Addiction Treatment
HomeWhat is cocaine?
There are two forms of cocaine: the hydrochloride salt and the "freebase." The hydrochloride salt, or powdered form of cocaine, dissolves in water and, when abused, can be taken intravenously (by vein) or intranasally (in the nose). Freebase refers to a compound that has not been neutralized by an acid to make the hydrochloride salt. The freebase form of cocaine is smokable.
Cocaine is generally sold on the street as a fine, white, crystalline powder, known as "coke," "C," "snow," "flake," or "blow”. Street dealers generally dilute it with such inert substances as cornstarch, talcum powder, and/or sugar, or with such active drugs as procaine (a chemically-related local anesthetic) or with such other stimulants as amphetamines.
What is crack cocaine?
Crack is the street name given to the freebase form of cocaine that has been processed from the powdered cocaine hydrochloride form to a smokable substance. Crack cocaine is processed with ammonia or sodium bicarbonate (baking soda) and water, and heated to remove the hydrochloride.
Because crack is smoked, the user experiences a high in less than 10 seconds. This rather immediate and euphoric effect is one of the reasons that crack became enormously popular in the mid 1980s. Another reason is that crack is inexpensive both to produce and to buy.
What are the methods of cocaine use?
The principal routes of cocaine use are oral, intranasal, intravenous, and inhalation. The slang terms for these routes are, respectively, "chewing," "snorting," "mainlining," "injecting," and "smoking" (including freebase and crack cocaine). Snorting is the process of inhaling cocaine powder through the nostrils, where it is absorbed into the bloodstream through the nasal tissues. Injecting releases the drug directly into the bloodstream, and heightens the intensity of its effects. Smoking involves the inhalation of cocaine vapor or smoke into the lungs, where absorption into the bloodstream is as rapid as by injection.
There is no safe method of cocaine use. Any route of administration can lead to absorption of toxic amounts of cocaine, leading to acute cardiovascular or cerebrovascular emergencies that could result in sudden death. Repeated cocaine use by any route of administration can produce addiction and other adverse health consequences.
What are the short-term effects of cocaine use?
Cocaine's effects appear almost immediately after a single dose, and disappear within a few minutes or hours. Taken in small amounts (up to 100 mg), cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find that the drug helps them to perform simple physical and intellectual tasks more quickly, while others can experience the opposite effect.
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The short-term physiological effects of cocaine include constricted blood vessels; dilated pupils; and increased temperature, heart rate, and blood pressure. Large amounts (several hundred milligrams or more) intensify the user's high, but may also lead to bizarre, erratic, and violent behavior. These users may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.
What are the long-term effects of cocaine use?
Cocaine is a powerfully addictive drug. Once having tried cocaine, an individual may have difficulty predicting or controlling the extent to which he or she will continue to use. Cocaine's stimulant and addictive effects are thought to be primarily a result of its ability to inhibit the reabsorption of dopamine by nerve cells. Dopamine is released as part of the brain's reward system, and is either directly or indirectly involved in the addictive properties of every major drug of abuse.
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An appreciable tolerance to cocaine's high may develop, with many addicts reporting that they seek but fail to achieve as much pleasure as they did from their first experience. Some users will frequently increase their doses to intensify and prolong the euphoric effects. While tolerance to the high can occur, users can also become more sensitive (sensitization) to cocaine's anesthetic and convulsant effects, without increasing the dose taken. This increased sensitivity may explain some deaths occurring after apparently low doses of cocaine.
What are the medical complications of cocaine use?
There are enormous medical complications associated with cocaine use. Some of the most frequent complications are cardiovascular effects, including disturbances in heart rhythm and heart attacks; such respiratory effects as chest pain and respiratory failure; neurological effects, including strokes, seizure, and headaches; and gastrointestinal complications, including abdominal pain and nausea.
Cocaine use has been linked to many types of heart disease. Cocaine has been found to trigger chaotic heart rhythms, called ventricular fibrillation; accelerate heartbeat and breathing; and increase blood pressure and body temperature. Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions and coma.
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Cardiovascular effects
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Different routes of cocaine administration can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow. And, persons who inject cocaine have puncture marks and "tracks," most commonly in their forearms. Intravenous cocaine users may also experience an allergic reaction, either to the drug, or to some additive in street cocaine, which can result, in severe cases, in death.
Research has revealed a potentially dangerous interaction between cocaine and alcohol. Taken in combination, the two drugs are converted by the body to cocaethylene. Cocaethylene has a longer duration of action in the brain and is more toxic than either drug alone. While more research needs to be done, it is noteworthy that the mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.
