How the Brain Understands and Manages Stress
In some circles the use of cocaine has become common, even acceptable. Nipping out for a quick line or two is not unusual at a party or dinner with friends. It is as acceptable as having a glass of wine with a meal or a couple of pints to wind-down after work. But there is a down side and it isn’t long before the down side is felt. Tiredness the next day, staying out much longer than previously intended, lower productivity, breaking your own moral and ethical standards like lying to your partner or not being there to read your kids their bedtime story. All this becomes a regular occurrence as the grip of cocaine takes hold. That once recreational use has now become a noose around your neck and that noose is becoming tighter. Does it sound all too familiar? Have you already been threatened by your partner? Have you told yourself you are going to stop but just haven’t been able to resist the odd line? What needs to happen before you finally stop? Do you really need to lose it all?
Cocaine is a powerful drug. It makes one feel euphoric or energised and heightens the sensations of sight, sound and touch. Cocaine is so much ‘fun’ that people are willing to pay high prices for it. However, it is also highly addictive; once an individual has tried it, for many, they cannot predict/control the extent to which they will continue to use it. Cocaine can be a very dangerous drug. Prices have come down in recent years but so has the ‘quality’ (strength) of the cocaine and this has led to a false sense of it’s not as addictive as it was before. This false sense feeds into the addictive mind that it’s OK to use but the addictive mind doesn’t ask the question “what dangerous substances are being used to ‘cut’ the cocaine. Additionally when some better quality becomes available on the market the addictive mind sends out messages of “I must try that”. This changing purity of the drug has long been a marketing technique used by dealers to pull in new customers who, once they have been seduced, can be sold the poorer quality drug and the dealers profits soar.
Cocaine in one form or another has been around for thousands of years. The ancient Peruvian people knew the stimulating qualities of the coca leaf. The Erthroxylum coca shrub is native to South America. It is usually grown in wet/humid regions. However, the ‘best’ cocaine is found in the remote western desert slopes of the Andes. Although most coca grows faster the closer it is to sea level, its cocaine content increases the higher it is and therefore, it is usually grown on steep Andean mountainsides. The leaves are plucked and processed into cocaine. Cocaine is normally sold as a fine white, crystalline powder known as “coke,” “C,” “snow,” “flake” or “blow.” It is diluted or ‘cut’ with such inert substances as corn-starch, talcum powder and/or sugar or with active drugs such as amphetamines. But it can also be cut with other cheaper stimulants such as speed or caffeine. The numbing effect can be simulated by adding other pain killers and anaesthetics some of which can cause cancers. In some cases laxatives and veterinary worming tablets are used. On their own you wouldn’t dream of using any of this but the reality is every time you snort a line you are also snorting unknown substances which can have lasting and possibly fatal side effects.
For many years cocaine was used in medicine; its analgesic and anaesthetic properties were promoted by leading doctors. In the early 1900’s it became the main stimulant drug used in most tonics and elixirs used to treat various illnesses. It was particularly useful in ophthalmic surgery. Cocaine is a strong stimulant of the central nervous system and an appetite suppressant. It interferes with the re-uptake of dopamine, a neurotransmitter (chemical messenger) that controls the pleasure centres in the central nervous system, creating a feeling of euphoria and heightened sexuality allied with decreased anxiety and social inhibitions. However, this feeling of euphoria is short lived lasting for about 15/20 min utes before the ‘crash’. The euphoria disappears; the user returns to their original mood level or even a little lower. The user then thinks that by using again, they will return to the high and so it goes on. The problem is that the level of the original high is never reached again and over time, users have to increase the amount of cocaine to obtain the same effect. ‘Chasing the high’ is typical of addiction and the user is trapped in a rapid downward spiral. Unfortunately, the euphoric experiences of the high are engraved on the user’s memory and the basis for craving the drug is formed.
With repeated exposure to cocaine, the brain starts to adapt, and the reward pathway (the part of the memory that tells you how to reward yourself and feel ‘good’) becomes less sensitive to natural reinforces (how to ‘feel good’ without drugs) and to the drug itself. Tolerance may develop which means that higher doses and/or more frequent use of cocaine is needed to register the same level of pleasure experienced during initial use. It may be easier to understand how this happens by imagining the memory as being a field of knee-high corn. If you continue to cross the corn field along the same path a distinctive pathway is ‘engraved’ in the field and it is easier to always cross the field using this pathway rather than forming a new one. In other words it easier to feel good using drugs than finding other methods. If you stop crossing the field the corn will start to grow again but the path will always be visible. If you stop using cocaine the engraving in the memory will heal over but it will always be visible. In other words if you stop using, the engraving in the memory will fade but should you pick up again you immediately tread the same path back into addiction.
