation of the nasal septum, which can lead to a chronically inflamed, runny nose
Ingesting cocaine may lead to severe bowel gangrene, due to reduced blood flow.
Injecting cocaine produces needle marks, called “tracks”, on the forearms. This intravenous use is more likely to produce an allergic reaction to the drug or an additive, which can cause death.
Cocaine and Alcohol – A Deadly Combination
Combining cocaine and alcohol produces a potentially dangerous interaction. The body converts the alcohol and cocaine to cocaethylene, which acts longer in the brain and is more toxic than either alcohol or cocaine alone. Mixing alcohol with cocaine use is the most common cause of death from combining two drugs.
Risk of HIV/AIDS and Hepatitis B and C
Injecting drugs like crack and cocaine is the leading risk factor in contracting HIV / AIDS. Cocaine abusers risk catching other infectious diseases like hepatitis, too, due to sharing contaminated needles and paraphernalia. Indirect transmission can also occur when an HIV-infected mother transmits it to her unborn child. This is a serious concern, as more than 60% of new AIDS cases are women.
Hepatitis C is also spreading rapidly among cocaine users who inject the drug. It is estimated that 65 – 90% of injecting users may carry hepatitis C. There is no vaccine for this virus – treatment has a high failure rate and is often unsuccessful, with dramatic side effects.
The use of cocaine reduces a user’s ability to make good lifestyle choices. The cocaine habit may result in taking more risks, such as unprotected sex and trading sex for drugs. This applies to both men and women who are desperate for more cocaine.
Effect of Cocaine Use by Mothers
While it’s not known for sure the extent of effects on an unborn child when the mother uses cocaine, studies show that the child often suffers the following problems:
- Premature birth
- Low birth weight
- Smaller head circumference
- Shorter in length
Babies born to mothers who use crack cocaine while pregnant are called “crack babies”. While the predicted effects on the children appear to have been exaggerated, it has been found that exposure to cocaine during fetal development may lead to subtle, but significant, deficits later, especially with behaviors that are crucial to success in the classroom, such as blocking out distractions and concentrating for long periods of time.
Mothers who use cocaine often provide inadequate prenatal care and abuse and neglect their children.
Cocaine Use in the United States
Cocaine has been labeled the drug of the ‘80s and ’90s, because of its extensive popularity and uses during this period.
In 1997, an estimated 1.5 million Americans (0.7 percent of people aged 12 and older) were using cocaine, according to the 1997 National Household Survey on Drug Abuse (NHSDA), down dramatically from the 1985 peak of 5.7 million cocaine users (3% of the population). Based on additional data sources that account for users underrepresented in the NHSDA, the Office of National Drug Control Policy estimates the number of chronic cocaine users at 3.6 million.
Adults 18 – 25 years old have a higher rate of cocaine use than those in any other age group. Overall, men seem to use cocaine more than women. The 1997 NHSDA also reports rates of cocaine use according to ethnic group:
- African Americans – 1.4%
- Hispanics – 0.8%
- Caucasians – 0.6%
The 1998 Monitoring the Future Survey, which annually surveys teen attitudes and recent drug use, reports that lifetime and past-year use of crack increased among 8th graders to its highest levels since 1991, the first year data was available for this grade. The percentage of 8th graders reporting crack use at least once in their lives increased from 2.7%in 1997 to 3.2% in 1998. Past-year use of crack also rose slightly among this group, although no changes were found for other grades.
Data from the Drug Abuse Warning Network (DAWN) showed that cocaine-related emergency room visits, after increasing 78% between 1990 and 1994, remained the same between 1994 and 1996, with 152,433 cocaine-related episodes reported in 1996.
Crack cocaine is still a serious problem in the United States. Many researchers believe that crack cocaine will continue to be a popular drug since it is relatively easy to obtain. The NHSDA estimated the number of current crack users to be about 604,000 in 1997, which does not reflect any significant change since 1988.
Effective Cocaine Treatments
Treatment providers in most areas of the country, except in the West and Southwest, report that cocaine is the most commonly cited drug of abuse among their clients. Due to the pervasive nature of cocaine use, drug treatment centers have responded by developing effective treatments for cocaine abuse.
Cocaine abuse and addiction are complicated. It involves biological changes in the brain as well as many social, family, and environmental factors. Treatment is also complex, in order to address all these problems and assess the psychobiological, social, and pharmacological aspects of the patient’s drug abuse.
No medications exist to treat cocaine addiction. However, NIDA is conducting aggressive research to find and test medicines that can treat cocaine. A promising drug that is still being investigated includes selegiline, which may become available in a timed-release pill or transdermal patch. Disulfiram, which has been used to treat alcoholism, has also been shown to help reduce cocaine abuse in clinical studies. Antidepressants have also shown to help with the wide mood swings characteristic of the early stages of cocaine abstinence. Medical treatments are also under development to treat acute emergencies from the overdoses that usually result in death.
Behavioral Interventions for Cocaine Treatment
Behavioral therapies are the only effective treatment available for cocaine addiction. Residential and outpatient programs at drug treatment centers have succeeded in treating cocaine and crack addiction.
Most importantly, the treatment regimen must be matched to the needs of the cocaine patient. The treatment should be adjusted as it proceeds, to meet the individual’s requirement for support in preventing relapse and other areas of a recovery program.
Contingency management is often used in cocaine addiction treatment. This involves providing rewards for positive results such as continuing to abstain from cocaine use. Passing drug urine tests lets cocaine patients collect points which can be exchanged for such positive rewards as a gym membership or dining experience.
Cognitive-behavioral therapy helps patients recognize, avoid, and cope with situations where they might be likely to fall back into cocaine use. It makes use of the learning process – in effect unlearning the habits of cocaine abuse that were learned earlier.
Cocaine and Crack Cocaine Treatment at Transitions Recovery
Transitions Recovery drug treatment center offers hope for those suffering from the obsessive clutches of cocaine or crack.
Our professional drug treatment center staff is experienced in helping youth and people of all ages recover from drug and alcohol abuse. We provide a compassionate, supportive environment in our North Miami Beach, Florida, drug treatment center.
Admissions can be accepted 7 days a week. Trained cocaine addiction professionals conduct individual assessments that address each individual’s treatment needs. You’ll find our cocaine and crack drug treatment programs offer access to a continuum of care that provides the intensity of therapy appropriate throughout each stage of recovery, from extended residential care to lifetime aftercare services. The individual program incorporates leading forms of therapy that have proven effective in addressing underlying causes of cocaine and crack drug use, dual diagnosis, and issues with family, employers, school and the legal system.
We work with cocaine and crack patients individually as well as in group sessions and a Family Program, once any necessary detoxification is complete. Emphasis on recovery from cocaine and crack addiction and maintained sobriety helps prepare the patient for gradual re-entry into society.
Treatment for cocaine or crack does not need to be voluntary. Often, a family member, employer, or the court system can be the motivating factor for an individual receiving drug treatment for cocaine or crack.