Cocaine has been abused for more than 100 years in its pure form of cocaine hydrochloride. The Coca plant, which is the source of cocaine has been used for even longer, for at least 1000 years. The reason for its popularity is the powerful central nervous system stimulant effects of Cocaine.
There are two basic chemical forms of cocaine
1- The hydrochloride salt - is a powdered form that dissolves in water and can be taken intravenously or intra-nasally (through the nose). 2- The freebase - is a non-neutralized form and can be smoked. The white, crystalline form of cocaine is known in streets as Coke, C, snow, blow, or flake.
Cocaine available in the street as illegal forms is often adulterer with non-reactive substances such as cornstarch, talcum, or with stimulant substances like amphetamines. Cocaine can be smoked, injected, snorted, chewed, or mainlined. None of these methods are safe and can lead to overdoses and toxicity. Crack is a free base form cocaine that has been processed with ammonia or sodium bicarbonate to remove the hydrochloride compound of cocaine hydrochloride. Crack when smoked, produces a high in 10 seconds making it very popular in the mid-1980s.
How Cocaine Affects Your Body
Cocaine blocks the retake of dopamine in nerve terminals increasing the concentration of dopamine in areas of the brain responsible for pleasure such as the nucleus accumbens. These areas are usually stimulated with pleasure due to food, water, sex, and drugs of abuse. Cocaine directly stimulates the nucleus accumbens, producing a feeling of pleasure and euphoria making it one of the most addictive drugs known to man. Continued use leads to tolerance where higher doses are required to achieve the same level of high as felt initially or even to feel normal.
Some of the effects of cocaine addiction are given below.
Crash Symptoms - experienced when cocaine effects are withdrawn - These symptoms usually resolve in 24 hours • Dysphoria - abnormal depression • Anhedonia - the inability to feel pleasure • Anxiety, irritation, fatigue, and hypersomnolence (increased sleepiness) After prolonged use the symptoms are more severe: • Intense craving • Depression • Severe suicidal tendencies
Managing Cocaine Abuse
Cocaine addiction is one of the most difficult addictions to treat. Cocaine withdrawal leads to intense cravings that are extremely difficult to resist. Even with successful initial management, relapses and urges to use can occur after months or even years. A multifaceted approach is required to treat cocaine addiction.
1- Cognitive behavioral therapy, motivation, counseling, and psychotherapy.
2- Medical management - acute intoxications require sedation and anti-psychotics. Managing co-morbidities such as hypertension and seizures are done pharmacologically.
3- Social support from family and friends is important to manage addiction.
1- Harrison, P. Shorter Oxford textbook of psychiatry (6th ed., pp. 478-479) 2- Www1.nyc.gov. 2020. Cocaine Abuse & Addiction. [online] Available at: <https:// www1.nyc.gov/site/doh/health/health-topics/cocaine-abuse-and-addiction.page> [Accessed 3 October 2020].
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