While opioids are the addictive substance that poses perhaps the greatest threat to the country, many other drugs have long been a problem in the United States, and, even in the midst of the opioid crisis, continue to be an issue.
One such drug is cocaine. While cocaine is most frequently associated with the 1970s and 80s, it is still very much in use today, with an estimated 1.5 million users in 2014. Cocaine also does play a role in the opioid epidemic due to how frequently it is used in combination with other drugs, including opioids like heroin. In 2015, cocaine was a contributing factor in about 7,000 overdose deaths.
Unlike heroin or other opioids, cocaine also carries with it an oddly glamorous association due to how often movies and television depict it as the drug of choice for the rich and famous. It has even been frequently referred to as the “caviar of street drugs.”
The effects of cocaine abuse, however, are as far from glamorous as it gets. Long-term cocaine abuse and addiction can cause serious, often permanent damage to the central nervous system, respiratory system, and cardiovascular system, often with fatal results.
It is possible to become addicted to cocaine in just one use and quickly build up a tolerance to its effects, needing to use more and more of it and putting yourself at an increased risk of overdose.
What Is Cocaine?
Cocaine is a central nervous system stimulant made from the coca plant, which is native to South America. While the plant has been used for medicinal purposes for hundreds of years, when synthesized into cocaine it becomes an extremely addictive recreational drug.
Cocaine is typically sold in the form of white powder that is often introduced into the body by rubbing it on your gums, although it can also be snorted and even injected. Cocaine can also be heated up and processed into a smokeable form known as crack.
Cocaine is classified by the Drug Enforcement Administration (DEA) as a Schedule II substance, which means that it has a high potential for abuse and addiction and is recognized as having extremely limited medical usage.
How Does Cocaine Work?
Once cocaine has entered the body, its effects begin to take hold very quickly, causing an intense but brief high. Like most stimulants, cocaine works by altering the user’s dopamine levels. Dopamine is a neurotransmitter that is responsible for regulating emotion, motivation, and reward, among other things, and is in what is referred to as the brain’s pleasure center.
Generally, when the brain produces dopamine as a chemical response, it sits in the synapses until it is no longer needed and is then reabsorbed until its next use.
Cocaine is what is known as a “reuptake inhibitor,” blocking the reabsorption of dopamine, and other brain chemicals tied to balancing mood and emotion like serotonin and norepinephrine so that they build up in the synapses. This buildup is what causes feelings of excitement, alertness, and euphoria.
How Does Cocaine Addiction Work?
Addiction is a disease that primarily affects your brain by influencing your reward center. Your reward center is designed to work with “feel-good chemicals” in the brain, including dopamine, serotonin, endorphins, and oxytocin. Dopamine is specifically tied to reward and motivation. When you experience something pleasurable, like eating your favorite meal, your brain releases dopamine as a reward to train your brain to seek out more food. The reward center is designed to keep you motivated toward activities that sustain and enrich your life.
However, drugs like cocaine, disrupt your natural chemical reward system. The buildup of dopamine in your system trains your brain to associate the act of taking cocaine with a significant source of reward. Your brain will begin to treat cocaine as an important life-sustaining resource like food and water, which is why people with severe substance use disorders may prioritize finding and using drugs over other important things like nutrition and hygiene.
Cocaine can also make it so that other sources of pleasure seem less pleasurable. Chronic use of a powerful stimulant like cocaine or methamphetamine can damage dopamine receptors over time. This can make it more harder to achieve a pleasurable feeling with typical rewarding activities. This can cause a side effect called anhedonia, which is the inability to feel pleasure. It can lead to depression and deepen your dependence on the drug.
What Type of Substances Are Typically Use To Cut Cocaine?
The number of potential fillers used to cut cocaine can be quite extensive. It often varies depending on the availability of cutting agents to the particular street dealer.
A general list of the categories of substances that are used to cut cocaine includes:
Categories of Substance Used To Cut Cocaine
- Substances with psychoactive effects can add to the belief that the drug is pure. Typically, these are substances with numbing effects.
- Substances that mimic the appearance of cocaine but have no psychoactive effects (typically white powdery substances).
- Potentially poisonous substances that can be toxic but do not have any significant psychoactive effects.
Psychoactive Substances
It is highly unlikely that cocaine bought on the street would include only cocaine as its psychoactive ingredient. Numerous psychoactive ingredients are used to cut cocaine.
Psychoactive Ingredients Used To Cut Cocaine
- Caffeine is commonly used.
