Is cocaine physically addictive?
What does it mean to by physically addicted? Is it possible for your body to be addicted? As it turns out, addiction is a condition defined by behaviors that are psychological, not physical.
Addiction is a chronic illness that involves compulsive, continued self-harm, with cravings and impaired control. In that last sentence, the five words that begin with the letter “C” are known as the 5 Cs of addiction, and they are all related to behavior.
As you know, behavior comes from the mind, which exists in the brain. This means that physical sickness that occurs when a drug is withheld from the body is not caused by addiction. What we think of as physical addiction is better described as physical dependence.
What we think of as physical addiction can occur without psychological addiction.
It is possible to be physically dependent on a drug and not be addicted to it. For example, there is a class of drugs used to lower blood pressure, the beta blockers.
If a beta blocker, such as atenolol, is taken for a long period of time and then stopped abruptly, the person will experience withdrawal symptoms, including palpitations and a fast heart rate. This is purely a case of physical dependence. Beta blockers are not at all addictive drugs.
Of course, since a person can manifest physical symptoms from their mind and the body reacts to mental state, the line between physical dependence and addiction can be blurred. Hence, while cocaine is considered to be a purely psychologically addictive drug, there are physical symptoms associated with quitting cocaine.
Mentally and physically, the withdrawal symptoms from cocaine seem to affect everything.
What does cocaine feel like? People who have never used it have a hard time relating to the sensations caused by such a potent stimulant.
While we might believe that it is similar to when you drink a lot of coffee and experience the effects of too much caffeine, it is nothing like that at all. Caffeine, and other legal stimulant drugs, such as pseudoephedrine, do not cross the blood brain barrier.
Their effects are purely physical, with little or no effects on the brain, in terms of altering mind or mood. Cocaine, on the other hand, does cross into the brain, making its effects far different from drinking a few cups of coffee.
Physical dependence vs psychological dependence: Is cocaine physically addicting at all?
When you take cocaine, there are physical changes that occur on a biochemical, cellular level in the brain. There are measurable changes in the areas of the brain known as the reward center. The receptors and cellular apparatus of the central nervous system neurons and associated proteins are altered in response to repeated cocaine exposure.
So, if there are physical manifestations within the brain, does that make cocaine physically addictive? No. Changes in neurochemistry are considered to be in the realm of the psychological. Addiction is known to alter neuroanatomy and changes in neurotransmitters, such as norepinephrine, serotonin, and dopamine, but these changes are not considered to be part of physical dependence.
What is a good example of a drug that causes physical dependence?
An example of an addictive drug that causes physical dependence is heroin. Heroin causes similar changes in the brain to cocaine, causing the victim of heroin addiction to crave heroin and continue using it in spite of clear self-harm.
However, heroin has effects that are considered to be related to physical dependence. When heroin is taken away, the addicted person experiences severe physical symptoms, including restless legs, cramps, aches, chills, sneezing, runny nose, abdominal cramps, nausea, and diarrhea.
In an episode of the talk show, “Raw Nerve,” starring William Shatner, guest Rush Limbaugh discusses what it was like to be addicted to opioids. He is especially emotional in describing the intensity of physical withdrawal symptoms.
At one point, he compares opioid
withdrawal to feeling like the flu times 1,000. This is consistent with what I have heard reported by patients. It has nothing to do with how tough or weak a person is. Opioid physical withdrawal is difficult for anyone and the effects it has on a person must not be underestimated.
Are there other addictive drugs that cause psychological and physical addiction?
As severe as opioid withdrawal is, in most cases, it is not physically dangerous. That means that if a person addicted to heroin were to be locked in a room for weeks without access to heroin, they would most likely come out alive and physically healthy.
Of course, this would be inhumane torture that might leave that person with lasting psychological trauma. Untreated opioid withdrawal often happens in jails and prisons and even in some rehabs.
While opioid withdrawal is not life-threatening and does not cause lasting physical harm, alcohol is a drug that has a potentially very dangerous withdrawal syndrome. Untreated alcohol withdrawal can lead to permanent neurological and physical damage, and even death.
Similarly, withdrawal from benzodiazepines, such as Valium, Xanax, Klonopin, and others, can cause potentially deadly seizures. When quitting these drugs, a medically supervised detox is critically important.
What about the physical vs psychological dependence of alcohol and cocaine combined?
I remember a new patient coming into the office who wanted to quit using cocaine. He told me that it was having a detrimental effect on his family relationships. While he genuinely wanted to quit using cocaine, he was having difficulty sticking with his commitment to quitting.