Strong psychological cravings are a major feature of cocaine use. The crashes become deeper and deeper. Another key feature of long term cocaine use is the near suicidal depths of depression that many users experience. In their minds they know that a ‘line’ (where the powder is shaped into a long ‘line’ in order to be inhaled through the nose) will take them out of that depression although only temporarily
“You believe that coke will increase your perceptions, that it will allow you to surpass yourself, that you will be able to control things. It’s bloody nonsense. After a while you don’t pay your bills anymore, you don’t wash yourself anymore, you give up your friends, your family. You will become defenceless and alone.” — anon
Effects on the Body and Brain
Cocaine is a dangerous drug despite the common misconception that the only physical long term damage through its use is damage to the septum (thin wall dividing the nose). Heart attacks, respiratory failure, increased blood pressure, gastrointestinal complications, strokes, seizures, convulsions and comas are all linked to cocaine use. As it is an appetite suppressant, regular users experience significant weight loss and malnourishment. Increased use may lead to psychoses, hallucinations and to cravings for other drugs such as alcohol. When taken together alcohol and cocaine are converted into coca ethylene in the liver, which acts for longer in the brain and is more toxic than either drug alone. The danger each drug poses is compounded and un- knowingly a complex chemical process is happening within the body. Cocaethylene intensifies the euphoric effects of cocaine but is linked to a significantly greater risk of sudden death, compared to cocaine alone. Mixing cocaine/alcohol is the most common two-drug combination that results in drug-related deaths. Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, may lead to a state of increasing irritability, restlessness and paranoia. This can result in a period of full-blown paranoid psychosis, in which the user loses touch with reality and experiences auditory hallucinations.
Forensic pathologists in south-west Spain revealed that over 3% of all sudden deaths are related to cocaine use. They believe the rest of Europe probably has a similar prevalence. The pathologists stress that a "safe" recreational amount of cocaine does not exist. Out of 668 sudden deaths that occurred between 2003 and 2006, 3.1% (21) were linked to cocaine use - they were all male and aged between 21 and 45.
“With coke, you are like a moth stuck on a light. It attracts you more and more and you can’t stop it. It’s not physical. It’s in your head. The more you have it, the more you take it. I borrowed money from the bank to buy it. One day I became unemployed. It was worse. I used all the time. This thing made me insane. I knew it, but I continued. I became a total failure.” —anon
For more information on the addicted brain visit: http://wireheading.com/article/addiction.html
There is huge denial when it comes to cocaine addiction. Denial is our natural defence against emotional pain and it automatically clicks in when we become uncomfortable with the feelings of, for example, guilt and shame we get when using when we promised not to or anger and frustration of not having the strength to say “No”. Unlike other substances, cocaine addiction is incredibly complicated because it involves a wide range of biological changes in brain chemistry, allied with a combination of complex family, social and environmental factors. The first step is admitting you have a problem. The following short test should help in identifying whether it is time to seek help for your drug use:
- Is your Cocaine use causing problems with your partner/family?
- Do you ever wish that you had never taken the first line?
- Do you have an anticipatory high just before you are about to use?
- Do you use alone?
- Have you ever lied or misled others about your usage?
- Have you ever tried to quit or cut down, but couldn’t?
- Are you afraid that you will lose your confidence if you stop using?
Cocaine affects your body, brain, heart and soul. It is a killer but many people don’t realise this until it is too late. It is common for addicts to relapse repeatedly before they achieve abstinence. Successful treatment isn’t just detoxing; it’s re-learning how to live. Permanent abstinence after long term use of cocaine is extremely difficult without professional help which often means residential rehabilitation. A period in rehab allows supervised detoxification, 24 hour support during the difficult early days when cravings can be overwhelming and therapy to help you re-learn how to live in a drug free environment.
Cocaine hydrochloride is the form in which cocaine is usually taken and is highly sensitive to heat. When it is burned it destabilises completely so attempting to smoke this way doesn’t work. In order to smoke cocaine, it must be chemically changed into a form that vaporises rather than degrades when heated. This is done by adding a strong alkali and dissolving this in a powerful solvent such as ether which allows the cocaine to crystallise out to form a ‘base’. The process is known as ‘freeing the base’ or ‘freebasing’. However, as ether is extremely volatile, the ‘freeing the base’ stage is often omitted and the rock that remains contains a small amount of water. When the rock is heated the water boils producing a ‘cracking’ sound hence “Crack Cocaine”.
But why go to such lengths?
Crack Cocaine is not only smokeable but it is also a lot more potent and available in small relative cheap quantities appealing to those with little money available. The rush induced by smoking cocaine is extremely intense but is matched by the brevity of the high. It is extremely addictive and despite it’s relatively cheapness leads many people into an addiction they cannot afford with the usual consequences of crime and prostitution.
