Cocaine Addiction And Mental Health Problems

Profile image placeholder
Pending Medical Review Last updated:
This content from MentalHelp.net will be updated by March 31, 2025. Learn more

What is a Dual Diagnosis?

To have a dual diagnosis means that a person has been evaluated by a professional, and determined be suffering from both a substance use disorder and some other mental health condition.  Struggling with two disorders at the same time can be complicated, often leading to:

  • More extreme symptoms.
  • Difficulty sticking to a treatment or medicine schedule.
  • Poor social adjustment.
  • Impaired decision making.
  • Dysfunctional thought processes.

Cocaine abuse can have a profound effect on a person’s mental health. Mental illness and cocaine addiction frequently co-occur, and this dual diagnosis can influence treatment engagement and outcomes—especially if not recognized and treated accordingly.

It is vital that a person struggling with cocaine abuse and other mental health issues seek professional help as soon as possible.


Cocaine Addiction and the Brain

Cocaine’s effects on the brain are a direct result of its action within the brain. Cocaine works by affecting a brain communication chemical called dopamine, which is involved with neural processes that control movement, pleasure and reward.

With long-standing exposure to cocaine – as may occur in cases of abuse and addiction – brain damage can extend beyond the reward pathways and into the areas of the brain responsible for processing emotions, memory, and new information.

Many mental illnesses involve imbalances in the brain’s dopamine system—particularly depression and schizophrenia. When cocaine abuse messes with this important dopamine system, it can impact the course of an individual’s mental disorder by potentially causing it or making it worse.

The point is, when a person abuses cocaine, they may begin to alter the communication between brain cells that use dopamine, and influence their own reward system pathways.

Emotional Blunting

Cocaine addiction can lead to reduced brain activity in regions related to emotional processing and error awareness. People addicted to cocaine also show problems in social interactions, placing value on their own gains when interacting with other people and less concern about how their behaviors affect both themselves and those around them.

Cocaine-dependent people have exhibited blunted emotions and egocentrism, and their risk of having an anti-social personality disorder is 22 times that of non-users.

This impaired emotional/social processing and reduced error recognition can be thought of as a problem with self-awareness, and it is present in a number of other psychological disorders.

Adequate social skills can have a major impact on the development and outcome of mental disorders as well as stimulant use disorders, so this cocaine-induced impairment presents a particular challenge to this type of dual diagnosis treatment.


Cocaine and ADHD

Attention deficit hyperactivity disorder (ADHD) is a mental disorder characterized by difficulty staying focused, behavioral control problems and hyperactivity.

  • Adults who have untreated ADHD may be at increased risk for substance abuse, and rates of ADHD diagnoses are higher in substance abusers than the general population. A diagnosis of ADHD is particularly associated with a higher risk of cocaine use disorder.

Dopamine deficiency is believed to be involved in the development of ADHD. This means that both ADHD and cocaine addiction may involve the brain’s real or perceived deficit of dopamine. Theoretically, the abuse of cocaine among people diagnosed with ADHD may be a form of self-medication to relieve ADHD symptoms.

A dual diagnosis of ADHD and cocaine dependence can be effectively treated with proper therapy and prescription medications. Preliminary research trials have evaluated the efficacy of oral amphetamines in the treatment of cocaine dependence.
  • Studies on extended-release formulations (where the effect of the medication is experienced over a period of time) are well-tolerated and have shown significant reductions in cocaine use.
  • In one randomized control trial, extended-release mixed amphetamine salts taken with cognitive behavioral therapy sessions was shown to be effective in treating cocaine dependence and reducing ADHD symptoms.

It is important to note that the research is still in early stages and some treatments are not FDA approved yet.


Cocaine Addiction and Depression

Lifetime prevalence rates of depression among people seeking treatment for cocaine abuse range between 25% and 61%. People who are coping with depression may even experience more intense euphoria when using cocaine as well as more intense cravings and withdrawal symptoms compared to non-depressed users when they do not use.

All of these factors may contribute to an even more severe cocaine dependency among depressed users. Furthermore, depression is known to have certain effects that may subsequently complicate recovery from cocaine addiction:

  • Decreased energy.
  • Persistent negative thoughts.
  • Impaired thinking.
  • Feelings of hopelessness.
  • Loss of interest or pleasure in hobbies.
  • Restlessness.
  • Difficulty sleeping.

