Introduction

Cocaine is an addictive drug that can require treatment at a rehab facility. It is used to increase energy and stay awake. It is one of many herbs, foods, drinks, and drugs that have been used and abused to increase “get up and go.” Cocaine is one of the oldest of these substances.

While the thought of cocaine may bring about images of parties or crack houses, it has actually been used as a stimulant drug for thousands of years. This article will briefly review the history of cocaine, its modern-day use and abuse, misconceptions, and treatment options for addiction.

The Rise of Cocaine Abuse

Until cocaine was banned by the federal government, people freely consumed it in the form of elixirs and tonics. In the early 1900s, people began snorting it, leading to an increase in cases of nasal damage reported by hospitals and in medical journals. After it was made illegal, it dropped in popularity as a recreational drug as the same stimulant effects became available in the 1930s through legal, pharmaceutical amphetamines.

Cocaine Use in the 1970s

Cocaine surged in popularity once again in the 1970s after legislation significantly restricted the availability of amphetamines. It was especially popular among wealthy business people, celebrities, and college students who were attracted by the ability of the drug to increase energy.  It was expensive and was viewed as a “rich man’s drug,” but the street price dropped as it surged in popularity and production.

The Arrival Of Crack

In the 1980s, drug dealers who were looking for more ways to make money began pushing crack cocaine. Crack, given this nickname by the crackling sound it made during processing, was formulated in a way that allowed it to be smoked, giving a shorter, more intense high. This process also made it more addictive. Drugs processed through this method were cheaper to produce and sell. The result was a sharp increase in the use of cocaine, with the number of regular users jumping from 4.2 million to 5.8 million between 1985 and 1989. By the early 1990s, Colombian drug cartels were shipping 500 to 800 tons per year to the United States, Europe, and Asia.

The Effect of the War on Drugs

While the “War on Drugs” of the 1980s and 1990s helped to disband the large cartels, many smaller organizations popped up to replace them. These smaller cartels are still operating in Colombia, the primary source of cocaine production today.

Use of the drug in the United States decreased during the 2000s, reaching a low point in 2012. Between 2012 and 2017, smuggling and new users in the United States rose once again, with 1.6 million new cocaine users reported in 2016 and about 1,100 metric tons exported from Colombia to the United States in 2017.

Street Names

There are many slang terms for cocaine. A few common street names include:

Common street names for crack include:

Current Use and Abuse

In 2018, use in the United States was estimated at about 5.5 million people age 12 and over, including 757,000 people who used crack. The following chart shows the percent of the general population age 12 and older who used cocaine from 2012 to 2018. The chart also shows the percent of users separated by age.

As shown in the chart, overall use shows a slight increase from 2012 to 2017. The rate of use by people age 18 to 25 shows the most significant increase, while use by people age 12 to 17 shows a slight decrease.

How is Cocaine Abused?

People use cocaine by snorting it up the nose, rubbing it on the gums, or smoking crack. Some people mix it with heroin and inject the mixture, which is called a “speedball.” 

Cocaine works by increasing levels of dopamine in the brain, which causes the stimulating effect. Once it has attached to the neuroreceptors that are used by dopamine, the substance also prevents dopamine from being reused and recycled as it normally is, causing the user to take larger and larger doses of cocaine for the same effect. The effects can last anywhere from 10 to 30 minutes, depending on the method of ingestion.

Health Risks

As a stimulant drug, cocaine affects the body by elevating the speed and sensitivity of the body’s systems. Immediately after taking it, a person might experience the following health effects:

People who use it for a long time can experience more serious health effects. Some of these effects are dependent on the method people use to take cocaine, as follows:

Snorting

Nosebleeds, frequent runny nose, loss of smell, difficulty swallowing

Oral Intake

Bowel irritation and decay due to restricted blood flow

Smoking

Coughing, risk of pneumonia and other respiratory infection, asthma, respiratory distress

Injection

Scarred or collapsed veins, skin and soft tissue infections, higher risk of contracting HIV or hepatitis C

It is possible to overdose on cocaine. An overdose may occur from taking too much by itself, or by combining it with alcohol or heroin.

Symptoms of cocaine overdose include:

People who have overdosed should receive immediate medical attention, especially if cocaine has been combined with another drug.

Withdrawal Symptoms

When a person begins to require more cocaine more often to achieve a high, they begin to experience symptoms of withdrawal when they do not get regular doses. These symptoms can lead to the person taking more, larger doses to avoid withdrawal symptoms. These symptoms include:

Fatigue

Slowed Thinking

Depression

Increased Appetite

Insomnia

Nightmares

Treatment

Detox

People who are addicted to cocaine may need to go through a detoxification process when beginning treatment. While cocaine does not stay in the body for a long time, people who have used it repeatedly for months or years may need medical management of the withdrawal symptoms and health effects. If a person has habitually combined it with alcohol or heroin, they will need inpatient medical management of withdrawal from the other substances as well as cocaine.

Medication

Currently, there are no medications approved for the management of cocaine addiction. Researchers are currently conducting studies on medications used to treat addiction for other substances and how those medications affect addiction. 

The drug that currently shows the most promise is disulfiram, which is used to treat alcoholism. Researchers are also investigating a vaccine that causes the immune system to bind to cocaine, preventing it from getting to the brain. This vaccine may help reduce the risk of relapse after treatment for addiction.

Therapy and Support

Once symptoms of cocaine withdrawal are managed, other forms of treatment may begin. These include:

Cognitive Behavioral Therapy

This form of one-to-one counseling helps a person recognize abnormal thought patterns associated with cocaine use and teaches the person strategies to help change those thought patterns.

Marital and Family Counseling

Counseling that includes a person’s spouse and/or family members to help heal relationships and address family issues affected by cocaine use.

Therapeutic Communities

Drug-free residences that help people learn to change drug-related behaviors. A person may stay in a therapeutic community for 6 to 12 months and may receive other support services as a part of the stay, including vocational rehabilitation, legal assistance, and mental health services.

Community-Based Groups

12-step programs such as Cocaine Anonymous can help people to maintain the progress they have made during drug rehabilitation. These programs reduce the chances of relapse by providing peer support and community resources for those who participate.

Telephone Counseling

Recent research has shown that people who participated in telephone counseling after completing inpatient rehabilitation were less likely to relapse than people who did not. Telephone counseling is more effective when combined with a voucher incentive system to encourage compliance.¹³

Resources

https://www.drugfreeworld.org/drugfacts/cocaine/a-short-history.html

https://www.history.com/topics/crime/history-of-cocaine

https://methoide.fcm.arizona.edu/infocenter/index.cfm?stid=168

https://www.dea.gov/sites/default/files/2018-11/DIR-032-18%202018%20NDTA%20final%20low%20resolution.pdf

https://www.samhsa.gov/data/

https://www.drugabuse.gov/publications/drugfacts/cocaine