- Other substances, such as PCP and ecstasy, have turned up in cocaine.
- Other stimulant drugs of abuse, like methamphetamine and other amphetamines, are often used.
- Anesthetics are commonly used because they have a numbing effect, which leaves the impression that the drug is purer than it really is.
- Procaine (Novocain)
- Lidocaine
- Benzocaine
- Opiates and other dangerous drugs are sometimes used to cut cocaine.
Fillers Without Significant Psychoactive Effects
Ingredients that may mimic the appearance of cocaine but have few, if any, psychoactive effects are often used to cut the drug on the street. This allows for a cheap way to increase profits.
Numerous white powders and other fillers can be used. The following substances are commonly found in samples of cocaine that is seized in drug raids:
Common Fillers
- Talcum powder, flour, cornstarch, and sugar powders of all types
- Quinine
- Baking soda, vitamin C powder, other vitamin powders (e.g., vitamin B1), and milk powder
- Many different chemical formations that are similar in appearance to powdered cocaine, such as magnesium, sodium, phosphorus, manganese, and others
- Powdered asbestos and/or Epsom salts
Toxic Substances
It is relatively rare for toxic substances without psychoactive effects to be mixed into cocaine, but it does happen.
For instance, a study of cocaine samples that were purchased through illicit sources online indicated that nearly 40 percent of the cocaine contained a medication called levamisole, a drug used to kill and expel parasitic worms in animals. The drug is not designed to be used by humans, and it is not available in the United States.
There are reports that the toxin strychnine is sometimes used in cocaine as filler, but these reports appear to be extremely rare if they are legitimate at all.
Arsenic, an extremely dangerous toxic substance, has been found in some samples of cocaine.
Acetone is a volatile substance that’s used in several common products, including house paint. It’s certainly not something you would want to consume, though acetone poisoning is rare. If cocaine is contaminated with excessive acetone, 40 grams of it in your system can be toxic. But acetone isn’t relevant to cutting cocaine as a harmful contaminant, but it may be dangerous for other reasons. Acetone is used in producing crystal and powder cocaine from the coca plant. It may also be used in converting powder cocaine back into rock cocaine, which is called re-rocking. This allows dealers to mix other substances into cocaine and then convert it back into rock form. Rock cocaine may sell at a higher price, because the average person may not realize it could have been adulterated.
How Does Cocaine Impact the Brain?
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 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.
REM Sleep
According to a study published by ScienceDirect, cocaine use increases wakefulness and suppresses REM (rapid eye movement) sleep. It is also important to note that the condition known as acute cocaine withdrawal has been linked with overall sleep disturbances and unpleasant dreams.
Cocaine withdrawal can cause several symptoms.
- Increased appetite
- Fatigue
- Depression
- Agitation
- Insomnia
- Restless behavior
- Nightmares
- Anxiety
- Suicidal thoughts
Nightmares are a common side effect of cocaine withdrawal. Most heavy dreaming occurs during REM sleep. Usually, when we sleep, we go through cycles of non-REM sleep and REM sleep. REM sleep occurs every 90 minutes or so, and it typically lasts 20 to 25 minutes.
Scientists so far have not been able to determine with certainty what causes vivid dreaming and specifically nightmares, but they have recognized some patterns and associations. Stress and anxiety are often linked to unpleasant dreams. Many different medications cause this as well.
Why Is Cocaine So Addictive?
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:
Fast Absorption and Results
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.
A Quick Buildup of Tolerance
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.
Withdrawal Symptoms
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.
Brain Damage
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.
Easy Access
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.
What Are the Signs of Cocaine Addiction?
The signs of a growing addiction are often hard to spot until it has progressed to the point where someone’s dependency on a substance has become obvious. It can be difficult to notice something if you are not specifically looking for it. That said, the signs of cocaine addiction tend to be more easily distinguished as opposed to those of alcohol abuse, for example.
The abnormal behaviors associated with heavy cocaine use will also typically clash with someone’s normal personality noticeably as they rely more on cocaine abuse to function in their daily lives.
As cocaine becomes the focus of someone’s life and the motivator behind the majority of the decisions they make, many behavioral signs signal not only cocaine addiction but are also consistent with substance use disorders in general.
These behaviors are all signs of cocaine addiction or at least cocaine abuse and dependency that is on its way to becoming a full-blown addiction. If you recognize these signs in someone you care about, or in yourself, then you must seek professional recovery treatment as soon as possible, starting with medical detoxification to clear your system of the substance and stem the physical and mental damage it may have already caused.
