Cocaine Addiction

What Causes Cocaine Addiction?

Cocaine produces feelings of well-being by increasing certain brain chemicals, called neurotransmitters, that cause those good feelings. Over time and with repeated use, cocaine causes changes in brain cells that alter the way the cells respond to certain neurotransmitters. These changes result in a dependency on cocaine because the now-altered brain can’t feel well without it.

Although anyone who uses cocaine is at risk of developing a dependency on the drug, some factors increase addiction risk. These risk factors include:

• Family history. People who have close relatives who have suffered from drug addiction are more likely to develop an addiction themselves.
• Abuse of other substances. Cocaine abuse often occurs in conjunction with the abuse of other drugs or alcohol.
• Use in childhood or adolescence. The earlier in life that cocaine is first used, the more likely the user will develop an addiction.
• Mental illness. Drugs are often used as a coping tool by people with depression, anxiety, post-traumatic stress disorder (PTSD), and other mental illnesses.

Is Cocaine Addiction Hereditary?

Environmental factors such as stress and peer pressure are likely why most people try cocaine for the first time. Although having a family member who uses cocaine may be one of those environmental factors, there is little firm evidence that an inherited component will make someone use the drug initially. However, there is evidence of an inherited increase in addiction risk once an individual begins using cocaine.

Studies have found that the risk of addiction is more significant when an individual has a family history of addiction. Also, studies of identical twins have suggested that the increased risk has a genetic component. The genetic component is true of addiction to many different substances, but cocaine is among the drugs in which the increased risk is most significant.

The same genes that cause the increased risk have not been determined, and hundreds of different gene variations could be blamed. These genes may affect how nerve cells communicate with each other in the brain or affect the brain’s response to neurotransmitter chemicals.

How is Cocaine Addiction Detected?

Cocaine users will often expend great effort to hide their drug use and dependency. Spotting the problem early and encouraging the user to get treatment is the best way to head off addiction’s worst consequences.

Warning signs that a loved one might be abusing or addicted to cocaine include:

• Nosebleeds or runny nose
• Excitability or unusual talkativeness
• Unexplained weight loss
• Irritability or moodiness
• Insomnia
• Decreased appetite
• Dilated pupils
• Withdrawal from social situations
• Secretive behavior
• Notable increase in confidence or optimism
• Financial problems
• Direct signs of drug use, such as white residue or chemical burns around the nose or mouth

How is Cocaine Addiction Diagnosed?

To determine whether or not a patient has a cocaine addiction, a doctor will look for indications that the patient is using cocaine, as well as a pattern of use that suggests dependency. Diagnostic steps can include:

• Blood and laboratory tests. These tests will look for indications that the patient is using cocaine. They will also look for conditions caused by cocaine use, such as high blood pressure, increased heart rate, and chest pain.
• Medical and psychological history. The doctor will determine whether the patient has a history of substance abuse or mental illness. The doctor will also ask the patient directly about the frequency and intensity of cocaine use or the presence of withdrawal symptoms.
• Family history. The doctor will look for evidence of abuse of cocaine or other drugs among the patient’s family members.
• Imaging and other exams. The doctor may also order exams to determine if the patient has other health problems associated with long-term cocaine use.

How is Cocaine Addiction Treated?

There are currently no medications that have been approved for the treatment of cocaine addiction. Researchers are pursuing the development of drugs that may counter the changes that cocaine makes in the brain or prevent a cocaine addict from relapsing after completing treatment. Medications used to treat other conditions, such as alcoholism, have shown promise in treating cocaine addiction, too. However, it is still unclear how these drugs work concerning cocaine dependency.

Until drug-based therapies are developed, the best treatment for cocaine addiction is behavioral or group-based therapies.

• Contingency Management Therapy (CM). Also called motivational therapy, this type of therapeutic approach rewards patients for successfully abstaining from cocaine use. This approach is especially effective as an initial treatment to encourage the user to begin beating the addiction.
• Cognitive Behavioral Therapy (CBT). This type of psychotherapy focuses on recognizing problem behavior and creating strategies for dealing with problematic situations when they arise. CBT is most effective at preventing relapses once the patient has begun to abstain from cocaine use.
• Therapeutic Communities. This treatment approach requires the patient to live in a drug-free environment with other patients undergoing treatment. In these communities, the patient gets support from the other community members in a similar situation. They also get support in developing behaviors that will help them succeed after they leave treatment.

How Does Cocaine Addiction Progress?

Cocaine is a powerful stimulant that can have adverse health effects even in the short-term, including:

• Headache
• Anxiety
• Paranoia
• Anger or aggressive behavior

A cocaine overdose (or an overdose of cocaine in conjunction with another drug) can cause immediate and sometimes fatal conditions, including:

• Seizures
• Heart arrhythmia
• Respiratory failure
• Kidney failure
• Stroke

Long-term health consequences of cocaine use can include:

• Seizures
• Heart disease or stroke
• Chronic nosebleeds or throat problems
• Lung disease
• Bowel disease
• Sexual impotence
• Hepatitis or HIV (for intravenous users)

In addition to the physical health impacts, cocaine addiction can lead to financial and social struggles, relationship problems, and mental health issues.

