What is cocaine use disorder?

Causes

Cocaine is a powerful central nervous system stimulant that causes the brain to release large amounts of the hormone dopamine. Dopamine, a neurotransmitter associated with feelings of pleasure, floods the brain’s reward pathways and results in the euphoria commonly reported by cocaine users. As a person continues to use cocaine, a tolerance is developed. This means that more frequent use and higher doses are required to achieve the same feeling of euphoria. Repeated use of cocaine can result in long-term disruptions to the brain’s dopamine levels and reward circuitry.

When a cocaine user stops using abruptly, he or she experiences a crash or withdrawal. This results in an extremely strong craving for more cocaine. It also results in fatigue, loss of pleasure in life, depression, anxiety, irritability, and paranoia. These withdrawal symptoms often prompt the user to seek more cocaine.

Risk Factors

Being male and between the ages of eighteen and twenty-five years are considered factors that increase one’s chances of developing cocaine use disorder.

Symptoms

The short-term effects associated with cocaine use include euphoria, increased energy, mental alertness, decreased need for food and sleep, dilated pupils, increased temperature, increased heart rate, increased blood pressure, erratic or violent behavior, vertigo, muscle twitches, paranoia, restlessness, irritability, and anxiety. A cocaine overdose can result in a dangerous elevation of blood pressure, leading to stroke, heart failure, or even sudden death

The long-term effects include uncontrollable or unpredictable cravings; increased tolerance; increased dosing; increasing irritability, restlessness, and paranoia; paranoid psychosis; and auditory hallucinations.

Medical complications that may result from cocaine use disorder include heart rhythm abnormalities, heart attack, chest pain, respiratory failure, stroke, seizure, headache, abdominal pain, and nausea.

Screening and Diagnosis

A doctor who suspects cocaine use disorder will ask the patient about symptoms and medical history. He or she will also perform a physical examination. The doctor will ask specific questions about the cocaine use, such as how long the patient has been using the drug and how often.

Treatment and Therapy

A medical professional should be consulted to develop the best treatment plan for an individual suffering from cocaine use disorder. Treatment programs may be inpatient or outpatient. Treatment programs may require that the patient has already stopped using cocaine prior to treatment or they may involve a supervised detoxification program.

Medications can be used to help manage the symptoms of withdrawal, but there are currently no medications that have been approved to specifically treat cocaine use disorder. Medications that have shown some promise include modafinil (Provigil), N-acetylcysteine, topiramate (Topamax), disulfiram, agonist replacement therapy, and baclofen. Antidepressants may also be helpful for people in the early stages of cocaine abstinence. A 2015 study from the Yale School of Medicine also found that progesterone may be effective as a treatment for cocaine use disorder in women.

Behavioral therapies to help people quit using cocaine are often the only effective treatment for cocaine use disorder. These therapies use contingency management. With this program, people receive positive rewards for staying in treatment and remaining cocaine-free. Additionally, cognitive-behavioral therapy helps people to learn the skills needed to manage stress and prevent relapse.

Recovery programs such as Cocaine Anonymous provide community support for people seeking to recover from cocaine addiction. In rehabilitation programs, people with cocaine use disorder stay in a controlled environment for six to twelve months. During this time, they may receive vocational rehabilitation and other support to prepare them to return to society.

Prevention

The best way to prevent cocaine use disorder is to never use cocaine because the drug is highly addictive. Education programs on the dangers of cocaine use have helped to lower rates of cocaine use in the United States since the 1990s.

Bibliography

DiGirolamo, Gregory J., David Smelson, and Nathan Guevremont. "Cue-induced Craving in Patients with Cocaine Use Disorder Predicts Cognitive Control Deficits toward Cocaine Cues." Addictive Behaviors 47 (2015): 86–90. Print.

DuPont, Robert L. The Selfish Brain: Learning from Addiction. Center City.: Hazelton, 2000. Print.

Julien, Robert M., Claire D. Advokat, and Joseph Comaty. A Primer of Drug Action: A Comprehensive Guide to the Actions, Uses, and Side Effects of Psychoactive Drugs. 12th ed. New York: Worth, 2010. Print.

Shorter, Daryl, Coreen B. Domingo, and Thomas R. Kosten. "Emerging Drugs for the Treatment of Cocaine Use Disorder: A Review of Neurobiological Targets and Pharmacotherapy." Expert Opinion on Emerging Drugs 20.1 (2015): 15–29. Print.

Sosinsky, Alexandra. "Progesterone Reduces the Use of Cocaine in Postpartum Women with Cocaine Use Disorder." MGH Center for Women's Mental Health. Massachusetts General Hospital, 4 Feb. 2015. Web. 29 Oct. 2015.

Sussman, Steven, and Susan L. Ames. Drug Abuse: Concepts, Prevention, and Cessation. New York: Cambridge UP, 2008. Print.

Weil, Andrew, and Winifred Rosen. From Chocolate to Morphine: Everything You Need to Know About Mind-Altering Drugs. Rev. ed. Boston: Houghton Mifflin, 2004. Provides basic information about psychoactive substances to the general reader. Psychoactive substances are identified and defined. Also outlines the relationships between different types of drugs, the motivations to use drugs, and associated problems.