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Cocaine is a powerful euphoriant that is legally used as a local anesthetic. Due to the extreme abuse potential, cocaine is considered one of the most addictive drugs in the world. It stimulates the nervous system, causing the irreversible changes in the human brain. The negative consequences of cocaine addiction on the physical level differ depending on the quality of drug and the way of its intake. To be aware of the possible complications caused by cocaine abuse, one should know the existing types of cocaine, the ways of its intake, its effects on the human body, and the treatment options offered by the contemporary medicine and psychology.
Cocaine is an intense stimulant of the central nervous system that causes significant addiction (Stout-Demps & Williams, 2012). It is probably one of the oldest psychoactive substances familiar to the world. Cocaine comes from the leaves of the coca plant, Erythroxylon coca (Goldberg, 2013). Goldberg (2013) mentions that chewing the leaves of this plant used to help the natives of the Andes Mountains to relieve fatigue and enhance well-being, and was used for the spiritual purpose. In the 1900s, purified cocaine hydrochloride became the primary active ingredient of the elixirs and tonics used in the treatment of a variety of illnesses (National Institute on Drug Abuse, 2010).
According to National Institute on Drug Abuse (2010), the use of cocaine has grown in popularity between the 1980s and 1990s. The large coca crop in Colombia makes this country the largest producer of cocaine in the world (Goldberg, 2013). The position of cocaine in the Schedule II today means that regardless of its potential for abuse, it is suitable for legitimate medical uses, namely local anesthesia particularly for ear, eye, and throat surgeries (National Institute on Drug Abuse, 2010).
Cocaine has many street names, including blow, bump, C, candy, Charlie, coke, flake, rock, snow, and toot (Stout-Demps & Williams, 2012).
Cocaine Hydrochloride. It is the purest form of cocaine, which looks like salt with chunk-like texture and its color ranges from off-white to pink (Chastain, 2012). Due to its stability and water-solubility, cocaine hydrochloride can be taken through drinking, injecting, and snorting. To charge more money for less pure cocaine, drug dealers often dilute it with “adulterates” such as baking soda (Chastain, 2012). However, it leads to the users’ exposure to a range of dangers in the process of consumption, namely nosebleeds, perforated nasal septums, irrational behavior, violence, the risk of heart attack, or even sudden death (Chastain, 2012).
Cocaine Sulfate. This form of cocaine, which is often called pasta, basuco, basa, patillo, or paste, is the drug of the lowest grade (Chastain, 2012). According to Chastain (2012), this drug is in a state between raw coca leaves and completed cocaine hydrochloride crystal. In order to make it, one should put coca leaves into a plastic pit with a water solution and dilute sulfuric acid (Chastain, 2012). After that, one should mash this mixture and lay it out to dry to get a paste-like substance. Chastain (2012) states that the majority of cocaine sulfate users include the urban poor of many South American cities. They combine this paste with marijuana or tobacco and smoke it in the form of a cigarette (Chastain, 2012).
Free-Base Cocaine. It is a highly addictive and quite dangerous to make this kind of cocaine. The procedure of making free-base cocaine includes using of ether, an extremely flammable substance (Chastain, 2012). Chastain (2012) mentions that this kind of cocaine is insoluble in water, which makes it not suitable for injecting or swallowing. However, the ability of free-base cocaine to vaporize at a low temperature makes it possible to inhale this drug (Chastain, 2012). According to Chastain (2012), the rush from inhalation comes more quickly than from injection and is more intense, lasting around five minutes.
Crack Cocaine. The inconvenience and danger of using ether resulted in the emergence of crack cocaine as a more popular way to inhale this drug. To make crack cocaine, one does not have to remove pure cocaine from the base mixture. It is enough to take the impure cocaine “rock” and heat it, inhaling the evaporating fumes (Chastain, 2012). Since the mixture consists of water and a base like baking soda, the rock tends to crackle when heated, which is why it is called “crack” (Chastain, 2012). According to Chastain (2012), the ways to take crack include smoking, heating it in a pipe or on a piece of tin foil, or mixing it with tobacco or marijuana in a joint. The euphoric rush from it usually lasts no longer than thirty minutes.