How Do I Prevent Cocaine Addiction?

The only sure way to prevent cocaine addiction is never to use cocaine. Beyond that, parents should educate their children about the dangers of cocaine use and model good behavior by abstaining from drug use themselves.

Those who have undergone treatment for cocaine dependency can help prevent relapse by avoiding situations in which drugs are used and getting immediate support when relapse happens.

Cocaine Addiction Caregiver Tips

• Get educated about addiction. It is essential to understand that cocaine addiction is a brain disease and not merely bad behavior. It will help you to be supportive of your loved one if you know how addiction affects them.
• Be involved in the recovery process. Often, an important component of addiction treatment is family therapy, in which the patient and their loved ones learn new behaviors and coping strategies together.
• Don’t get discouraged. The battle with addiction is challenging and usually long. There are almost sure to be setbacks and obstacles along the way. Be prepared for disappointments, and don’t let them discourage you from continuing the fight.
• Get help for yourself. Take time to keep yourself healthy, both physically and mentally. Be careful to get enough sleep and exercise, eat well, and walk away from the situation’s stress when you’re able. Don’t be afraid to ask for help from your friends or family, and find a support group if you feel overwhelmed.

Many people with cocaine use disorder (CUD) also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with CUD:

• Many people with CUD also have an anxiety disorder, including panic disorder, social anxiety disorder, or post-traumatic stress disorder (PTSD). As many as one-third of cocaine abusers experience PTSD.
• Alcoholism and other substance use disorders are commonly comorbid with CUD.
• Many people with CUD have a personality disorder. One study found that nearly half of cocaine abusers had antisocial personality disorder.
• Almost one in five people with CUD suffers from depression.

Cocaine Addiction Brain Science

Researchers are working to determine how cocaine alters brain chemistry to produce a dependence on the drug. They know that the drug interferes with the normal processing of neurotransmitter chemicals, and the most likely key is dopamine. This pleasure-producing neurotransmitter is a factor in many kinds of addiction. However, recent research has suggested that cocaine causes changes in the brain’s response to other neurotransmitters such as serotonin, glutamate, gamma-aminobutyric acid (GABA) norepinephrine, too.

As scientists work to develop drugs to treat cocaine addiction, they focus on compounds that can directly lower the level of neurotransmitters where those levels are elevated by cocaine use. Another approach is searching for a drug that can restore the balance between different neurotransmitters where that balance has been thrown off by long-term cocaine abuse.

Cocaine Addiction Research

Title: Investigation of Cocaine Addiction Using mGluR5 PET and fMRI

Stage: Recruiting 

Principal Investigator: Patrick Worhunsky, PhD     

Connecticut Mental Health Center

New Haven, CT

The proposed research program will investigate the changes in brain chemistry and circuitry that ‘re-wire’ the brain during chronic cocaine use, promote relapse, and complicate treatment efforts. Currently-using and non-treatment-seeking individuals with a cocaine use disorder will undergo a cocaine self-administration paradigm 2-5 days before completing positron emission tomography (PET) and functional magnetic resonance imaging (fMRI).

Title: Safety Study of a Disrupted Adenovirus (Ad) Serotype Cocaine Vaccine for Cocaine-dependent Individuals

Stage: Recruiting 

Principal Investigator: Ronald G. Crystal, MD     

Weill Medical College of Cornell University

New York, NY

The purpose of this study is to assess the safety and preliminary efficacy of an anti-cocaine vaccine called dAd5GNE in cocaine-dependent individuals. It uses the concept of a vaccine to treat the neurological effects of cocaine by evoking “immunity” to prevent the effects of cocaine on the brain.

Title: Theta-Burst Stimulation as a Treatment for Reducing Cocaine Use

Stage: Recruiting 

Principal Investigator: Elliot Stein, PhD     

National Institute on Drug Abuse (NIDA)

Baltimore, MD

Illicit drug use affects tens of millions of Americans and costs nearly $200 billion annually in health care costs and lost productivity. Cocaine dependence accounts for 25% of reported lifetime drug dependence though few successfully abstain with treatment. For positive long-term outcomes, it is imperative to identify risk factors of poor outcomes, specialized treatments, neural mechanisms that change with treatment, and predictive measures of treatment outcomes. Substance abusers are known to have dysregulation in cue reactivity, reward processing, executive control, and intrinsic network connectivity. Non-invasive brain stimulation (NIBS) has proven effective at reducing drug craving in nicotine, alcohol, and cocaine users. Here, intermittent theta-burst stimulation (iTBS), a type of NIBS, delivered to the left dorsolateral prefrontal cortex (dlPFC), is implemented to modulate substance abuse-related circuit dysregulations and assess the effectiveness of iTBS in promoting abstinence.