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Based on the 2013 Annual National Survey on Drug Use and Health, which was conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), there were approximately 24 million Americans (ages 12 and up) who used illicit drugs a month before the survey was conducted (National Institute on Drug Abuse, 2015). From this figure, 1.5 Americans used cocaine (National Institute on Drug Abuse, 2015). Knowing that many people continue to use prohibited drugs despite the fact that it is associated with many adverse effects, I became interested on this area, specifically on understanding what could help this people. Therefore, I chose Drug and Alcohol Abuse Counsel as my course. Personally, I have lost a lot of friends along the way due to cocaine, and this contributed to my desire to spread awareness of what triggers people to use this drug and what influences their addiction. I want to raise awareness about the nature of cocaine, it’s adverse effects on people’s lives, and the help that can be extended to those who are addicted to it.
Despite being associated to many negative effects, cocaine is actually derived from nature. It is a psychoactive ingredient of a plant, specifically a shrub, called coca plant (Cooper, 2002). Before it’s commercialization, people use it by chewing on the leaves. In fact, the Amara Indians of Peru have been ingesting it for a thousand years, and no adverse effects were recorded. This is because it will take a lot of chewing before it creates a toxic effect on the body (Karch, 1999).
Currently, cocaine is being used in its chemical form. Known as cocaine hydrochloride, it acts as a stimulant and an anesthetic (Cooper, 2002). Unlike before when chewing is the only way to take cocaine, people now take the chemical form in different ways. First is through snorting. Using a glass or a mirror, the crystalline cocaine is chopped finely and is separated into several lines. Using a straw or a dollar bill, the user sniffs the substance into the nostril where it makes its way into the brain (Cooper, 2002). Depending on the user, the effect or the “high feeling” usually happens within five minutes after snorting, and it can last up to 2 hours (Cooper, 2002). The second way that people use to take cocaine is through injecting. As explained by Washton and Gold, cocaine powder is a water soluble substance, so it can be injected to the body by liquefying and placing it in an intravenous syringe (ac cited in Cooper, 2002). This produces an even quicker high effect. According to Dr. Ronald Siegel, “it takes only 14 seconds for the drug to reach the brain through IV” (ac cited in Cooper, 2002). The third way of taking cocaine is by smoking that involves a chemical procedure. First, the cocaine powder is mixed and boiled with an alkali substance (e.g., ammonia) and a solvent (e.g., ether) (Cooper). Once the moisture is dried, cocaine crystals are produced and these are known as “freebase.” Then, users heat the crystals to produce vapor which they inhale (Cooper, 2002). Technically, the process is called smoking but the actual intake of the drugs is still through inhaling.
No matter which way people take cocaine, the fact remains the same; it’s chronic use creates many adverse effects on people’s health. This includes psychological and physical effects. One of the very first effect of cocaine use is cocaine dependence, which is classified as a psychiatric disorder (Morton, 1999). When a person takes cocaine, they experience euphoric feeling. The brain’s reward system is overstimulated by the drug. When the effect wears off, they experience a significant feeling of being down. This includes depression, anxiousness, and irritability (Cooper, 2002). In order to escape these negative emotions, they crave for more cocaine and its continuous use. Over time, the same amount of cocaine no longer provides the same level of euphoria, so the user takes higher dosage. This is cocaine dependence. Based on the Diagnostic and Statistical Manual on Mental Disorder by the American Psychiatric Association, people with cocaine dependence can have the following symptoms: tolerance to euphoric feeling which requires higher dosage of cocaine, withdrawal symptoms when cocaine use is stopped, engaging in crime or spending too much time and energy on acquiring cocaine, inability to perform work properly, and continuous use despite knowing its adverse effects (Morton, 1999). Aside from cocaine dependence, using this drug can also lead to psychosis. This mental disorder is characterized by paranoia and psychosis. According to the groups of Satel and Miller, up to 68% of cocaine users experience paranoia (Morton, 1999). Hallucinations and delusions that are also associated with psychosis were also observed among 53% of cocaine users (Morton, 1999). On top of cocaine’s effect on people’s psychological well-being, it also has different physical effects. An example of this is kidney damage. Several studies showed that chronic use of cocaine contributes to the development of renal failure (Van der Woude, 2000). Moreover, according to Attoussi, Faulkner, Oso, and Umoru, “scleroderma renal crisis, characterized by accelerated hypertension, rapidly progressive renal failure, and hyperreninaemia can be precipitated by heavy cocaine abuse” (as cited in Van der Woude, 2000). In addition, chronic cocaine use also impacts cardiovascular health. First, it impacts a person’s heart rate and blood pressure. In order to confirm this effect, several studies have been conducted with animals. In a study which was conducted by Wilkerson, he found out “that pentobarbital abolished the cocaine-induced increase in blood pressure observed in the conscious dog, suggesting that the anesthetic agent masked the cocaine effect” (Kloner et al., 1992). Moreover, cocaine also impacts the heart’s left ventricular function, coronary caliber, blood flow, and it can also cause an alteration in the platelet function (Kloner et al., 1992). Furthermore, several reports based on clinical cases and autopsy materials revealed additional effects on people’s cardiovascular status. This includes myocardial infarction, myocarditis, dilated cardiomyopathy, and arrhythmias (Kloner et al., 1992).