We spoke for a while about cocaine addiction
and how cocaine is highly addictive, but it is not considered to by physically addicting. While it is easy to say that stimulants such as cocaine and methamphetamine are “only” psychologically addictive, that does little to help a person who wants to quit and cannot do it alone.
Unfortunately, there is no approved Medication-assisted treatment
protocol for treating cocaine addiction. While there has been discussion in the scientific medical community for using drugs such as, topiramate, disulfiram, naltrexone, ketamine, or psilocybin, there has not been adequate research to support widespread use of these therapies.
Gateway drugs: can alcohol be a gateway to cocaine?
In the case of this particular patient who wanted to quit cocaine, further conversation revealed an interesting point. It turned out that he only used cocaine after drinking alcohol. In fact, he stated that he never used cocaine without first being drunk.
Armed with this new piece of information, I realized that we now had the opportunity to use medication-assisted treatment. Since there is proven MAT that works to help people to stop drinking, I decided to prescribe that particular therapy to him to help him avoid alcohol, which was the drug that always led him back to cocaine.
In addition to MAT, there are also psychological therapies that can help with cocaine addiction. These include cognitive behavioral therapy (CBT) and contingency management, also known at motivational incentives.
CBT is a useful form of psychotherapy that can be performed by psychiatrists, psychologists, and even lay people if properly trained. SMART Recovery meetings use CBT as part of their peer support group program. There are even phone apps that can deliver a form of CBT.
Paying the patient to heal from addiction.
I remember as a medical student walking by a patient room and hearing a man complain about being stuck in the hospital. I stopped to talk to him for a few minutes. At one point, he jokingly said to me, “they should be paying me to lay here!”
As silly as his comment was, when it comes to addiction, paying the patient for treatment success is an effective evidence-based therapy. Contingency management interventions, such as giving movie tickets, gift cards, or points towards redeeming a prize, really do work. It is just a matter of authorities and health care providers getting past their personal prejudices against the idea of paying an “addict” to do the right thing.
Surprisingly, these motivational incentives are effective in helping people addicted to cocaine or crack cocaine to remain in recovery. Rewarding regular urine drug screens that are cocaine free increases success rates.
Is coke physically addictive when purchased from a street drug dealer?
A fact that you may not be aware of is that cocaine is an FDA approved drug that has medical usefulness. It is classified as a schedule II drug, meaning that it has high abuse potential, but it is still used by doctors to treat patients, unlike heroin, which is a Schedule I.
Even marijuana is still classified as a Schedule I drug, meaning that the federal government considers it to have not medical use. Of course, the federal classifications of drugs do change over time, so we can expect updates in the future for cannabis and certain psychedelic drugs.
The danger of purchasing cocaine on the streets is that you are getting more than just cocaine. One disturbing new trend is drug dealers adding the synthetic opioid fentanyl to a variety of street drugs.
Why would drug dealers add the physically addicting drug fentanyl to cocaine?
Fentanyl is cheap, and easily purchased from China and delivered through the US mail. By adding it to other drugs, such as cocaine and methamphetamine, it adds a new dimension to the high from those drugs, helping to hook the user even more so than they would be with cocaine alone.
When a cocaine user quits using cocaine, if their supplier was adding fentanyl regularly, there will likely be a physical withdrawal component to deal with. In this sense, it is possible for street cocaine to be physically and psychologically addicting.
One way for drug users to address the problem of fentanyl contamination of the street drug supply is to have fentanyl test strips on hand. Before using drugs purchased on the street, the user has the option to test their drug to see if fentanyl is present. Fentanyl is highly potent and can easily cause respiratory depression and death. Drug users should not take a drug that tests positive for fentanyl.
If cocaine is only psychologically addictive, why go to a medical detoxification program?
In most detox programs, medications are offered to sooth the extreme anxiety that can occur during the withdrawal period. Medications, such as Valium or Librium, are offered short term as tranquilizers. In the case of alcohol or benzodiazepine withdrawal, providing these anxiolytics can prevent a deadly seizure. For cocaine withdrawal, anxiety meds can make the psychological withdrawal more tolerable.
In addition to basic medical management, the detox facility as well as residential rehab provide another benefit. When a person is in rehab for cocaine addiction, they will not be around cocaine or the people they used it with or bought it from.
Rehab can provide a safe place for a person to have the time for their brain to recover at a biochemical level without the constant reintroduction of cocaine back into their system. While most rehab stays last 2-4 weeks, 5-6 months works better, because it can take that long for the cocaine addicted brain to heal enough where cravings have significantly subsided.
