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The busiest day of the year in my rehab is January 13th. The hope at home is that everybody will be relaxed, enjoying themselves and having a good time over the holidays. The reality of the Christmas period is that it is often a very stressful time.
Ali G, a character created by the comedian Sasha Baron-Cohen, was interviewing the Drug Tsar. He asked him about the effects of cocaine. The Tsar replied that it caused dilated pupils, blurred vision, a runny nose, agitation, disturbed sleep patterns and… ‘Yes, yes’, said Ali G. ‘But has it got any bad effects?’
I tell this story to illustrate the nonchalance of addicts in taking various symptoms for granted. They feel they’re a price worth paying in the quest for the euphoric rush they get from drugs.
As I see it, there are three causes for addiction.
The antecedent cause is genetic. Some of us are born that way. We may resent that, or try to deny it, but it makes no difference. We are what we are.
Then the contributory cause is emotional, physical or social trauma. This leads to a craving for mood-alteration.
Then the precipitant cause is exposure. We discover something that lifts our mood. Therefore we use it.
All three of these causes must be present for addiction to take off.
My wife, Meg, had a dreadful childhood. But she inherited what I saw as her mother’s compulsive helping – doing too much for other people and not enough for herself – rather than her father’s addictive nature.
My childhood was odd rather than significantly more abusive than that of any other boy in private school at that time. But I inherited my mother’s addictive gene along with osteoporosis. I also inherited the short sight that affected all my family. So I do the things that I need to do on a day-to-day basis to counter the influence of my genes. Meg never needed to. She just got on with playing her piano.
Any pleasurable sensation releases dopamine, a brain hormone. Meg got it in her natural way. I got it through the artificial stimuli of various addictive behaviours. About 1 in 6 people are like me in this respect, using one or another – or several – mood-altering substances, processes or relationships to change the way we feel. I felt ‘minus 1’ even when there was nothing wrong in my life. So I went looking for a ‘plus 1’. And I found several. Having made that discovery, I saw no reason whatever why I should give up my new-found pleasures. After all, I didn’t see – at that time – that they harmed anyone else.
Using cocaine exaggerates the normal pleasure response in the brain. In normal circumstances, dopamine is re-circulated so that it can give another dose of pleasure when stimulated again. Cocaine blocks that re-uptake process so that the pleasurable feelings stay switched on. Whoopee! That’s a result. Isn’t it?
There are feelings of excitement, confidence, being energised and sexually aroused. And if that isn’t a result, I don’t know what is.
Corticosterone (Cortisol), the stress hormone, is also involved in cocaine use. High stress levels in cocaine users lead to greater sensitivity to the drug.
The reason people take cocaine is simple: it makes them feel good. Very good. Without having to work for it.
Some people use it as self-medication for pain, anxiety and depression. It modifies thoughts, feelings and behaviour and it enhances performance in school or work or sports. Yet more results!
Using alcohol and cigarettes and drugs may also be a response to pressure to fit in with peers and to distance adolescents from their parents.
Eventually there is no need for reasons. They just do it. But, by that time, the first use of a mood-altering substance, behaviour or relationship in any day triggers the need for more. It is as if there is a ‘more’ button in the brain of some people like me. Stimulate it just once and the cravings begin.
The survival/pleasure response in the brain is the same for cocaine as it is for sugar, alcohol, cannabis, gambling and sex – and anything else that has a mood-altering effect. By contrast, nothing happens in response to eating potatoes or beans. We addicts discover for ourselves what ‘works’ and what doesn’t.
Dopamine stimulates the limbic system in the mood centres of the brain. Then we feel good. This leads to a feed-back loop: the more we do it, the more we want it. And then we want to repeat these magical experiences yet again. The build-up of dopamine when cocaine blocks its re-uptake causes continuous stimulation of neurons and a euphoric feeling. Addiction occurs when this process becomes compulsive, repetitive and damaging.
The brain quickly adapts to the rush of feelings produced by cocaine.
