Cocaine Use Disorder

What is cocaine use disorder?

Like other stimulant use disorders, cocaine use disorder is where an individual is addicted to cocaine. It occurs when someone continues to take cocaine - a highly addictive drug - despite the noticeable harm it is causing and the adverse effects they experience. They will experience withdrawal symptoms if they stop taking it.

Side effects of cocaine use disorder can occur immediately after taking it and after long-term use. As with other drug use disorders, there are risks you expose yourself to depending on how you take the drug, such as contracting an infection through needles.

Immediate side effects can include: ^[2]

• Hypersensitivity to light and sound
• Paranoia
• High irritability

Long-term use can lead to: ^[2]

• Irregular heartbeat
• Weakened immune system
• Future development of movement disorders such as Parkinson’s

There are many options for treatment. These include: ^[3]

• Cognitive Behavioral Therapy (CBT)
• Motivational Therapy

Types of cocaine use disorder

People with cocaine use disorder can experience different symptoms depending on how they take the illegal drug. ^[2]

• Snorting cocaine can cause loss of smell, nosebleeds, and decaying of your septum.
• Smoking can lead to lung infections such as pneumonia, as well as difficulty breathing.
• Consuming cocaine by mouth can restrict blood flow to the bowel and cause it to decay.
• Injecting cocaine with needles risks exposing yourself to infections such as HIV and hepatitis, as well as scarring and collapsed veins.

Symptoms of cocaine use disorder

Cocaine works by increasing the build-up of dopamine in your brain. However, this can have some severe long-term effects that can be behavioral, physical, and psychological.

Behavioral

• Behavior similar to schizophrenia include unusual aggression, severe paranoia, and confusion ^[4].
• You may have trouble maintaining relationships due to your dependence on cocaine and any other symptoms you face.
• Severe cocaine addiction has been linked to suicidal thoughts ^[4].

Physical

• Continued cocaine use can have a severe effect on the health of your heart. Your heart rate and blood pressure may become irregular, which increases your risk of strokes and heart attacks ^[5].
• As mentioned before, some physical symptoms depend on how cocaine is taken. For example, snorting cocaine can cause loss of smell and nose bleeds, while injecting it carries other risks, such as infections that are transmitted through blood, like HIV.
• Using cocaine can lead to a decreased appetite which may cause severe weight loss over time.

Psychological

• Hallucinations after taking cocaine for an extended period are common. These hallucinations can cause the feeling that something is crawling under your skin, nicknamed ‘coke bugs.’ ^[6]
• Cocaine withdrawal symptoms make it difficult to stop taking cocaine. They occur because your body adapts to the amount of dopamine it produces when you take cocaine. People, therefore, take more cocaine more frequently to get the same effects. Symptoms of cocaine withdrawal include depression, fatigue and insomnia, making quitting the drug challenging mentally. ^[2]

Diagnosing cocaine use disorder

Diagnosis for cocaine use disorder is based on the DSM-5 criteria for ‘stimulant use disorders.’ Diagnoses can be mild (2-3), moderate (4-6), or severe (more than 6), depending on how many of the following symptoms you have experienced. ^[1]

• Needing to take an increased dose each time
• Not being able to stop taking cocaine even if you try to
• Spending lots of your time getting, using, and recovering
• If using cocaine disrupts daily commitments like going to work
• Intense cravings to use cocaine
• Using cocaine despite it causing relationship issues
• Taking cocaine, even if it has caused a severe health problem like a heart attack
• Taking cocaine despite having a pre-existing mental or physical disorder that will be negatively affected
• Giving up activities that you would usually enjoy doing
• Experiencing withdrawal symptoms

As well as your doctor asking you about what symptoms of the DSM-5 criteria you have experienced, they may also ask if there is any family history of addiction. They can also run blood tests to determine how much cocaine you take accurately.

Causes of cocaine use disorder

Cocaine use disorder is caused because of changes in dopamine levels in the brain over time. Dopamine is a neurotransmitter in the brain, and after repeated cocaine use, changes in the number of dopamine receptors result in tolerance. This process means that you will need more and more cocaine to get the same effect. When you take cocaine, dopamine builds up in the synapse. This increased amount of dopamine is what causes the feelings referred to as the ‘high.’ ^[7]

After repeated cocaine use, the more tolerant you become. It is this cycle that causes addiction.

It is thought that people aged between 24 and 26 are most at risk of developing cocaine use disorder if they start taking it. ^[8]

Treatment and prevention of cocaine use disorder

Currently, there are no FDA-approved medications for cocaine use disorder. The most effective treatments for cocaine addiction have been found to be therapeutic methods.

• Talking therapies such as cognitive behavioral therapy can help you understand your addiction to cocaine and how to best manage the symptoms you are facing. CBT can take place as a group therapy session too so that you can talk to others facing similar situations as yourself. ^[9]
• Incentive therapies can be helpful ^[9]. This type of therapy works by rewarding you with vouchers, for example for staying off cocaine and continuing with any other treatments such as CBT.
• Therapeutic communities are places where you live with other people recovering from addictions. You will have no access to cocaine and can support each other through withdrawal symptoms. ^[2]
• 12-step programs work by examining past errors you have made leading up to your addiction and trying to make amends for them. These programs help people establish new routines and behavior post-addiction and recovered people help others struggling with addiction. ^[10]

Helping someone with cocaine use disorder

When helping a friend or loved one with cocaine use disorder, it is important to be considerate of what you say and supportive through all stages of recovery.

• Do make it clear that you will be there through the whole process, including any potential relapses.
• Do give them time to accept treatment themselves as cocaine use disorder is an addiction they will need to be willing to give up.
• Do seek help for yourself if confronting them is too difficult at first. Community Reinforcement and Family Training (CRAFT) has proven useful in helping to prepare a plan to confront their addicted loved one, as well as dealing with stress and anxiety. ^[11]
• Don’t be confrontational or blame them for what they are going through. Addiction should be treated like any other disease, and stigmatizing them will not help them realize they need help.
• Don’t blame yourself for their addiction or if they do not want to seek help.