Carbonell Institute

Cocaine

Cocaine is a powerful brain-stimulating drug. People who use it can develop a severe addiction. They may need to use increasingly larger amounts of the drug to get the same high. It is sold on the streets as a fine, white powder. There are two forms of cocaine: hydrochloride salt and cocaine crystals (crack). The salt dissolves in water. People can inject it into a vein or snort it. The crystals can be smoked. The form of cocaine that is smoked is known as crack. Regardless of how it is used, cocaine is dangerous. Some of the most common and serious problems include: heart problems, including heart attacks; respiratory effects, including respiratory failure; nervous system problems, including stroke; and digestive problems. Any of these can be fatal. Using cocaine in combination with alcohol is a common cause of drug-related death.

How does cocaine affect the brain?

Cocaine is a powerful stimulant of the central nervous system. It increases the concentration of the neurotransmitter dopamine in the brain circuits that regulate pleasure and movement.


Normally, dopamine is released in these circuits by neurons in response to potential reward (for example, the delicious smell of food) and is then recycled back to the cell that released it, thus turning off the signals between neurons. Cocaine works by preventing dopamine from being recycled, causing excessive amounts of the neurotransmitter to accumulate in the synapse, which is the point of communication between neurons. This amplifies the dopamine signal and ultimately disrupts normal brain communication. It is this surge of dopamine that causes the characteristic euphoria of cocaine.


When used repeatedly, cocaine can induce long-term changes in the brain's reward system, as well as other brain systems, which can lead to addiction. Repeated use often also creates tolerance to cocaine. Many cocaine users report that they try unsuccessfully to get the same pleasure from the drug as they felt the first time they used it. Some users increase the dose to try to intensify and prolong the euphoric effects, but this can also increase the risk of harmful psychological or physiological effects. What other adverse health effects does cocaine have?


Cocaine use has a variety of effects on the body. It constricts blood vessels, dilates pupils, and increases body temperature, heart rate, and blood pressure. It can also cause headaches and gastrointestinal complications such as abdominal pain and nausea. Because cocaine tends to decrease appetite, many regular users may also suffer from malnutrition.


Among the most serious effects, people who use cocaine can suffer heart attacks or strokes, which can result in sudden death. Cocaine-related deaths often result from the heart stopping (cardiac arrest) followed by respiratory arrest.


Some effects of cocaine depend on the method of consumption. For example, regular snorting of cocaine can lead to loss of smell, nosebleeds, difficulty swallowing, hoarseness, and chronic runny nose. Snorting cocaine can cause severe intestinal gangrene due to reduced blood flow. Injecting cocaine can cause severe allergic reactions and an increased risk of contracting HIV, hepatitis C, and other bloodborne diseases.


Episodes of repeated drug use, often described as "binging," can lead to irritability, restlessness, and anxiety. Cocaine users may also experience intense feelings of paranoia, a temporary period of full-blown paranoid psychosis, during which the user loses touch with reality and suffers auditory hallucinations.

Cocaine withdrawal

Cocaine withdrawal occurs when a person who uses a lot of cocaine reduces or stops using this drug.
Causes: Cocaine produces a feeling of extreme euphoria by causing the brain to release higher than normal amounts of certain biochemicals. However, the effects of cocaine on other parts of the body can be very serious and even fatal. When cocaine use is stopped or its effects wear off, a crash occurs almost immediately, accompanied by an intense craving for more cocaine. Additional symptoms include fatigue, lack of pleasure, anxiety, irritability, drowsiness, and sometimes extreme agitation or paranoia. Cocaine withdrawal usually does not exhibit visible physical symptoms such as vomiting and tremors that often accompany heroin or alcohol withdrawal. In the past, people underestimated how addictive cocaine can be. However, this drug is addictive when addiction is defined as a desire for more of the drug, despite negative consequences. The level of intense craving, irritability, delayed depression, and other symptoms produced by cocaine withdrawal equals or exceeds what is felt with other withdrawal syndromes.
Symptoms: Primary symptoms include: Agitation and restlessness, discouragement, fatigue, general malaise, increased appetite, excessively vivid and unpleasant dreams, and decreased activity. Intense cravings and depression can last for months after stopping heavy (especially daily) use over a prolonged period. In some people, withdrawal symptoms may also be associated with suicidal thoughts. During withdrawal, powerful and intense cravings for cocaine may occur. However, the "high" associated with progressive use becomes less and less pleasurable and may lead to an experience of fear and paranoia rather than enjoyment. Likewise, the cravings may remain intense.
Possible complications: Depression, intense craving and overdose, suicide. Because many users will abuse more than one drug, it is necessary to rule out other withdrawal syndromes, such as alcohol withdrawal.

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