Cocaine Abuse Behaviors
- Experiencing withdrawal symptoms when not using cocaine
- Attempting to rationalize or justify cocaine use
- Financial or legal difficulties due to cocaine use
- Being unable to perform basic daily functions without using cocaine
- Loss of interest in hobbies and activities
- A decline in school or work performance
- Prioritizing cocaine use over responsibilities and relationships
- Lying or being secretive about using cocaine
- Wanting to stop using cocaine but being unable to
- Noticeable lack of hygiene
If you suspect a loved one may be using crack cocaine, common signs of addiction that you can look for include:
- Rapid weight loss
- Loss of interest in activities
- Disappearing for days at a time
- Loss of financial stability
- Disheveled appearance
- Involvement with crime
- Stealing or pawning objects
- Frequently asking for money
- Unexplained loss of money or property
- Discovery of drugs or drug paraphernalia
- Changes in mood, behavior, appearance
- Decreased personal hygiene habits
- Dental damage
How Addictive Is Cocaine?
Cocaine is known for being extremely addictive. Since it’s also expensive, it’s known for causing some of the most expensive substance use disorders. But even though the addiction can cost you hundreds of dollars per week, poor health, and strain relationships, many people struggle to stop. But is cocaine addictive if you only use it once or twice?
It’s rare that any substance would cause a severe substance use disorder after a single use, but the danger of drugs like cocaine is that they encourage repeated use. But why is cocaine so addictive?
Cocaine causes an intense high that wears off within minutes, followed by overstimulating effects that can be uncomfortable. Because the initial few minutes are so pleasurable and the comedown is so unpleasant, the drug encourages binge use, which is taking several doses in a row. A cocaine binge can significantly increase your risk of developing a cocaine use disorder.
The drug’s addiction potential comes from the nature of addiction itself. Dopamine is a common chemical implicated in addiction because of its role in the reward center of the brain. Because cocaine causes such potent euphoric effects and encourages repeat use, it can quickly train the brain to seek it.
Why Should I Detox From Cocaine?
The process of cocaine withdrawal is not typically a life-threatening one, and so a cocaine detox can usually be done on an outpatient basis, with regular visits to a detox clinic. However, if someone has tried to quit using cocaine multiple times without success, then an inpatient detox may be necessary.
It is important to keep in mind though that just because cocaine has a comparatively less dangerous withdrawal than other substances, that does not mean that someone should attempt to detox on their own without at least some level of medical supervision.
If you have a particularly severe cocaine addiction, then attempting to quit on your own all at once can trigger an intense shock to your body due to the sudden loss of the dopamine supplied by cocaine, which can lead to intense emotional and psychological cocaine withdrawal symptoms.
The symptoms of depression and suicidal thoughts can often feel overwhelming to the point of not only potentially causing a relapse before completing the detox process but also increasing the risk of self-harm or worse.
A professional medical detox team can properly and safely handle these kinds of complications that would be much more dangerous if faced alone.
Another reason medical detox for cocaine is a smart choice is that generally, batches of cocaine that make it to the streets are very rarely pure cocaine. Imported cocaine is often cut with all kinds of different substances to stretch out the batch and make more money for the dealer.
Since there is no way to know just what might be in the cocaine you’ve been abusing, you may have been ingesting other drugs or hazardous substances as well.
A detox center can provide you with an accurate medical assessment that provides insight into drugs you may have inadvertently been taking without even knowing it ensures your health and safety during the detox process
What Are the Cocaine Withdrawal Symptoms?
As a stimulant, cocaine withdrawal symptoms are very different from most other drugs. Cocaine withdrawal, for the most part, lacks the physical withdrawal symptoms associated with substances like opioids or benzodiazepines.
This means that instead of tremors, nausea, vomiting, and other flu-like symptoms, cocaine withdrawal symptoms are mostly mood-based and psychological in nature.
Common Cocaine Withdrawal Symptoms
- Intense Cravings
- Exhaustion
- Depression
- Increased appetite
- Anxiety and panic attacks
- Difficulty concentrating
- Restlessness
- Agitation and mood swings
- Suicidal thoughts
- Intense nightmares
- Inability to experience sexual arousal
How Long Does Cocaine Withdrawal Last?
The intensity and length of the symptoms of cocaine withdrawal depend on several different factors, including how long someone has been abusing cocaine, how much of it they were taking, and how they were taking it, to name a few.
