Why is cocaine so addictive?
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.