Neurological effects of cocaine addiction and treatment approaches

¶ … Brain Effects Cocaine Dependent Individuals and Treatment

One of the most addictive substances in the modern society that is increasingly abused is cocaine, which is a drug that generates several problems in the society and today's health care programs. As a result of the increased use of this drug, users sometime develop cocaine addiction or dependence, which is a condition characterized by an overwhelming psychological desire to use the drug regularly. Despite its associated psychological impacts, people increasingly use cocaine and become addicted because it generates euphoria and high levels of energy similar to caffeine. Cocaine addiction or dependence has become a major issue for health care providers because it may contribute to brain and cardiovascular damage, which in turn generates heart attacks, strokes, and constricting heart arteries. Therefore, the treatment of cocaine addiction or dependence is increasingly important in today's society.

This article focuses on examining how the brain effects cocaine dependent individuals and treatment. The first section primarily focuses on providing a biopsychosocial description of cocaine addiction or dependence based on recent research findings. This description includes a discussion on the evolution of cocaine dependence to become a major public health issue. This is followed by an evaluation of the social impact of the problem. The analysis is carried out on the premise on why cocaine dependence and treatment methods are important in today's society. The final segment provides a review of treatment methods in light of treatment outcomes, personalization of the treatment procedure, ethical issues, and program planning.

The treatment of cocaine dependence is an important measure for improving the health and well-being of individuals and the society. The most suitable treatment measure for cocaine dependence is a comprehensive approach that addresses the major ethical issues and is based on the specific case.

Biopsychosocial Description of the Problem

Morton (1999) defines cocaine as an addictive drug that creates several psychiatric symptoms, disorders, and syndromes (p.109). The signs of using these drugs include hallucinations, agitation, violence, paranoia, and delusions. The use of cocaine by individuals is attributed to the fact that the drug usually produces high levels of energy and euphoria similar to caffeine. The psychological and brain effects of cocaine can basically be linked to the primary effect of the drug or secondary to exacerbation of comorbid psychiatric disorders. As some individuals use cocaine to experience the euphoria and high energy it creates, they develop a psychological desire for regular use of the drug. The psychological desire in turn develops to become an addiction or dependence on the drug, which is characterized by overdose.

Given the psychological impact of the drug, cocaine has developed to become one of the most addictive substances in the modern society. While many clinical practitioners know that crack is linked to cocaine, very few know the exact composition of crack. However, crack is cocaine though not the cocaine in powder form, which produces high intensity. As compared to crack, cocaine has a slower start of action that develops or increases to produce the euphoric impacts. The increased intensity of cocaine is brought by the fact that it is not combined with other substances or liquids that relatively decreases its actions.

According to Moreno-Lopez et al. (2014), cocaine addiction is linked to gray matter anomalies in prefrontal and striatal brain segments that control impetus toward rewards and goals (p.1). The striatal brain regions encode the present value of tangible incentives while the prefrontal brain regions are reflections of long-term goals and rewards. In the striatal regions, the motivational value of rewards is encoded by the ventral striatal segments while habit learning and habit-based control of behavior is directed by the dorsal striatal aspects, which are central for these processes. The prefrontal cortex in the prefrontal brain regions consists of ventromedial elements that represent the subjective significance of rewards and goals and coordinate goal-directed behavior. In addition, the dorsomedial aspects in prefrontal cortex are necessary to deal with conflict and sustain motivation for challenges and goals over time. Therefore, the use of cocaine is attributed to decrease in ventromedial and dorsomedial prefrontal gray matter as well as magnification of striatal gray matter (Moreno-Lopez et. al., 2014, p.1).

Cocaine dependence or addiction is caused by the effect of the brain as a result of the use of the product. The drug has very potent stimulating effects on the nervous system, which significantly affect the brain and result in dependence or addiction. This most commonly abused illegal drug increases the amounts of dopamine, which is a neurotransmitter in the brain's reward circuit that is associated with movement and pleasure. The effects of cocaine on the brain's reward circuit vary from 5, 15 or 30 minutes depending on how the drug is taken. Neurons in the brain's reward circuit usually release dopamine in reaction to a motivational or pleasurable stimulus. The dopamine is then recycled back into the same neuron, which in turn results in shutting off the signal between neurons (Nordqvist, 2014). An accumulation of dopamine takes place since the drug prevents dopamine from getting back into the neuron or from being recycled. This contributes to eventual disruption of normal communication since the process magnifies the message to and reaction of receptive neurons. Consequently, the user experiences feelings of euphoria, high intensity of motor activity and energy, enhanced well-being, and increased alertness.

