Cocaine Use Disorder

(Cocaine Abuse; Cocaine Dependence)
  • Definition

    Cocaine use disorder is when the use of cocaine harms a person’s health or social functioning, or when a person becomes dependent on cocaine. The powdered form of cocaine can be snorted or dissolved in water and injected. Crack is cocaine in a rock crystal form. It can be heated so its vapors can be smoked.
    Cocaine use disorder is treatable. But, it takes hard work. Talk to your doctor if you think you have this condition.
  • Causes

    Cocaine stimulates the brain to release large amounts of the hormone dopamine. Dopamine results in the euphoria commonly reported by cocaine abusers. As a person continues to use cocaine, a tolerance is developed. This means that higher doses and more frequent use are needed to maintain the euphoria.
    Release of Dopamine in the Brain
    neurotransmitter
    The dopamine connecting to the receptors causes a euphoric feeling. This occurs naturally, but cocaine causes an exaggerated response that can lead to addiction.
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    When a cocaine user stops using abruptly, a crash or withdrawal occurs. This results in an extremely strong craving for more cocaine. It also results in fatigue, loss of pleasure in life, depression, anxiety, irritability, suicidal thoughts, and sometimes paranoia. These withdrawal symptoms often prompt the user to seek more cocaine.
  • Risk Factors

    Factors that increase your chances of getting cocaine use disorder include:
    • Age: 18-25
    • Sex: males
  • Symptoms

    Symptoms associated with cocaine use disorder include:
    • Short-term effects include:
      • Euphoria
      • Increase in energy
      • Excessive talking
      • Being mentally alert
      • Decreased need for food and sleep
      • Dilated pupils
      • Increased temperature
      • Increased heart rate
      • Increased blood pressure
      • Bizarre, erratic, or violent behavior
      • Vertigo
      • Muscle twitches
      • Paranoia
      • Restlessness, irritability, and anxiety
      • Heart attack
      • Seizures
      • Sudden death
    • Long-term effects include:
      • Cravings that can't be controlled or predicted
      • Increased tolerance
      • Increased dosing
      • Use of cocaine in a binge
      • Increased irritability, restlessness, and paranoia
      • Paranoid psychosis
      • Hearing sounds that aren't there
    • Medical complications include:
      • Heart rhythm abnormalities
      • Heart attack
      • Chest pain
      • Respiratory failure
      • Stroke
      • Seizure
      • Headache
      • Abdominal pain
      • Nausea
      • Chronic runny nose or septal perforation
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will ask specific questions about your cocaine use, including how long you have been using the drug and how often.
  • Treatment

    Talk with your doctor about the best treatment plan for you. Treatment programs may be inpatient or outpatient and may:
    • Require that you have already stopped using cocaine
    • Involve a detoxification program
    Medications
    There are currently no medicines to specifically treat cocaine use disorder. Treatment with medicine focuses on the symptoms of euphoria and craving. Medicines that have shown some promise include:
    • Modafinil—wakefulness promoting agent
    • N-acetylcysteine
    • Topiramate—seizure medication
    • Disulfiram
    • Agonist replacement therapy
    • Baclofen
    • Antidepressants—may be helpful for people in the early stages of stopping cocaine use
    Behavioral Therapy
    Behavioral therapies to help people quit using cocaine are often the only available, effective treatment for cocaine use disorder. Therapies include contingency management. With this program, people receive positive rewards for staying in treatment and remaining cocaine-free. Also, cognitive behavioral therapy helps people to learn how to abstain and remain abstinent from cocaine.
    Rehabilitation Programs
    In rehab programs, people with cocaine use disorder stay in a controlled environment for 6-12 months. During this time, they may receive vocational rehab and other support to prepare them to return to society.
  • Prevention

    The best way to prevent cocaine use disorder is to never use cocaine. It is highly addictive.
  • RESOURCES

    Cocaine Anonymous http://www.ca.org

    National Institute on Drug Abuse http://www.nida.nih.gov

    CANADIAN RESOURCES

    Cocaine Anonymous of Southern Ontario http://www.ca-on.org

    Native Alcohol and Drug Abuse Counseling Association of Nova Scotia http://nadaca.ca

    References

    Amato L, et al. Dopamine agonists for the treatment of cocaine dependence. Cochrane Database Syst Rev . 2011; Dec 7;(12):CD003352..

    Carson-DeWitt R, ed. Encyclopedia of Drugs, Alcohol, and Addictive Behavior . 2nd ed. New York, NY: MacMillan Reference Books; 2000.

    Cocaine abuse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 15, 2013. Accessed February 20, 2013.

    Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet . 2012;379:55-70

    Karila L, Reynaud M. Therapeutic approaches to cocaine addiction. [article in French] Rev Prat. 2009;59(6):830-834.

    NIDA InfoFacts: crack and cocaine. National Institute on Drug Abuse website. Available at: http://www.nida.nih.gov/Infofacts/cocaine.html. Accessed. Updated March 2010. Accessed February 20, 2013.

    Research report series: cocaine abuse and addiction. National Institute on Drug Abuse website. Available at: http://www.drugabuse.gov/ResearchReports/Cocaine/Cocaine.html. Updated September 2010. Accessed February 20, 2013.

    Revision Information

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