What are the long-term effects of crack cocaine?
In addition to the usual risks associated with cocaine use, crack users may experience severe respiratory problems, including coughing, shortness of breath, lung damage and bleeding. Long-term effects from use of crack cocaine include severe damage to the heart, liver and kidneys. Users are more likely to have infectious diseases. Continued daily use causes sleep deprivation and loss of appetite, resulting in malnutrition. Smoking crack cocaine also can cause aggressive and paranoid behaviour.
As crack cocaine interferes with the way the brain processes chemicals, one needs more and more of the drug just to feel “normal.” Those who become addicted to crack cocaine (as with most other drugs) lose interest in other areas of life.
Coming down from the drug causes severe depression, which becomes deeper and deeper after each use. This can get so severe that a person will do almost anything to get the drug—even commit murder. And if he or she can’t get crack cocaine, the depression can get so intense it can drive the addict to suicide.
Cocaine Dependence (Addiction)
Any drug, which causes changes to the mind, can cause a dependence syndrome. This means there are symptoms and behavioural patterns which form a recognised illness:
- There is a strong desire or compulsion to use, which overrides other everyday activities; family, friends, work and hobbies are neglected. They neglect the alternative pleasures of life as the cocaine use becomes the major focus for the individual.
- There is a degree of tolerance requiring higher doses to have the same psychological effect. There are difficulties in controlling the amount of use so consumption escalates.
- The user continues to use cocaine despite evidence of harm such as ill health, debts, relationship difficulties or psychological problems
The people most at risk of cocaine dependency are those who have difficulty dealing with their emotions and who have trouble facing everyday life. Cocaine is used as an “escape mechanism” for life’s problems rather than confronting them. There is an increased risk for those who are shy, have low self-esteem and have problems with family/work. There are genetic risks for susceptibility to addiction. Research, particularly in the USA, shows that the risk for developing cocaine addiction does run in families. The genes a person inherits partially explain this pattern but lifestyle and psychological environment are also factors. However, a genetic predisposition to cocaine addiction does not mean it is inevitable; just because addiction tends to run in families, it does not mean that a child of an addict parent will automatically become an addict too. Some people develop an addiction even though no one in their family has a using problem.
Recent studies have shown that, during periods of abstinence from cocaine use, the memory of the euphoria associated with cocaine use or mere exposure to cues associated with drug use, can trigger tremendous craving and relapse to drug use, even after long periods of abstinence.
Treatment of Cocaine Dependence
The treatment of cocaine addiction is complex and must address a variety of problems. Presently, there are no approved medications to treat cocaine addiction and a therapeutic approach is the accepted method. Cognitive Behavioural Therapy (how we think and how we behave) has been proven to be most effective in both in and outpatient settings and particular with relapse prevention. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and addiction. These same learning processes can be harnessed to help individuals reduce drug use and successfully prevent relapse. This approach attempts to help patients recognise, avoid, and cope; that is, they recognise the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviours associated with drug abuse. This therapy is also noteworthy because of its compatibility with a range of other treatments patients may need during the course of their recovery programme.
For those with dependence there is usually a repeated pattern of failed attempts to give up without seeking help. In such cases outpatient treatment is seldom the answer and they need to be admitted into a rehabilitation centre in order to address the underlying personal issues which have promoted the dependency and to counteract the effects of the illness itself. Invariably once this stage of dependency is reached, the user will never be able to control cocaine use again and abstinence is the only way forward. A return to use will cause a return to the original patterns of use and the vicious circle continues. Inpatient treatment looks at all factors hidden behind the dependency, such as relationship issues, previous psychological trauma or self-esteem issues.
Some dependency is in conjunction with other psychiatric disorders such as depression. Often the user does not recognise the harm that cocaine is doing to themselves or others (denial) or the social isolation that it is causing. The illness is accompanied by guilt/shame so there is a reluctance to accept help. The therapeutic environment enables the return to previous attributes and the ability to ask for help when there is trouble so they can view the future with confidence without returning to mind-altering substances. Family relationships, which are also damaged by the illness, can be repaired with the help of treatment. Treatment is for life and after either in or outpatient care it is essential for continuous aftercare. This can include Community-based recovery groups—such as Cocaine Anonymous (CA)—that use a 12-step programme. CA is helpful to people trying to sustain abstinence; participants may benefit from supportive fellowship and from sharing with those experiencing common problems and issues.
It is important that patients receive services that match all of their treatment needs. For example, if a patient is unemployed, it may be helpful to provide vocational rehabilitation or career counselling along with addiction treatment. If a patient has marital problems, it may be important to offer couples counselling.
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