Cocaine is an alkaloid and belongs to a group of plant substances that combines nicotine, morphine, and caffeine (“Chemistry,” n.d.). Its chemical name is benzoyl-methyl-ecgonine. Cocaine’s chemical components can be divided into three parts: a hydrophilic group, a lipophilic group, and an aliphatic group, which combines the previous two groups (“Chemistry,” n.d.). As mentioned before, both free-base and crack cocaine represent the same chemical forms of this drug, which differ only in the way they are produced.
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The most common ways to take cocaine include insufflations (nasal), absorption (oral), injection, and pulmonary (Brick & Erickson, 2013). The mode of intake is directly related to its potential to cause addiction. The quicker one gets high, the more likely it is that the addiction will occur. Goldberg (2013) states that injected cocaine reaches the brain faster than other forms of the drug, causing a rapid and intense euphoria. However, most recreational or experimental users start from snorting cocaine (Goldberg, 2013). In this way, one can become high in 10 to 15 minutes from the time of intake.
Insufflation (Nasal). This way of cocaine administration is more familiar as “snorting”. During insufflation, one uses a straw or a rolled dollar bill, placing one end of it into the nostril while the other moves along a prepared “line” of the drug (Brick & Erickson, 2013). According to Brick and Erickson (2013), the user closes off the opposite nostril and inhales the drug quickly and deeply, drawing the powder up the tube and into the posterior portion of the nasal septum. It takes about three minutes for the drug to absorb through the nasal epithelium into the blood circulation and then the brain.
Absorption (Oral). Oral administration of cocaine manifests itself in chewing the leaves of Erythroxylon coca. This process results in the extraction of small amounts of cocaine into the saliva and their absorption into the blood circulation from the membranes in the mouth (Brick & Erickson, 2013). This way of taking cocaine is popular in the countries where the leaves of the plant are more accessible, such as Peru, Bolivia, and Colombia (National Institute on Drug Abuse, 2010).
Injection. The water-solubility of cocaine hydrochloride makes it possible to mix this drug with water or some other liquid and to inject it through a needle with a syringe. According to Brick and Erickson (2013), the most effective and common type of injection is intravenous, when the drug reaches the brain in about fifteen seconds, and soon afterwards the “rush” begins.
Pulmonary. Since crack cocaine is hard, the most common way to take it is smoking. During this process, crack cocaine is absorbed immediately into the blood through the lungs (Brick & Erickson, 2013). The rush from smoking is very rapid since the drug reaches the brain in about five seconds.
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Initially, the cocaine users feel a “rush” through their body and brain, which manifests itself in the form of euphoria. Such intense pleasure that overwhelms the user’s brain and senses from the early beginning makes this substance highly addictive. The duration of the rush from a few minutes to an hour depends on the method of cocaine intake and its purity. After the feeling of intense pleasure, the user experiences a “comedown” of sensations, which leads to a depressed state of the body and mind (“Cocaine effects,” n.d.). While the initial stage of cocaine intake serves as a “hook” for users, the deficiency of pleasure makes them look for greater pleasure so that they become addicted to cocaine.
Being under the influence of cocaine, most people experience the feelings of comfort, well-being, extreme energy, and extraordinary sense of being invincible and confident (“Cocaine effects,” n.d.). However, these benefits are not real but caused by cocaine. Thus, to maintain their highs, cocaine users frequently “binge” on cocaine by ingesting, inhaling, or injecting it several times in rapid succession (Stout-Demps & Williams, 2012).
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The effect of cocaine spreads over every organ in the human body system. Its cardiovascular impact includes constriction of blood vessels, elevation of blood pressure, and an increase in the heart rate (Stout-Demps & Williams, 2012). According to Stout-Demps and Williams (2012), in two weeks after cocaine use some patients with and without any symptoms of cardiac disease experienced acute myocardial infractions.
Cocaine is the most common stimulant that causes seizures. Its extreme neurotoxicity also takes forms of subarachnoid hemorrhage, cerebral infarction, vasculitis, transient ischemic attacks, and toxic delirium (Stout-Demps & Williams, 2012). In addition, the use of cocaine leads to various psychiatric and mood disorders, such as anxiety, irritability, restlessness, paranoia, and auditory hallucinations (Stout-Demps & Williams, 2012). Stout-Demps and Williams (2012) also indicate other symptoms caused by cocaine administration, namely dilated pupils, increased body temperature, abdominal pain and nausea, poor appetite and malnourishment when used regularly. What is more, cocaine readily crosses the placenta and excretes in breast milk for up to 36 hours after its use (Stout-Demps & Williams, 2012).