Studies indicate that the antidepressant medications prescribed will work best if they possess a similar, activating effect profile as cocaine—depressed abusers should not be prescribed sedating medications, as it may exacerbate the underlying mood disorder. Desipramine and buproprion are more stimulating antidepressant medications that may work best for recovering cocaine users.

Two effective therapeutic modalities employed to treat a dual diagnosis of cocaine abuse and depression include cognitive behavioral therapy and motivational interviewing. Cognitive-behavioral therapy, or CBT, is utilized with the hopes of altering the mindset of the addicted individual, and curtailing maladaptive drug use behavior in response to stressors and other precipitating life events. Motivational interviewing uses positive incentives to promote change.

Treatment for concurrent cocaine abuse and depression must simultaneously address both issues. Studies support a combined use of antidepressant medications and therapy for this type of dual diagnosis treatment.

Cocaine-Induced Psychosis

Long-term cocaine abuse can elicit temporary psychotic symptoms such as hallucinations and paranoia. This is known as cocaine-induced psychosis, and it can be difficult to distinguish from schizophrenia.

The prevalence for cocaine-induced psychosis is difficult to determine, but studies have reported rates between 48% and 88% among cocaine abusing people.
  • Both the amount of cocaine used and earlier onset of first use are correlated with the development of cocaine-induced psychosis, though strangely the total number of years using is not related.
In these instances, these symptoms are often temporary and stop once the user maintains abstinence. Despite how distressing it may for the individual to experience such symptoms, and how serious any resultant behavior may seem to those witnessing it, treatment should
primarily focus on the user’s cocaine abuse problem rather than on the extensive treatment of the psychosis. As mentioned, such forms of effective cocaine abuse treatment can include replacement medications and therapy—specifically, cognitive-behavioral therapy.

Bipolar Disorder

Cocaine dependence among people with bipolar disorder has lifetime prevalence rates from 15% to 39%. The impact of substance use on bipolar disorder is overwhelmingly negative, with more hospitalizations, more aggression, and less adherence to medications.

  • A wide range of specific brain functions may be significantly more compromised in those with a dual diagnosis of cocaine use disorder and bipolar disorder than in bipolar disorder alone, making this particular dual diagnosis one of the strongest risk factors for poor treatment adherence among people with bipolar disorder.
In cases of comorbid cocaine abuse and bipolar disorder, some of the more commonly seen problems that may  impact treatment adherence include:
  • Poor decision-making skills.
  • Impulsivity.
  • Deficits in attention.
  • Problems planning ahead.
  • Poor cognitive functioning.

 

While medications may not be of huge help in those with cocaine addictions alone, there is promising evidence that they may benefit those struggling with a dual diagnosis. Bipolar patients must take medication in order to manage their disorder—care must be taken so that any other medication taken to manage cocaine cravings and/or withdrawal cannot react with bipolar medications.

  • Citicoline is an inexpensive, over-the-counter supplement that has shown promising results in reducing cocaine cravings. Because it has no known drug-drug interactions, it is a viable option for patients with comorbid bipolar disorder who need to take medication to manage their bipolar symptoms.

In addition to medication management, therapy continues to be an important part of dual diagnosis recovery.

  • Cognitive behavioral therapy is the main form of therapy used to treat dual diagnosis patients. It remains crucial that treatment for concurrent cocaine use disorder and bipolar disorder account for potential cognitive impairments in these patients and tailor treatment plans accordingly.

Instantly Check The Insurance Coverage

  •  We’ll instantly check the coverage offered by your insurance provider.
  •  You may receive treatment at one of our facilities at a reduced rate.
  •  Though not required, entering your policy membership ID will help expedite your verification process.