The nature of a particular ‘high’ feeling depends on which way cocaine is used but one effect is guaranteed: it reduces the natural secretion of dopamine in response to everyday happy experiences. This means that cocaine becomes the only pleasure. And that gets progressively weaker. Increasing the dose is the solution to this problem – but that brings more trouble.
Over-confidence, coupled with decreased regulation of behaviour, results in aggressive, inconsiderate and careless actions.
Addicts will hide their use from other people by hiding themselves. They suddenly disappear and then return in a different mood. That is certainly something to look for but there could be many other possible reasons for this behaviour.
They have a reduced appetite, constant sniffing and recurrent nosebleeds and damage to the septum between the nostrils. They may have burns around the mouth. They may be distressed for no apparent reason. They lose their commitment to their friends, family and work. Putting all these signs together makes cocaine addiction a progressively more probable diagnosis. The magic is dying.
Finding crack pipes and tiny plastic bags around the place makes the diagnosis a near certainty.
Mental and physical deterioration is seen when anxiety, depression, irritability, apathy, disturbed sleep and nightmares are coupled with damage to the heart and blood vessels, kidney damage and progressively more frequent minor or major illnesses.
The prefrontal cortex of the brain, just behind the brow, is often damaged in cocaine users. The brain in that area loses much of its white matter. Hallucinations and loss of self-control present a very disturbing picture.
I’m sure Ali G wouldn’t laugh at that. Nor would Sasha Baron Cohen’s brother who is a consultant neurologist. There is a time for humour – even on this issue – but not when seeing as much destruction from cocaine use as I have seen.
The body does not have an inexhaustible supply of neurotransmitters and they take time to produce. The body and mind take time to heal. Giving up using the drug is only the beginning of the road to recovery.
If you want to get on that road, or want a friend or family member to do so, I know how to help. Call me on 07540281820 and we’ll get the show on the road.
All mood-altering drugs are addictive to anyone who has an addictive nature. Cocaine is highly addictive. So are some individuals. The combination of an addictive drug and a highly addictive person is deadly. Focussing solely on the drug sends healthcare and education professionals and law enforcement authorities down the wrong route.
To identify adults with an addictive nature, we need to look at five specific risk factors that are common:
Even so, these people may be charming and highly successful professionally and socially. They tend to be imaginative and creative and are super-charged with energy. Eventually their wheels come off when they become dependent on addictive substances and processes but not before they have been wildly adventurous.
The genetic pool of potential addicts is probably only one in six of the total population. But they often breed with other people – compulsive helpers – who also come from addictive families. So the relatively small genetic pool ticks over. Society benefits from their imagination and enterprise but also suffers from the effects of their compulsive behaviour. In time that leads to big trouble.
When individuals express concern that their own problematic behaviour might be addictive in origin, my questionnaires – on this website on all aspects of addictive behaviour – should settle the matter. Here’s the one on recreational drugs, including cocaine:
‘Recreational’ (street) drugs
Any four positive answers indicates the need for further assessment.
Assessing someone else’s behaviour for the possibility of addiction is more challenging. Many people – perhaps all of us – can do stupid things at times. But addicts tend to do them more frequently and therefore pile up more damaging consequences. Observing the recurrent crises in their lives is the most accurate way of seeing an addict behind the bluff and bombast.
But, first of all, it helps to understand a bit about cocaine itself.
When snorted or inhaled, cocaine enters the blood stream via the nasal tissues. Injecting cocaine puts it directly into the blood stream. Mixing it with water and baking soda or ammonia causes it to crackle when heated. Smoking ‘crack’, as it is then called, leads to a shorter but more intense high. It is sold in small ‘rocks’ the size of raisins. The effect of smoking crack is immediate, the same as when cocaine is injected, but the ‘high’ lasts for only five minutes.