What new treatments are on the horizon for treating psychological dependence on cocaine?
As mentioned earlier, the drugs psilocybin and ketamine show promise in treating addiction to various substances. Psilocybin is a naturally derived psychedelic substance that can help a patient gain perspective on their lives and drug use with the professional guidance of a trained therapist. There are also likely subtle changes in brain structure that might be considered similar to a reprogramming or reset.
Ketamine is a dissociative anesthetic drug that is already in use for a variety of medical uses, including the treatment of depression. The drug is believed to introduce a new plasticity to the brain, allowing for changing and new connections. When administered in conjunction with therapy from a trained psychotherapist, ketamine may be effective in treating addiction as well.
There are also drugs that are used for other substance dependencies that may be effective in treating cocaine addiction. For example, Naltrexone
, which is already approved to treat alcohol use disorder and opioid use disorder, may be effective in treating stimulant addiction. Ondansetron, an anti-nausea drug, is also being looked at as a genetically targeted therapy for a variety of addictions.
Can harm reduction help when it comes to cocaine addiction?
Harm reduction, like contingency management, is hard for some people to accept because it involves helping a drug user while they continue to use drugs. It goes against the long-accepted concept of “tough love” which is popular amongst members of All-Anon and Narc-Anon meetings.
Tough love means to completely cut off a person from any assistance until they are ready to stop using drugs and get help. It involves withholding any money, food, or assistance, and changing the locks on the doors. The thinking is that when the person suffering from addiction is out on the street, homeless, cold, and hungry, they will start to think clearly and reasonably about the consequences of their drug use.
Unfortunately, tough love can end with tragedy. Harm Reduction, on the other hand, has proven to be effective in keeping drug users alive and safe until they are ready to give up drug use. Harm Reduction for opioid use, for example, involves providing clean syringes, needles, and other paraphernalia. It can also involve giving them a safe place to use opioids under supervision.
Harm reduction for opioid use also involves making Narcan, or naloxone, widely available. Narcan is an overdose reversal rescue drug nasal spray that is easy to administer to a person who is overdosing on heroin
What would harm reduction look like for cocaine use?
It is hard to say how we might help the cocaine user on the street to stay safe until they have had enough and are ready to seek help. Cocaine is a dangerous drug, but not nearly as deadly as opioids such as heroin and fentanyl.
Hence, a person who uses cocaine might spend many years out on the streets, having sold their possessions and cut off all contact with family. It is not uncommon to hear accounts of recovering people who were addicted to cocaine who spent time living under a bridge without a safe indoor living space.
One possible way to help people on the streets would be to allow them to live in shelters, even if they have not completely stopped using cocaine or crack. By forming therapeutic relationships with these people and offering help when they are ready would go a long way towards keeping cocaine users safe and possibly shorten the time to seeking treatment.
Would prescription cocaine help people to overcome psychological dependence on cocaine?
One solution that has proven to be successful in other countries in treating heroin addiction is to provide medical prescription heroin. Could this work for cocaine?
It is hard to say if it would be helpful to offer cocaine users a pure, pharmaceutical grade cocaine to use instead of the contaminated product sold on the streets. Another solution might be to offer medication-assisted treatment similar to a methadone clinic.
A long-acting stimulant could be dispensed to patients once daily to help them to function throughout the day without the need for cocaine. Combined with motivational incentives and regular drug testing, this could be a harm reduction-based therapy that might make a difference in getting cocaine users off the streets and eventually into treatment.
Should I see a doctor about cocaine dependency and cocaine physical dependence?
If you are using cocaine and you are on the roller coaster of ups and downs of mood associated with cocaine use, you may feel as if you are physically and psychologically addicted. Seeing your doctor can help for several reasons.
First, your doctor can examine you for any potential complications from cocaine use. Snorting cocaine can cause damage to the nasal passages and sinuses. Cocaine can also harm the cardiovascular system, particularly the heart. Because cocaine use often involves unsafe practices, you may have been exposed to HIV or hepatitis. Your doctor can do complete testing to evaluate you for a variety of conditions.
Second, your doctor can provide guidance in taking the next steps to overcoming your addiction. While addiction is difficult to overcome, it is possible to stop using cocaine and start appreciating and enjoying life.
I recommend starting out by making an appointment with your doctor for a complete exam. If you are concerned about going in person to see the doctor, consider starting with a video telemedicine visit. Most health insurance companies now offer telehealth services to their customers. Then, you can start taking the next steps on the road to recovery. It is possible to be drug free and to live a fulfilling and productive life.