The cocaine withdrawal timeline is generally broken into three different phases: crash, craving, and extinction. While the previously mentioned factors will have a significant impact on how an individual experiences cocaine withdrawal, it will typically resemble the following process:
Crash Phase
Cocaine has a very short half-life and peaks very quickly, so someone can begin feeling cocaine withdrawal symptoms as soon as 90 minutes after their last dose. However, it can sometimes take closer to 24 hours for symptoms to manifest.
The early symptoms include anxiety, exhaustion, hunger, and depression, and can last as long as several days. This is also generally when the withdrawal symptoms will be at their most uncomfortable.
Craving Phase
Once the crash stage has run its course, the fatigue, depression, and anxiety will have mostly faded and been replaced with extremely strong cocaine cravings. Symptoms of irritability, restlessness, and difficulty concentrating will be at their peak strength as thoughts of and cravings for cocaine become almost all-consuming.
Unlike the crash phase, the craving phase can last anywhere from one week to more than two months. The longer someone has been abusing large amounts of cocaine, the more likely they are to stay in the craving phase, sometimes for as long as 10 weeks.
Extinction Phase
The final stage of cocaine withdrawal is also the longest, sometimes lasting up to six months. At this point, the majority of the cocaine withdrawal symptoms should have either faded or disappeared entirely, although there are still likely to be random, intermittent cravings for cocaine.
On the bright side, these cravings will at least be much weaker and less frequent than the cravings experienced in the craving phase.
Who Uses Cocaine?
Addiction knows no bounds, so any person can become addicted to cocaine regardless of race, age, sex, or geographic location. However, there are protective and risk factors that can cause certain demographics to be at higher risk for cocaine addiction.
According to the National Institute on Drug Abuse (NIDA), there were more than 1 million current cocaine users in 2014, and rates remained the same for years. According to a 2014 demographics study of powder and crack cocaine use among high-school seniors, some identifying markers were risk factors while others lowered the odds for cocaine use.
Demographics with lower odds included:
- Identifying as Black
- Living with one or two parents
- Making less than $50 per week
- Identifying as religious
- Having highly educated parents
Demographics with increased odds included:
However, despite the assumption that cocaine is a drug of high socioeconomic status, according to a NIDA paper published during the crack cocaine epidemic in 1991, income may not play a big role in cocaine use. It writes, “…total income per week showed only a small association with cocaine use.”
Not Just for the White Collar
A six-figure salary may be ideal if you have a cocaine addiction, but your brain’s reward center doesn’t know what’s in your checking account.
If you develop a severe substance use disorder involving cocaine, you may be stuck in an addiction you can’t afford. The financial and chemical demand can lead to risky, desperate behavior. In fact, a 2017 study showed that cocaine-addicted people who are homeless turn to illegal and informal means of funding their drug use.
Can Taking Cocaine Lead To Feelings of Depression?
Although cocaine is in the class of CNS stimulant drugs, frequently using it in large amounts can lead to feelings of depression. There are several different ways a person may experience depression resulting from their use of cocaine.
- People who regularly use cocaine find they experience feelings of stimulation, euphoria, hyperactivity, and other effects from the stimulant effects of the drug. However, after they discontinue its use, they often find they experience a crash that consists of feelings of apathy, lack of motivation, fatigue, lethargy, increased appetite, and depressive symptoms. This cycle of ups and downs occurs most often in individuals who use large amounts of cocaine or use it regularly.
- Chronic cocaine use can lead to a person having difficulty experiencing pleasure because of the changes in neuroanatomy resulting from repeated cocaine use.
- Excessive use of cocaine can result in the development of physical dependence (withdrawal). One of the symptoms of withdrawal from stimulants is an alteration in mood that can include feelings of depression.
- People who buy cocaine on the street may not be getting pure cocaine. They may be getting cocaine laced with other substances that have the potential to produce feelings of depression.
How Cocaine’s Mechanism of Action Can Lead To Depressive Symptoms
Cocaine affects numerous neurotransmitters, particularly dopamine, norepinephrine, and serotonin. When these neurotransmitters are activated, there is the perception of reinforcement or reward. Depletion of these neurotransmitters is believed to be associated with many effects, particularly depression.
These neurotransmitters are released in massive amounts when people use cocaine, and cocaine blocks their reuptake, leaving them in the space between neurons where they can reattach to the receptor sites. The high from cocaine is extremely short-lived, and abusers of the drug will often go through episodes where they binge on cocaine to maintain the feeling of euphoria.
