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Cocaine Use Disorder by Krisha McCoy, MS

Definition

Cocaine use disorder is when the use of cocaine harms a person’s health or social functioning, or when a person becomes dependent on cocaine. The powdered form of cocaine can be snorted or dissolved in water and injected. Crack is cocaine in a rock crystal form. It can be heated so its vapors can be smoked.

Cocaine use disorder is treatable. But, it takes hard work. Talk to your doctor if you think you have this condition.

Causes

Cocaine stimulates the brain to release large amounts of the hormone dopamine. Dopamine results in the euphoria commonly reported by cocaine abusers. As a person continues to use cocaine, a tolerance is developed. This means that higher doses and more frequent use are needed to maintain the euphoria.

Release of Dopamine in the Brain

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

Risk Factors

Factors that increase your chances of getting cocaine use disorder include:

Age: 18-25
Sex: males

Symptoms

Symptoms associated with cocaine use disorder include:

Short-term effects include:
- Euphoria
- Increase in energy
- Excessive talking
- Being mentally alert
- Decreased need for food and sleep
- Dilated pupils
- Increased temperature
- Increased heart rate
- Increased blood pressure
- Bizarre, erratic, or violent behavior
- Vertigo
- Muscle twitches
- Paranoia
- Restlessness, irritability, and anxiety
- Heart attack
- Seizures
- Sudden death
Long-term effects include:
- Cravings that can't be controlled or predicted
- Increased tolerance
- Increased dosing
- Use of cocaine in a binge
- Increased irritability, restlessness, and paranoia
- Paranoid psychosis
- Hearing sounds that aren't there
Medical complications include:
- Heart rhythm abnormalities
- Heart attack
- Chest pain
- Respiratory failure
- Stroke
- Seizure
- Headache
- Abdominal pain
- Nausea

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will ask specific questions about your cocaine use, including how long you have been using the drug and how often.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment programs may be inpatient or outpatient and may:

Require that you have already stopped using cocaine
Involve a detoxification program

Medications

There are currently no medicines to specifically treat cocaine use disorder. Treatment with medicine focuses on the symptoms of euphoria and craving. Medicines that have shown some promise include:

Modafinil
N-acetylcysteine
Topiramate
Disulfiram
Agonist replacement therapy
Baclofen
Antidepressants—may be helpful for people in the early stages of stopping cocaine use

Behavioral Therapy

Behavioral therapies to help people quit using cocaine are often the only available, effective treatment for cocaine use disorder. Therapies include contingency management. With this program, people receive positive rewards for staying in treatment and remaining cocaine-free. Also, cognitive behavioral therapy helps people to learn how to abstain and remain abstinent from cocaine.

Rehabilitation Programs

In rehab programs, people with cocaine use disorder stay in a controlled environment for 6-12 months. During this time, they may receive vocational rehab and other support to prepare them to return to society.

Prevention

The best way to prevent cocaine use disorder is to never use cocaine. It is highly addictive.

RESOURCES:

Cocaine Anonymous http://www.ca.org
National Institute on Drug Abuse http://www.nida.nih.gov

CANADIAN RESOURCES:

Cocaine Anonymous of Southern Ontario http://www.ca-on.org
Native Alcohol and Drug Abuse Counseling Association of Nova Scotia http://nadaca.ca

References:

Amato L, et al. Dopamine agonists for the treatment of cocaine dependence. Cochrane Database Syst Rev . 2011; Dec 7;(12):CD003352..
Carson-DeWitt R, ed. Encyclopedia of Drugs, Alcohol, and Addictive Behavior . 2nd ed. New York, NY: MacMillan Reference Books; 2000.
Cocaine abuse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated February 15, 2013. Accessed February 20, 2013.
Degenhardt L, Hall W. Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet . 2012;379:55-70
Karila L, Reynaud M. Therapeutic approaches to cocaine addiction. [article in French] Rev Prat. 2009;59(6):830-834.
NIDA InfoFacts: crack and cocaine. National Institute on Drug Abuse website. Available at: http://www.nida.nih.gov/Infofacts/cocaine.html . Updated March 2010. Accessed February 20, 2013.
Research report series: cocaine abuse and addiction. National Institute on Drug Abuse website. Available at: http://www.drugabuse.gov/ResearchReports/Cocaine/Cocaine.html . Updated September 2010. Accessed February 20, 2013.

Last reviewed March 2013 by Rimas Lukas, MD

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.