The leaves of the coca plant are chewed by South American Indians in the Andes. This gives them the strength to carry heavy loads at high altitudes. From the leaves a paste, called basuco, can be made and then, when it is dried out and purified, it forms a powder – cocaine. Further refinement creates crystals called ‘crack’.
At each stage the purity and the potency of the effect of cocaine becomes progressively more intense. Give the American Indians crack and they would probably keel over, despite a lifetime of habituation to chewing coca leaves.
Cocaine is powerfully addictive. Smoking or snorting or injecting cocaine can all lead to dependence and addiction. Initial pleasurable effects, caused by stimulation of the dopamine receptors in the brain, are followed by anxiety and cognitive impairment.
The euphoria does not last. The initial stimulant effects lead to agitation and insomnia. The reward centres of the brain become overloaded. Cocaine’s euphoric effects all wear off. Withdrawal symptoms of fatigue and depression may sometimes be followed by intense craving.
The mental and physical effects of chronic cocaine abuse and dependence are similar to those of alcohol and other drugs but their onset will tend to be more rapid. Mental disorders and behavioural problems associated with chronic cocaine addiction are common. Medical complications can be severe.
Rehab treatment after chronic cocaine abuse will vary according to the intensity and frequency of use. It will also vary according to the level of use of other drugs, such as alcohol or ecstasy or marijuana or LSD or heroin or other addictive substances.
People who smoke cocaine or snort it, so that it is absorbed through the mucous membranes of the nose, may have just as much of an addiction as those who inhale a vapourised ‘rock’ through a crack pipe or those who inject cocaine, with or without heroin.
People who are addicted to either powdered or crack cocaine need careful clinical management because they can be very fragile emotionally and behaviourally. They can be very jumpy. However, they do not necessarily require detoxification with pharmaceutical substances.
Some addiction treatment centres use warm baths and massage as a way of helping cocaine addicts to come down from their highs and up from their lows. Psychiatric supervision may not be required in such circumstances. Antidepressant drugs, or other prescription drugs, may simply lead to another drug addiction.
The most effective help comes from other addicts who have themselves previously been addicted to mood-altering drugs. They can give reassurance that all will be well once the paranoia and other delusions have naturally resolved.
Acute paranoid delusions are very frightening to the cocaine user and to other people around him or her. A calm and supportive environment is much more helpful than the use of anti-psychotic medication or tranquillisers. That being said, a prescription for pharmaceutical drugs, over a period of two or three days, can assist in calming the patient and also in reassuring everyone else.
Not all users of cocaine are addicted to it. The same is true for alcohol, nicotine or any other mood-altering drug. Differentiating casual users from addicts is a vital clinical assessment. Addicts can give up at any time but then they relapse back to their former drug use. Or they may cross-addict into using other addictive substances or behaviours.
Assessment of a wide range of addictive behaviours is therefore necessary if the individual is to avoid being misdiagnosed and inadequately clinically managed.
Frequently, cocaine users will convince themselves that they are not addicted because they don’t use it every day. Even those who use crack cocaine may give themselves this false reassurance. Specific addictive characteristics have to be considered:
- Preoccupied by using it or giving it up
- Content to use the drug on one’s own rather than in company
- Using it as a medicine to take away unpleasant feelings or give good ones
- Using it primarily for mood-altering effect
- Protecting the supply so that time and energy and money is primarily focused on drug use
- Being driven from the first use to the next in any day
- The tendency to have a higher capacity than other people as tolerance develops in time
- Continuing despite physical, social, psychological and financial damage
- The tendency to cross-addict into using other mood-altering substances and behaviours
- Experiencing drug-seeking behaviour, going looking for it
- Experiencing drug-dependent behaviour, needing it in order to function effectively
- Continuing to use the drug despite the repeated serious concern of other people
- Positive answers to any four of these addictive characteristics indicate a significant addiction problem.
Addiction goes with the person as well as with the substance. Some people appear to have addictive natures that may well be genetically inherited. These people will be particularly prone to developing addiction problems.
Casual or social users may become physiologically addicted. They can get off it and would tend not to go back to it or to another addictive substance or process. They are fortunate in getting away with it. Addicts may wish that they were like these occasional users but they are not. They will remain trapped in the addictive cycle, going from one binge to another.
Treatment for cocaine addiction and crack addiction is the same. The first requirement is total abstinence from all addictive drugs and processes. The second essential treatment is regular attendance at meetings of Narcotics Anonymous or Cocaine Anonymous and daily working of the Twelve Step programme in order to prevent relapse.
The desperate ravages of cocaine addiction, for most addicts, can be totally reversed. The financial haemorrhage can stop. The marital and professional disasters can be overcome. In place of despair and destruction, the future can be met with enthusiasm and creativity.