This activity leads to a cycle of massive neurotransmitter release followed by significant decreases in their availability once a person stops using cocaine.
This cycle accounts for the crash, leads to permanent changes in the neural pathways of the brain, and results in withdrawal symptoms in those who have developed a cocaine dependence. Over time, this can result in permanent changes in the brain that result in difficulty experiencing pleasure from events that would normally produce it. Chronic feelings of apathy or depression are more likely.
What Is a Cocaine Come Down?
A cocaine come down, like a cocaine crash, is associated with cocaine withdrawal. However, a crash occurs after you become chemically dependent on the drug, or use it repeatedly over a certain period of time. A comedown can occur after just one use. A drug comedown involves the drug’s effects as it begins to wear off.
Cocaine’s initial effects can be pleasurable, causing an intense feeling of euphoria, energy, empowerment, and alertness. However, as the pleasurable feelings start to wear off, you will still experience the stimulating effects of the drug, only they may cause insomnia, anxiety, paranoia, and panic. You might also feel jittery, restless, and uncomfortable. As the stimulant’s effects wear off, you may start to feel tired and drained of energy. After cocaine wears off, many people experience hypersomnia, which is sleeping for long hours.
What Are the Next Steps of Cocaine Addiction Treatment?
To give yourself the highest chance of recovering from dependence on cocaine, as well as just about any other addictive substance, detoxification is the crucial first step. However, it is only just that, the first of many steps involved in cocaine addiction treatment. If you do not take that next step to ongoing care, then it will be as if you just placed a bandage on the problem instead of truly addressing it. Detox removes the cocaine from your system, but that’s all it does.
To change your addictive behaviors and give yourself the best chance at maintaining sobriety and avoiding an almost certain relapse, then addiction rehabilitation treatment is essential. Depending on the severity of your addiction, this can be done in either an inpatient or outpatient setting. Typically though, most people recovering from cocaine addiction can do so on an outpatient basis.
Whichever type of treatment program you choose, you will have access to different therapies and methodologies meant to help you get to the root of the issues behind your addiction, and learn to understand and better manage addictive behaviors.
Typical Treatment Techniques
- Addiction Education
- Individual counseling
- Group therapy
- Relapse prevention planning
- Stress management
- Dual diagnosis treatment
- Medication management
No one’s recovery treatment program is going to look the same. Your treatment program will generally be tailored to what will have been determined to be most effective for you personally, often in collaboration between you and your therapist or counselor.
Many treatment centers will also provide post-graduation support services, including alumni programs. These are meant to make it easier for people who have bonded during their shared experience during treatment to keep in touch and act as a network of support for each other.
How Dangerous Is Cocaine?
Cocaine is much more dangerous than many people might think. Since the use of cocaine carries the association of being affiliated with people of high social status, the negative effects of cocaine can often be misconstrued.
But make no mistake, long-term use of cocaine can lead to damaging effects on the body as well as the brain. Cocaine’s effects on blood vessels, heart rate, and blood pressure can lead to serious heart problems and an increased risk of heart attack and stroke.
Other dangers associated with cocaine abuse are based on how someone uses the drug. For example, if you are mainly abusing cocaine by snorting it, you are likely to experience difficulty swallowing, chronic sinus problems and nosebleeds, a loss of sense of smell, and the possibility of perforating your nasal cavity and causing it to collapse.
Effects of Regular Cocaine Use
- Confusion
- Extreme paranoia
- An increased risk of seizures
- Delusions
- Unstable moods and aggression
- Psychosis
- Permanent damage to the brain
- Intense “post-high” depression
- Suicide ideation
- Constricted blood vessels
If you are primarily injecting cocaine, then you are at extremely high risk of an infection in the lining of your heart valves, as well as contracting hepatitis, HIV, or other diseases borne from sharing needles. There is also a high risk of the injection site becoming infected or getting an abscess.
It is not only possible to overdose on cocaine, but it can also be fatal if it is not treated in time, as cocaine overdoses are commonly followed by a fatal seizure, heart attack, or stroke.
Cocaine abuse and addiction should never be taken lightly. It can permanently damage key pathways in the brain and throw off brain chemistry levels to the point where it can be almost impossible to restore them to normal, pre-addiction functioning.
Signs That Someone Is Overdosing on Cocaine
- Irregular, erratic heart rate
- Convulsions
- Dangerously elevated blood pressure
- Psychosis
- Extremely high body temperature