This drug also increases the amounts of serotonin and norepinephrine, which are the two other fundamental neurotransmitters. While serotonin is partly responsible for regulation of appetite, mood and sleep, norepinephrine is responsible for increase in blood pressure and heart rate, preparation of the body for emergency situations, activation, and alertness (Morton, 1999, p.110). Cocaine use results in instant release of these neurotransmitters and affects their normal and effective function. The instant release of these chemicals as well as overall depletion of dopamine impairs an individual's normal functioning.

Apart from these effects, cocaine dependence or addiction is associated with the physical changes in the brain that brought by the drug. As previously indicated, cocaine-using behavior creates abnormal brain structure in the brain's frontal lobe. This abnormal brain structure is a by-product of extensive loss of grey matter due to prolonged cocaine use. Individuals who use cocaine have much larger basal ganglia, the brain system where the actions and processes of cocaine are exerted. Therefore, the use of cocaine not only generates psychological effects on the brain but contributes to physical changes in brain structure and system.

Social Impact of the Problem

As previously mentioned, the psychological effects of cocaine are the major factors that contribute to its regular use and eventual addiction and dependence. Cocaine addiction and dependence is a major issue in the modern society, particularly the public health sector because of its increased use among adolescent and adult populations in the recent past. The increased concern and attention on cocaine dependence and addiction is because of its significant effect on the user, his/her family, the public health sector, and the society at large.

Psychological and Brain Damage Effects on Users

Cocaine dependence or addiction is associated with significant health impacts such as cardiovascular and brain damage, heart attacks in the central nervous system, panic attacks, high blood pressure, and cognitive impairments. This implies that users of these drugs are increasingly vulnerable to several cardiovascular and psychological health effects. The psychological and brain effects of cocaine dependence or addiction on a user is because of the significant changes the drug causes on the structure and functioning of the brain. The increased use and dependence on this drug not only generates physical changes to the brain structure but also its operations, especially with regards to attention. Due to its effect on brain networks and processes, cocaine dependence results in attentional bias (Kilts et. al., 2013, p.1135). These effects are largely brought by disruptions of networks and processes in the frontal, parietal, occipitotemporal, cingulate, and premotor cortex.

Increased Criminal Behavior and Crime Rates

For the individual's family and the society, cocaine addiction or dependence has been associated with irresponsible sexual behaviors and criminal activity. Cocaine contributes to increased criminal behavior and crime rates through inducing psychiatric symptoms that result in the emergence of violence. Based on the findings of a survey, psychiatric symptoms related to cocaine addiction or dependence contributed to 55% of violent behaviors (Morton, 1999, p.111). Cocaine users have increasingly reported engagement in violent crimes because of the effect of the drug on neurotransmitter dysfunction. While cocaine increases amounts of neurotransmitters in the brain's pleasure centers, cocaine contributes to violent behaviors by causing significant changes in serotonin and norepinephrine levels that may aggravate paranoia, aggression, impaired judgment, and hyperactivity. Comiskey, Stapleton & Kelly (2012) state that recent analysis shows that people who use cocaine are increasingly likely to commit an acquisitive crime as compared to individuals use benzodiazepines (p.406).

The impact of cocaine addiction or dependence on increased crime rates and criminal activity is attributed to the link between the drug and a significant number of illegal activities. Apart from being associated with increased violent activities, cocaine dependence has also resulted in increased homicide and suicide. A study in New York City demonstrated that homicide deaths were strongly linked to cocaine or its metabolite (Morton, 1999, p.111). In the survey, most of the victims and perpetrators of homicide tested positive for cocaine use. Cocaine dependence or addiction may contribute to suicide because of the probability of the user to suffer from depression, which tends to occur frequently among cocaine users.

Inappropriate Sexual Behaviors

Cocaine dependence has been linked to inappropriate sexual behaviors that in turn contribute to spread and increase of sexually transmitted diseases such as HIV / AIDS. Winhusen et. al. (2013), states that there is a strong link between cocaine usage and increased sexual risk behavior (p.1). These claims are based on the findings of multiple studies that have proven the strong association between cocaine use and increased sexual risk behavior. Users of these drugs tend to ignore safe sex practices because of the effect of the drug on normal psychological functioning of the brain.

Increased Health Risks

The public health sector is concerned with this problem because it creates new health concerns and increases the overall costs of health care delivery. As evident in the analysis, cocaine dependence affects brain structure and operations, which in turn result in the emergence of new health risks among adolescent and adult populations. Health care providers are increasingly concerned about the effect of cocaine on an individual's health and well-being. Apart from the health effects of cocaine on the brain, cocaine dependence contributes to unsafe sex practices, which in turn generates significant health risks and concerns. The emerging health risks due to cocaine addiction in turn increases health care costs since these health risks increases health care needs of populations and related costs.