Crack has a powerful stimulating effect on the nervous system by raising the level of dopamine, the neurotransmitter associated with pleasure. Cocaine blocks the re-uptake process of dopamine that enables it to be recirculated. So it stays around and gives an artificial dramatic high in place of natural pleasures that have to be earned.
Physical ‘tolerance’ of the drug occurs through repeated use. An increased dose is required to get the same effect as before. Loss of behavioural control, obsessive thinking and altered priorities come as the result of continued use.
The younger people are when they start to use cocaine, the bigger the problems in store. Adolescents often take drugs in order to conform with the behaviour of their peers and break away from their parents. Individuation is a necessary process but it doesn’t have to be done this way.
The brain initially responds to cocaine in the same way as to any pleasurable sensation. But then it rapidly adapts to the new level of perceived pleasure. It needs a greater stimulus for the same effect. The euphoric feelings don’t last. The talkativeness often does. So does the poor decision-making, diminished attention span and confused thinking. The collapse of previous inhibitions results in addicts doing things that make no sense – even to them. But memories of previous highs still drive them on. This pleasurable feedback loop means that recurrent relapse is likely.
People born with temperament problems may be drawn to use cocaine. It counters shyness but at the price of foolhardiness. A quick high appeals to many people, particularly in party situations. But eventually cocaine takes over the whole of the addict’s life. Restlessness, nervousness, depression and severe mood swings are common symptoms. But the addict shrugs all this off in an attempt to recapture the initial dramatically profound high.
Cocaine is the addict’s ultimate sweetheart. It stimulates the brain immediately after use. This new experience for the brain leads to heightened sexual arousal. Trying to recapture that feeling makes cocaine particularly addictive. But it’s a false lover. It takes much more than it gives. Eventually money problems, damaged relationships and physical symptoms illustrate the personal price behind the high financial price and superficial glamour of initial use. A Binge/Crash cycle is a dreadful experience.
Addicts often combine cocaine with other drugs in order to pick and mix the effects. Alcohol, benzodiazepines, amphetamines, opiates and cannabis are frequent partners in self-inflicted damage.
Addiction affects motivation. The body’s natural reward systems become corrupted. Previous pleasures no longer satisfy. Cocaine dominates all other concepts of happiness and fulfilment. It becomes the only ‘real’ friend. As the addiction takes hold, there is a constant sense of ‘needing’ the drug.
Other addictions offer occur at the same time. Co-existing mental problems are common. Cocaine gives feelings of invincibility. The mind and body take the consequence of that tragically false belief. It is also frequently used for self-medication for physical or emotional discomfort. It modifies thoughts, feelings and behaviour. It enhances performance. It’s magic! But at a fearful price. Addicts often say they intend to quit. But they fail. The addiction wins every time until the individuals are utterly defeated and washed up.
Psychological withdrawal symptoms are worse than physical symptoms, which hardly exist at all in the early phases of drug use. This used to lead people – doctors included – to believe that cocaine is not addictive. How wrong they were!
The important lesson from this observation is that only those of us who are addicts of one kind or another ourselves know what addiction really is. And we know what needs to be done about it in order to achieve long-term abstinence, peace of mind and mutually rewarding relationships.
There may be a genetic predisposition in the size of the basal ganglia in the brain. Future addicts have this feature even before they take cocaine and other substances and processes of addiction. But, with persistent use of cocaine, family and social influences, social pressures, exposure to stressful circumstances, emotional or physical trauma and susceptibility to impulsive behaviour all make the situation appear hopeless.
But it isn’t. I’m an addict and I haven’t used anything addictive in over 30 years. There are lots of people like me. We enjoy each other’s company in ways we never dreamed of in the bad old days.
If you want what we’ve got you need to do what we do. We tried all sorts of other ways but they didn’t work until we were given what we call ‘the gift of desperation’. That turned us round and gave us the rewards we have now.
If you want to know how to get them – for yourself or for a family member or friend – please call me on 07540281820 and I’ll be glad to listen and maybe suggest some things that could be helpful.