Despite all these negative effects, those who have been dependent and addicted on cocaine can still be saved through pharmacological and behavioral approaches. According to Millman, there are three conditions in which pharmacological intervention can be applied. First, medications can be used to target the symptoms associated with cocaine intoxication (as cited in Platt, 1997). For instance, those who experience depression can be given antidepressants. Second, medications can be used to address disabling conditions that reinforces users to take cocaine repeatedly (Platt, 1997). This includes medications to address withdrawal symptoms. Lastly, medication can be used to block the effects of cocaine or to avoid euphoria (Platt, 1997). Among these three conditions, different agents or medications can be used. Weiss and Mirin categorized these agents into four groups: agents that block the effects of cocaine (e.g., bromocriptine), aversive agents (e.g., phenelzine), agents for the treatment of psychiatric disorder (e.g., desipramine for depression), and agents for cocaine-induced conditions like cravings and withdrawal (e.g. flupenthixol decanoate) (as cited in Platt, 1997). Although medications are offered to cocaine users, it is important to consider that the available agents only treat the conditions that are associated with cocaine usage, but it does not directly treat the drug dependence. On the other hand, behavioral interventions can also be used to help cocaine dependent users. One type of this intervention is called motivational incentives. Through this program, those who intend to abstain from cocaine are given rewards points for every urine test that is drug-free. The accumulation points can be exchanged for items which usually encourages a healthier lifestyle (National Institute on Drug Abuse, “What Treatments,” 2010). Cognitive-behavioral therapy (CBT) is another approach that can help cocaine users. The goal of this kind of intervention is to “help patients recognize, avoid, and cope” (National Institute on Drug Abuse, “What Treatments,” 2010). In a nutshell, users are trained to identify the situations when they are most likely to take cocaine, and they are trained to avoid these situations. Moreover, they are also educated on how they can deal with negative behaviors that are associated with their drug dependence issue. Aside from cognitive-behavioral therapy, residential programs, also known as therapeutic communities, is another way to deal with cocaine dependence. This is a 6 to 12 months-program that includes rehabilitation and other services that encourages the users to be reintegrated as an integral part of the society (National Institute on Drug Abuse, “What Treatments,” 2010). Because of the benefits being offered by both the pharmacological and behavioral approaches, using these two approaches at the same time proves to be promising and more successful.
Overall, the use of cocaine is a serious issue that many people continue to face. It affected some people that I personally know, and this ignited my interest on taking a course in Drug and Alcohol Abuse Counsel. With continued use, cocaine can cause drug dependency, which is associated with negative psychological and physical health implications. Fortunately, there is still hope for those who have been trapped and addicted to this drug. Several pharmacological and behavioral interventions can now be taken in order to address cocaine dependence. By being informed about all these aspects regarding cocaine use, raising awareness is possible in order to save many people’s lives.
References
Cooper, E. F. (2002). The emergence of crack cocaine abuse. New York, NY: Novinka Books.
Karch, S. (1999). Cocaine: history, use, abuse. Journal of the Royal Society of Medicine, 92, 393-397.
Kloner, R. et al. (1992). The effects of acute and chronic cocaine use on the heart. Circulation, 85 (2), 407-419.
Morton, W.A. (1999). Cocaine and psychiatric symptoms. Primary Care Companion Journal Clinical Psychiatry, 1 (4), 109-113.
National Institute on Drug Abuse (2015). DrugFacts: Nationwide trends. Retrieved from https://www.drugabuse.gov/publications/drugfacts/nationwide-trends
National Institute on Drug Abuse (2010). What treatments are effective for cocaine abusers? Retrieved from https://www.drugabuse.gov/publications/research-reports/cocaine/what-treatments-are-effective-cocaine-abusers
Platt, J. (1997). Cocaine addiction theory, research, and treatment. Massachusetts, MA: Harvard University Press.
Van der Woude, F. (2000). Cocaine use and kidney damage. Nephrology Dialysis Transplantation, 15, 299-301.