Are cocaine users at risk for contracting HIV/AIDS and hepatitis B and C?
Yes. Cocaine users, especially those who inject, are at increased risk for contracting such infectious diseases as human immunodeficiency virus (HIV/AIDS) and hepatitis. In fact, use and abuse of illicit drugs, including crack cocaine, have become the leading risk factors for new cases of HIV. Drug abuse-related spread of HIV can result from direct transmission of the virus through the sharing of contaminated needles and paraphernalia between injecting drug users. Research has also shown that drug use can interfere with judgement about risk-taking behavior, and can potentially lead to reduced precautions about having sex, the sharing of needles and injection paraphernalia, and the trading of sex for drugs, by both men and women.
Additionally, hepatitis C is spreading rapidly among injection drug users; current estimates indicate infection rates of 65 to 90 percent in this population. At present, there is no vaccine for the hepatitis C virus, and the only treatment is expensive, often unsuccessful, and may have serious side effects.
What is the effect of maternal cocaine use?
The full extent of the effects of prenatal drug exposure on a child is not completely known, but many scientific studies have documented that babies born to mothers who abuse cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are often shorter in length.
What treatments are effective for cocaine users?
There has been an enormous increase in the number of people seeking treatment for cocaine addiction during the 1980s and 1990s. The majority of individuals seeking treatment smoke crack, and are likely to be users of more than one substance. The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse. Cocaine addiction and use is a complex problem involving biological changes in the brain as well as a myriad of social, familial, and environmental factors. Therefore, treatment of cocaine addiction is complex, and must address a variety of problems.
Behavioral Interventions
Many behavioral treatments have been found to be effective for cocaine addiction, including both residential and outpatient approaches. Indeed, behavioral therapies are often the only available, effective treatment approaches to many drug problems, including cocaine addiction, for which there is, as yet, no viable medication.
Therapeutic communities, or residential programs with planned lengths of stay of 6 to 12 months, offer another alternative to those in need of treatment for cocaine addiction. Therapeutic communities are often comprehensive, in that they focus on the resocialization of the individual to society, and can include on-site vocational rehabilitation and other supportive services.
What is the scope of cocaine use in the United States?
Monitoring the Future (MTF) Survey
Lifetime annual and 30-day cocaine use remained stable among all three grades in 2005. Perceived harmfulness of occasional use also remained stable in 2005, measuring at 65.3% among 8th-graders, 72.4% among 10th-graders, and 60.8% among 12th-graders.
National Survey on Drug Use and Health (NSDUH)
In 2004, 34.2 million Americans aged 12 and over reported lifetime use of cocaine and 7.8 million reported using crack. About 5.6 million reported annual use of cocaine and 1.3 million reported using crack. An estimated 2 million Americans reported current use of cocaine, 467,000 of whom reported using crack. There were an estimated 1 million new users of cocaine in 2004 (approximately 2,700 per day), and most were aged 18 or older although the average age of first use was 20.0 years.
The percentage of youth ages 12 to 17 reporting lifetime use of cocaine was 2.4% in 2004. Among young adults aged 18 to 25, the rate was 15.2%, showing no significant difference from the previous year. However, there was a statistically significant decrease in perceived risk of using cocaine once a month among Americans in the 12 to 17 age bracket in 2004.
Past month crack use was down for 16- or 17-year-olds but up for 21- to 25-year-olds; 21-year-olds also showed increases in past year use of both crack and cocaine.
Past month use of cocaine was down among females aged 12–17 and Asians 12 or older, but up among Blacks aged 18 to 25. There was a decrease in past year cocaine use measured among Asians aged 18 to 25.
Following a decline between 2002 and 2003, NSDUH data show an increase in the number of people receiving treatment for a cocaine use problem during their most recent treatment at a specialty facility, from 276,000 in 2003 to 466,000 in 2004.
Community Epidemiology Work Group (CEWG)
Cocaine-related death mentions in 2003 were particularly high in New York City/Newark, Detroit, Boston, and Baltimore, as measured by one Federal data source. Reports from local medical examiner data named Texas and Philadelphia as sites with the highest rates of cocaine-related deaths from 2003 through 2004.
Primary cocaine treatment admissions in 2004 accounted for 52.5 percent of treatment admissions, excluding alcohol, in Atlanta, 38.9 percent in New Orleans, and approximately 36 percent in Texas and Detroit.
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