As evident in this analysis, cocaine dependence and addiction is an issue that requires significant attention because of its effect on the health of individuals, the well-being of the society, and effectiveness of the public health sector in addressing the health needs of populations. The effect on this problem on individuals, the society, and the health sector is largely because cocaine users have problems thinking logically. Cocaine dependence or addiction affects individuals, the society, and the public health sector through generating several cognitive difficulties and impaired functioning. Actually, cocaine use impairs a person's attention, mental flexibility, judgment, decision making, and planning.

Treatment Methods

In light of its effect on individuals, the society, and public health sector, the treatment of cocaine dependence is increasingly important in order to promote individual and society's well-being. The need for dealing with cocaine dependence or addiction has contributed to the development of several treatment methods including

HIV Education/Counseling

HIV education/counseling is a treatment method that has been developed because of the effect of cocaine dependence in contributing to unsafe sexual practices that in turn generate sexually transmitted diseases. HIV education/counseling is a comprehensive intervention measure that helps patients i.e. cocaine addicts lessen risky behaviors. The approach has been considered effective in treatment of cocaine dependence or addiction among users because of its contribution to increased knowledge that helps in development of safe sex practices. Apart from focusing on increasing safe sex among cocaine addicts, this comprehensive approach is also centered on total abstinence. Following research on the efficacy of the approach, Winhusen et. al. (2014) found that HIV education/counseling generates significant increases on clinically meaningful initiatives of safe sex and constant use of condoms (p.6).

One of the ethical concerns of this comprehensive approach is whether the treatment method is effective on reducing sexually risky behavior or mainly focuses on increase knowledge regarding sexually transmitted diseases such as HIV / AIDS. Secondly, the approach is characterized by concerns on whether its helps lessen sexual risky behavior in a manner that is clinically meaningful. The third ethical concern is that HIV education/counseling is sometimes characterized by lack of systematic medical monitoring and supervision.

Behavioral and Supportive Psychotherapy

Behavioral and supportive psychotherapy is used as one of the successful treatment program that also incorporates family treatment because of the effect of cocaine dependence on families of users of the drug. The focus of this psychotherapy approach is to help the user to stop using cocaine and prevent relapse. In some cases behavioral and supportive psychotherapy is used in combination with drug treatments. However, the use of this approach sometimes does not require the inclusion of pharmacological treatment in order to help in normalizing brain chemistry and functioning. This approach is renowned to be successful in dealing with issues of relapse and addiction prevention through eventual normalization of brain chemistry and functioning. Notably, behavioral and supportive psychotherapy is usually structured based on the needs of the specific individual in order to help him/her learn and practice alternative, safe activities that help in treatment and recovery (Morton, 1999, p.112).

The major ethical concern related to this treatment method is its effectiveness since some addicts may be unwilling to participate. This ethical concern has contributed to the need for proper pre-planning before initiating the treatment program. The other ethical concern associated with this method is practitioners' familiarity with the existing interventions and support groups, which may affect the program's effectiveness.

Conclusion

Cocaine is one of the most addictive substances in today's society because of its stimulant effect on users in relation to euphoria and high levels of energy. The increased use of cocaine leads to addiction or dependence through which users usually experience an overwhelming desire to abuse this illicit drug. However, cocaine use has significant impacts on the health and well-being of an individual, which makes cocaine dependence and addiction a major issue for the health sector. The significance of cocaine dependence or addiction issue is also evident in the impact of this issue on individuals, the society, and the health. For the individual user, cocaine dependence generates numerous psychiatric effects because of brain damage associated with it. For the individual's family and the society, cocaine dependence results in increased criminal activities and crime rates. For the health sector, cocaine dependence is a major issue because it generates significant health risks and concerns emerging from unsafe sex practices and eventually increases health care costs.

Therefore, the treatment of cocaine dependence is a major issue towards promoting the health and well-being of individuals and the society as well contributing to enhanced effectiveness of the healthcare sector by lessening health care needs and burdens. Given the significance of treatment of this issue several treatment methods have been developed and utilized in this process. The most common treatment methods for the issue include pharmacological treatment, behavioral and supportive psychotherapy, and HIV education/counseling. These treatment methods are characterized by several ethical concerns and issues relating to their effectiveness, program planning, treatment process, issues of relapse, and addiction prevention. The most suitable treatment measure for cocaine dependence is a comprehensive approach that addresses the major ethical issues and is based on the specific case.