Sources

  1. http://www.drugabuse.gov/news-events/nida-notes/2008/12/long-term-cocaine-self-administration-depresses-brain-activity
  2. Tye, K. M., Mirzabekov, J. J., Warden, M. R., Ferenczi, E. A., et al. (2013). Dopamine neurons modulate neural encoding and expression of depression-related behaviour. Nature, 493. 537-541.
  3. Brisch, R., Saniotis, A., Wolf, R., Bielau, H., et al. (2014). The role of dopamine in schizophrenia from a neurobiological and evolutionary perspective: Old fashioned, but still in vogue. Frontiers in Psychiatry, 5(47). 1-11.
  4. Moeller, S. J., Konova, A. B., Parvaz, M. A., Tomasi, D., et al. (2014). Functional, structural, and emotional correlates of impaired insight in cocaine addiction. JAMA Psychiatry, 71(1). 61-70.
  5. Hulka, L. M., Eisenegger, C., Preller, K. H., Vonmoos, M., et al. (2014). Altered social and non-social decision-making in recreational and dependent cocaine users. Psychological Medicine, 44. 1015-1028.
  6. Rounsaville, B. J. (2004). Treatment of cocaine dependence and depression. Biological Psychiatry, 56. 803–809.
  7. Orfei, M. D., Robinson, R. G., Bria, P., Caltagirone, C., & Spalletta, G. (2008). Unawareness of illness in neuropsychiatric disorders: phenomenological certainty versus etiopathogenic vagueness. Neuroscientist, 14(2). 203-222.
  8. Couture, S. M., Penn, D. L., & Roberts, D. L. (2006). The functional significance of social cognition in schizophrenia: a review. Schizophrenia Bulletin, 32. 44–63.
  9. Homer, B. D., Solomon, T. M., Moeller, R. W., Mascia, A., DeRaleau, L., Halkitis, P. N. (2008). Methamphetamine abuse and impairment of social functioning: a review of the underlying neurophysiological causes and behavioral implications. Psychological Bulletin, 134. 301–310.
  10. http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml
  11. Weiss, M.D. & Weiss, J.R. (2004). A guide to the treatment of adults with ADHD. Journal of Clinical Psychiatry, 65(3). 27–37.
  12. Wilens, T.E. (2004). Impact of ADHD and its treatment on substance abuse in adults. Journal of Clinical Psychiatry, 65(3). 38–45.
  13. Levin, F.R., Evans, S.M., & Kleber, H.D. (1998). Prevalence of adult attention- deficit hyperactivity disorder among cocaine abusers seeking treatment. Drug and Alcohol Dependency, 52. 15–25.
  14. Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clinical Psychology Review, 31(3). 328-341.
  15. Faraone, S.V. & Biederman, J. (1998). Neurobiology of attention-deficit hyper- activity disorder. Biological Psychiatry, 44. 951–958.
  16. Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142. 1259–1264.
  17. Levin, F. R., Mariani, J. J., Specker, S. Mooney, M., et al. (2015). Extended-release mixed amphetamine salts vs placebo for comorbid adult attention-deficit/hyperactivity disorder and coaine use disorder: A randomized clinical trial. JAMA Psychiatry, 72(6). 593-602.
  18. Newton, T. F., Kalechstein, A. D., Tervo, K. E., & Ling, W. (2003). Irritability following abstinence from cocaine predicts euphoric effects of cocaine administration. Addictive Behaviors, 28. 817– 821.
  19. Uslaner, J., Kalechstein, A., Richter, T., Ling, W., & Newton, T. (1999). Association of depressive symptoms during abstinence with the subjective high pro- duced by cocaine. American Journal of Psychiatry, 156. 1444 –1446.
  20. Elman, I., Karlsgodt, K. H., Gastfriend, D. R., Chabris, C. F., & Breiter, H. C. (2002). Cocaine-primed craving and its relationship to depressive symptomatology in individuals with cocaine dependence. Journal of Psychopharmacology, 16. 163–167.
  21. Helmus, T. C., Downey, K. K., Wang, L. M., Rhodes, G. L., & Schuster, C. R. (2001). The relationship between self-reported cocaine withdrawal symptoms and history of depression. Addictive Behaviors, 26. 461–467.
  22. http://www.nimh.nih.gov/health/topics/men-and-mental-health/signs-and-symptoms-of-depression/index.shtml
