Psychoactive drugs and their effects

Physiological Effects and Treatments for Cocaine Use and Abuse

Cocaine is a powerfully addictive stimulant that directly affects the brain. Cocaine is generally sold on the street as a fine, white, crystalline powder. Cocaine can be snorted through the nose, smoked, or injected. Injecting cocaine carries the added risk of infection with HIV, the virus that causes AIDS, if the user shares a needle with a person already infected with the virus. The drug can also be rubbed onto mucous tissues.

Freebase is a form of cocaine that is smoked and is extremely dangerous. It appears that compulsive cocaine use may develop even more rapidly if the substance is smoked rather than snorted. Cocaine reaches the brain within seconds, resulting in a sudden and intense high. However, the euphoria quickly disappears, leaving the user with an enormous craving to freebase again and again. The user usually increases the dose and the frequency to satisfy this craving, resulting in addiction and physical debilitation.

Crack is the name given to one form of freebase cocaine that comes in the form of small lumps or shavings. The term crack refers to the crackling sound made when the mixture is smoked. Smoking crack is very dangerous since it produces the same debilitating effects as freebasing cocaine. Crack has become a major problem in many American cities because it is inexpensive and easily transportable, sold in small vials, folding paper, or tinfoil.

Cocaine's effects appear almost immediately after a single dose, and disappear within a few minutes or hours. Taken in small amounts, up to 100 mg, cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find that the drug helps them to perform simple physical and intellectual tasks more quickly, while others can experience the opposite effect. Users often report feelings of restlessness, irritability, and anxiety, and cocaine can trigger paranoia. Users also report being depressed when they are not using the drug and often resume use to alleviate further depression. In addition, cocaine users frequently find that they need more and more cocaine more often to generate the same level of stimulation. Thus, any use can lead to addiction 1, 2.

Once having tried cocaine, an individual may have difficulty predicting or controlling the extent to which he or she will continue to use the drug. Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness, and paranoia. This may result in a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.

Different routes of cocaine administration can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow. Persons who inject cocaine have puncture marks and tracks, most commonly in their forearms. Intravenous cocaine users may also experience an allergic reaction, either to the drug, or to some additive in street cocaine, which can result, in severe cases, in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine users lose their appetites and can experience significant weight loss and malnourishment. The human liver combines cocaine and alcohol and manufactures a third substance, cocaethylene, which intensifies cocaine's euphoric effects 3. The mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.

Many behavioral treatments have been found to be effective for cocaine addiction, including both residential and outpatient approaches. It is important to match treatment to the needs of the individual. A behavioral therapy component that is showing positive results in many cocaine-addicted populations, is contingency management. Contingency management uses a voucher-based system to give positive rewards for staying in treatment and remaining cocaine-free. Based on drug-free urine tests, the patients earn points, which can be exchanged for items that encourage healthy living, such as joining a gym, or going to a movie and dinner 4.