Cocaine addiction can lead to a myriad of negative consequences. The physical effects of cocaine depend on the way the drug enters the body. Cocaine snorting results in irritation of the nasal membranes, hoarseness, sore throat, and inflamed sinuses (Goldberg, 2013). Due to the anesthetic features of cocaine, the nasal passages, throat, and palate become numb from frequent snorting. Moreover, the consequences of cocaine snorting include sneezing, congestion, burns, sores, and upper respiratory infections including pulmonary congestion, bronchitis, and pneumonia (Goldberg, 2013). According to Goldberg (2013), in a number of cases, the regular snorting of cocaine resulted in septal necrosis, in which the cartilage separating the two nostrils was destroyed.
When the effect of cocaine wears off, the users’ blood pressure and respiration descend below normal levels, accelerating withdrawal symptoms and a strong desire to take more cocaine (Goldberg, 2013). Goldberg (2013) states that free-base cocaine abuse can lead to significant lung damage such as acute bronchoconstriction. Crack smokers often suffer from chest pain, rapid heart rate, irregular heart contractions, circulatory failure, and many other complications. Cocaine injections are associated with additional risks, namely AIDS, hepatitis C, and inflammation of the heart lining (Goldberg, 2013). Finally, cocaine abuse may lead to the death of the drug addict.
The increasing amount of cocaine addicts encourages the rapid development of treatment programs for this kind of abuse. Since this disease comprises of a complex of biological, familial, social, and environmental changes, its treatment should be complex and include all these factors of a person’s drug abuse. Moreover, patients with co-occurring mental disorders demand additional pharmacological and behavioral assistance.
Today, there exist no specially approved medications for the treatment of cocaine addiction. However, some medicines for other diseases, namely modafinil, vigabatrin, disulfiram, tiagabine, and topiramate, are used to reduce cocaine intake during the controlled clinical trials (National Institute on Drug Abuse, 2010). According to National Institute on Drug Abuse (2010), the most efficient results in cocaine abuse reduction were achieved by using disulfiram, a medication used in the treatment of alcoholism. At the same time, the observation of brain changes caused by cocaine encourages the development of the new ways of drug addiction treatment. For instance, the primary achievements in this field include medications that act at dopamine D3 receptors and a vaccine that averts cocaine entry into the brain (National Institute on Drug Abuse, 2010). Since these innovations are still at the stage of testing, the new medical means to respond to the emergencies caused by cocaine overdose continue to be found every year.
In many cases, behavioral therapies seem to be the only effective treatment option in many cases of drug addiction. Thus, the positive results in cocaine-addicted people emerge after receiving contingency management or motivational incentives (MI) therapy. This is a prize-based program that rewards patients who abstain from cocaine by providing them with means for healthy living based on their drug-free urine test (National Institute on Drug Abuse, 2010). Another effective way to prevent relapse lies in undergoing cognitive-behavioral therapy, which assumes that learning processes can be helpful in reducing drug abuse. Other alternatives that can be used by people suffering from cocaine addiction include therapeutic communities and community-based recovery groups, such as Cocaine Anonymous.
To summarize, cocaine addiction is one of the most significant problems in the modern world. The variety of its types and the enormous euphoric effect have made this drug popular in many countries. After a person starts using cocaine, he/she can hardly stop taking it and constantly strives to heighten the pleasure, which makes this drug extremely addictive. In spite of the common negative effects of cocaine, the further complications of this addiction depend on the mode of the drug’s intake. Taking into account the variety of negative physical, psychological, familial and public consequences of cocaine abuse it is hard to find a common solution to this problem. Since there are still no medications that can be used to directly treat cocaine addiction, some medical means can be rather helpful for reducing the risk of relapse. However, the most productive way of treating cocaine dependence is a combination of both pharmacological and behavioral therapies. Thus, to get rid of this addiction, one should be ready to face an extreme psychological challenge and find the way to overcome it.