  23. Weiss, R. D. (2003). Pharmacotherapy for co-occurring mood and substance use disorders. In: Westermeyer, J. J., Weiss, R. D., Ziedonis, D. M., Eds. Integrated Treatment for Mood and Substance Use Disorders. Baltimore, MD: Johns Hopkins University Press, 122–139.
  24. Carroll, K. M., Nich, C., Rounsaville, B. J. (1995). Differential symptom reduction in depressed cocaine abusers treated with psychotherapy and pharmacotherapy. Journal of Nervous and Mental Disease, 183. 251–259.
  25. Daley, D. C., Salloum, I. M., Zuckoff, A., Kirisci, L., Thase, M. E. (1998). Increasing treatment adherence among outpatients with depression and cocaine dependence: Results of a pilot study. American Journal of Psychiatry, 155. 1611–1613.
  26. Shaner, A., Roberts, L. J., Eckman, T. A., Racenstein, J. M., et al. (1998). Sources of diagnostic uncertainty for chronically psychotic cocaine abusers. Psychiatric Services, 49(5). 684-690.
  27. Roncero, C., Daigre, C., Gonzalvo, B, Valero, S., et al. (2013). Risk factors for cocaine-induced psychosis in cocaine-dependent patients. European Psychiatry, 28. 141-146.
  28. Reid, M. S., Ciplet, D., O’Leary, S., Branchey, M., Buydens-Branchey, L., & Angrist, B.. Sensitization to the psychosis-inducing effects of cocaine compared with measures of cocaine craving and cue reactivity. American Journal on Addictions, 13(3). 305–315.
  29. Brown, S. E., Suppes, T., Adinoff, B., et al. (2001). Drug abuse and bipolar disorder: comorbidity or misdiagnosis? Journal of Affective Disorders, 65. 105–115.
  30. Brown, E. S., Todd, J. P., Hu, L. T., Schmitz, J. M., et al. (2015). A randomized, double-blind, placebo-controlled trial of citicoline for cocaine dependence in bipolar I disorder. American Journal of Psychiatry, 172(10). 1014-1021.
  31. Levy, B. & Weiss, R. D. (2009). Cognitive functioning in bipolar and co-occurring substance use disorders: A missing piece of the puzzle. Harvard Review of Psychiatry, 17. 226–230.
  32. Sajatovic, M., Ignacio, R. V., West, J. A., Cassidy, K. A., Safavi, R., Kilbourne, A. M., et al. (2009). Predictors of non-adherence among individuals with bipolar disorder receiving treatment in a community mental health clinical. Comprehensive Psychiatry, 50. 100–107.
  33. Baldessarini, R. J., Perry, R., & Pike, J. (2008). Factors associated with treatment non- adherence among U.S. bipolar disorder patients. Human Psychopharmacology: Clinical and Experimental, 23. 95–105.
  34. Colom, F., Vieta, E., Martínez-Arán, A., Reinares, M., Benabarre, A., & Gastó, C. (2000). Clinical factors associated with treatment noncompliance in euthymic bipolar patients. Journal of Clinical Psychiatry, 61. 549–555.
  35. Fagan, C. S., Carmody, T. J., McClintock, S. M., Suris, A., et al. (2015). The effect of cognitive functioning on treatment attendance and adherence in comorbid bipolar disorder and cocaine dependence. Journal of Substance Abuse Treatment, 49. 15-20.
  36. Renshaw, P. F., Daniels, S., Lundahl, L. H., et al. (1999). Short-term treatment with citicoline (CDP-choline) attenuates some measures of craving in cocaine-dependent subjects: a preliminary report. Psychopharmacology, 142. 132–138.
About MentalHealth.com

MentalHealth.com is a health technology company guiding people towards self-understanding and connection. The platform offers reliable resources, accessible services, and nurturing communities. Its mission involves educating, supporting, and empowering people in their pursuit of well-being.

Content Disclaimer

The content on this page was originally from MentalHelp.net, a website we acquired and moved to MentalHealth.com in September 2024. This content has not yet been fully updated to meet our content standards and may be incomplete. We are committed to editing, enhancing, and medically reviewing all content by March 31, 2025. Please check back soon, and thank you for visiting MentalHealth.com. Learn more about our content standards here.