Cocaine is derived from the coca plant, which is native to South America. It is most often found in powder or rock form, which can be snorted, smoked, or injected to produce a euphoric high.
The addictive substance is classified as a Schedule I controlled drug by the U.S. Drug Enforcement Agency.
Cocaine use has remained at stable levels in the U.S. since 2009, according to the National Survey on Drug Use and Health. Young adults ages 18 to 25 are more likely to use cocaine than other age groups, with about 1.4 percent of these adults reporting cocaine use in the prior month. Furthermore, NIDA reports that in 2014, one in three drug misuse-related emergency room visits were associated with cocaine.
Cocaine addiction has become a major public health concern, with associated costs estimated at $180 billion.
Addiction works by stimulating the reward or pleasure sensors in the brain, thereby creating a psychological and physiological habit that engrains compulsive behaviors in the individual using the substance. The National Institute on Drug Abuse states that cocaine stimulates the release of the neurochemical dopamine in the brain, which facilitates the development of addiction and drives compulsive addictive behaviors.
Dopamine is a chemical that is normally released by cells and then recycled back into the cells, where it is not then acting on the nerve cells in the brain. Cocaine prevents dopamine from being recycled back into the cells, leaving large amounts of the neurochemical to act on the nerve cells and halt normal communication.
When dopamine floods the brain’s circuitry like this, it creates a strong reinforcement for the drug-taking behavior by lighting up the brain’s pleasure sensors. However, the brain becomes acclimated to the excess dopamine in the brain and develops a tolerance to the chemical, becoming less receptive over time to the floods of dopamine.
As this tolerance to the excess dopamine develops in the brain, an individual must take increasing amounts of the cocaine to experience the same levels of pleasure from the dopamine release. This results in a compulsion to take more of the drug to produce the same effects and further reinforces the drug-seeking behaviors.
Research has shown that cocaine addiction is difficult to treat. Cocaine use affects brain tissue and functioning, and the damage that it causes can make addiction treatment more difficult.
Several factors contribute to the relatively high potential for abuse and addiction to cocaine, including:
The ingestion methods for cocaine contribute to the addictive nature of the drug. Snorting, smoking, or injecting the drug creates and quick, euphoric high that almost immediately impacts the brain and triggers the release of dopamine. The quick high associated with cocaine use results in immediate gratification, which reinforces the use of the drug.
Since individuals can quickly build a tolerance to cocaine, high doses often follow the initial onset of use, resulting in addictive patterns that worsen over time with continued use.
Cocaine use can result in withdrawal symptoms that are unpleasant and include cravings for the drug. After tolerance builds up and psychological dependency sets in, withdrawal symptoms are unpleasant enough to cause individuals to seek out more of the drug to prevent withdrawal.
Cocaine use is associated with a loss of gray matter in the brain and white matter decay. It further changes the dopamine-binding process, resulting in impacts to the brain’s reward system that reinforce drug use.
Cocaine is an easily obtainable drug. It is widely available despite being illegal. In fact, cocaine may be easier to obtain than alcohol for some minors, as the drug’s illicit status means that it is sold solely on the black market, a resource available to people regardless of age. Minors seeking to get high may find cocaine to be a relatively accessible drug of choice, leading them down the path to addiction before they can legally seek out other substances like alcohol.
Adolescents may be particularly vulnerable to addiction, given that their brain tissue has not fully developed. Animal studies have found that adolescent rats are more sensitive to lower doses, took cocaine more readily, showed a more rapid escalation in cocaine use, and were less susceptible to detractors of use. These results are expected to be replicated in humans.
This evidence is concerning because cocaine is a more popular party drug among younger people. Individuals who start cocaine use when they are younger may find themselves in the grip of addiction before their brains have had the chance to develop fully.
Women are also particularly vulnerable to cocaine addiction. Research has found differences between men and women in rates of cocaine use and addiction, including the age of use onset; rates of progression to dependency and abuse; and rates of relapse and receptivity to treatment.
No specific risk factor can determine whether someone will become addicted if they try cocaine. The development of addiction happens over time, and it may be a result of many different factors.
Some of the factors that put people at risk for cocaine addiction or that impact how quickly they will become addicted include:
These factors all combine to affect an individual’s addiction risk. The more risk factors a person has for developing any addiction, the more susceptible they will be to developing an addiction to cocaine if they try the drug.
Cocaine is a stimulant, which means it tends to give people energy and confidence, which reinforces the psychological rewards when the drug is taken. This is also why it is commonly used as a party drug. It can facilitate staying awake for long periods, enabling individuals to feel more outgoing and social as they take the drug.
These psychological factors can create vulnerability in people who have struggled with social acceptance or experienced past trauma that leads them to seek escape from negative feelings. The positive rush of euphoria as well the feelings of confidence and energy that accompany cocaine use can be powerful motivators to someone who is struggling emotionally or socially.
The added reinforcement of social pressure can encourage a person who is at risk for addiction to further delve into addictive patterns as they receive reinforcement from the drug’s impact on the brain. They also feel a higher level of social acceptability in some subsets of party culture when they use the drug.
People overdose and die from using cocaine regularly. Cocaine overdose deaths spiked in 2017, with an estimated 14,556 cocaine-related deaths.
One complication of addiction treatment is the intersection between tolerance, sobriety, and relapse. Once tolerance has developed, people become accustomed to using larger quantities of cocaine.
However, if they detox and begin a recovery journey, their tolerance drops as they spend more time in sobriety. Unfortunately, if a person then relapses and uses again, they may mistakenly think they can still use the same dosage they were using before their period of sobriety. Individuals can overdose and die during a relapse by unintentionally overusing the drug at levels they were accustomed to before detoxing.
Furthermore, they may not know what other substances have been added to the product, leaving them unaware of potential drug interactions that could occur during cocaine use. Many illicit drugs are mixed with other substances to make the batch more potent or to bulk up supplies so that dealers can make more money from their product. This increases the risk of both fatal overdoses as well as co-occurring addictions.
Cocaine can be incredibly dangerous because of its high addiction potential. Overdose and death are always possible risks when using the substance.
Everyone who uses cocaine runs the risk of developing a serious addiction that can impact every aspect of their life, family, career, and health.
(July 2018). What is Cocaine? National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/drugfacts/cocaine
(May 2016). What is the scope of cocaine use in the United States? National Institute on Drug Abuse. from https://www.drugabuse.gov/publications/research-reports/cocaine/what-scope-cocaine-use-in-united-states
(August 2018). Overdose Death Rates. National Institute on Drug Abuse. from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
(July 2016).Biomarkers for success: using neuroimaging to predict relapse and develop brain stimulation treatment for cocaine dependent individuals. International Review of Neurobiology. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5492974/
Drug Scheduling. U.S. Drug Enforcement Agency. from https://www.dea.gov/drug-scheduling
(March 2013). Adolescents are More Vulnerable to Cocaine Addiction: Behavioral and Electrophysiological Evidence. Journal of Neuroscience. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3630505/
(February 2015). Sex differences in Psychiatric Comorbidity and Plasma Biomarkers for Cocaine Addiction in Abstinent Cocaine-Addicted Subjects in Outpatient Settings. Frontiers in Psychiatry. from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329735/