COCAINE ADDICTION: SIGNS, EFFECTS AND TREATMENT - Written by Dean Gustar, Relapse Prevention Specialist

Cocaine addiction is a problem that affects millions of people worldwide. It is a drug that can cause long-term damage to both physical and mental health and has devastating consequences for personal relationships, work, and finances. Despite the well-known risks and consequences of cocaine addiction, it continues to be a major public health concern, with many individuals struggling to break free from its grip.

Treating cocaine dependency can be challenging for several reasons. First, cocaine is a drug that can cause both physical and psychological dependence, making it difficult for individuals to quit using it without professional support and help. Additionally, the withdrawal symptoms associated with cocaine addiction can be severe and uncomfortable. The withdrawal symptoms can include depression, anxiety, fatigue, alongside intense cravings for the drug.

Many individuals who struggle with cocaine addiction may also have co-occurring mental health disorders, such as depression, anxiety, or ADHD which can complicate the withdrawal and treatment process. Also, they may have suffered from episodes of drug-related psychosis during times of excessive use of cocaine. There is no single, perfect treatment approach that works for everyone, and finding the right combination of therapies and support can take time and require ongoing adjustments. Despite these obstacles, however, many people can overcome addiction to cocaine with comprehensive and individualised treatment that addresses their unique needs and challenges.

The latest figures from around the world show that in 2022 authorities across the world made more cocaine seizures than at any time in history. In 2022 in Columbia, 671 tonnes of cocaine were impounded by security services. Record figures are being recorded in most countries. We know that the manufacture of cocaine takes place almost exclusively in South America. We also know that 80% of the world's consumption of cocaine takes place in the Americas and Europe. We are manufacturing and taking more cocaine than ever.

One team of UK researchers at King's College regularly tests wastewater for signs of drug consumption. They estimated that in 2019 London cocaine users were getting through approximately 23 kg per day.

What is Cocaine?

Cocaine is a stimulant drug that comes from the leaves of the coca plant. The coca plant is native to South America. The leaves of the coca plant are soaked in chemical solvents and then crushed to form a paste. This paste is then treated with acids and oxidising agents to create cocaine hydrochloride, which is the substance known more commonly as cocaine.

Cocaine is a powerful central nervous system stimulant that increases levels of dopamine, a neurotransmitter associated with pleasure and movement, in the brain. It is typically consumed in powder form and is known for its euphoric effects, as well as its highly addictive nature. However, it also has many negative side effects, including increased heart rate and blood pressure, and risk of heart attack or stroke. Long-term use can also lead to damage to the heart, brain, and other organs, as well as mental health problems.

How is cocaine consumed?

Cocaine can be consumed in several ways, depending on the preference of the user. The most common method of consumption is through snorting the drug, where cocaine powder is inhaled through the nose. Another method is injecting the drug into the bloodstream with a needle, which is the most dangerous way to use cocaine due to the risk of overdose and infection. Smoking crack cocaine, which is a form of the drug that has been processed into a crystal form, is another popular method of consumption. Some users also ingest cocaine orally, either by mixing it with a drink or food, but this method is less common than the others.

The risk of developing cocaine dependency is related to the method of consumption. The exact percentage of users who become addicted can be difficult to determine as it can vary depending on several factors, including individual susceptibility, frequency and duration of use, and environmental and social influences. Research suggests that around 20% of people who snort cocaine become dependent users. When it comes to crack cocaine research suggests that it has a particularly high addiction potential, with some estimates suggesting that up to 75% of individuals who try crack cocaine will become addicted to the drug. This is because crack cocaine produces a rapid and intense high that can lead to cravings and compulsive use, making it difficult for users to control their drug use. Additionally, the withdrawal symptoms associated with crack cocaine addiction can be particularly severe, which can also contribute to the high rate of addiction.

What are cocaine users?

Cocaine is used by people of all ages, genders, and socioeconomic backgrounds, but is mostly used by young adults in urban areas. It is often used recreationally, in social settings or parties. It can also be used by individuals seeking to self-medicate for mental health issues such as depression or anxiety. Cocaine use is also associated with certain occupations and lifestyles, such as those in the finance sector, entertainment industry or high-powered business.

According to the latest statistics (based on self-reported drug use) from the UK government's Office for National Statistics (ONS), the estimated number of people aged 16 to 59 who have used cocaine powder in 2019 in England and Wales was 3.4% in 2020.

In terms of age groups, the highest proportion of cocaine powder use in the last year was among those aged 20 to 24 years (9.1%), followed by those aged 25 to 29 years (7.4%).

In terms of gender, the proportion of males using cocaine powder in the last year was higher than that of females, with 4.4% of males reporting use compared to 1.8% of females.

The use of crack cocaine, which is a more potent form of cocaine, was less common, with an estimated 0.6% of people aged 16 to 59 reporting use in the last year in England and Wales.

It is important to note that these statistics are self reported and may not fully reflect the actual prevalence of cocaine use in the UK.

What are the short- and long-term physical effects of cocaine?

Short-term Effects of Cocaine

In the short-term, cocaine users will generally feel a burst of energy and a state of euphoria. When the cocaine is snorted the effect lasts around 15-30 minutes. If cocaine is injected or smoked, the effect is extremely intense and is felt within a matter of seconds, the duration would be around 5-10 minutes. Users will notice an increase in alertness, body temperature, and heart rate. There may also be agitation and paranoia, and a risk of cocaine-related psychosis. There is also a risk of overdose which can involve chest pains, confusion, convulsions, respiratory depression, arrhythmia and may result in the death of the user.

In 2019 the data from the Centre for Disease Control and Prevention (CDC) indicates that there were around 16,000 overdose deaths in the USA involving cocaine.

Long-term Effects of Cocaine

Longer-term effects would include cardiovascular issues, sleep disturbance, weight loss, nasal damage, kidney failure, depression and tolerance to the drug. Users who smoke crack are vulnerable to bronchial damage, hallucinations, seizures and memory disruptions. Injecting users are at high risk of blood-borne viruses such as Hepatitis C and HIV.

Why do people become addicted to cocaine?

Though many people can use cocaine and not become dependent, there are significant numbers of people who run into difficulties with the substance and develop a cocaine use disorder. Here are some of the factors that can make a person more vulnerable to becoming addicted to cocaine:

• Neurochemical changes: Cocaine affects the levels of dopamine, a neurotransmitter that plays a key role in reward and pleasure, in the brain. When someone uses cocaine, it floods the brain with dopamine, causing intense feelings of euphoria and pleasure. Over time, the brain can become desensitised to the drug, leading to tolerance and the need for higher doses to achieve the same effects.

• Genetics: Some studies have suggested that genetics may play a role in addiction to cocaine and other drugs. Certain genetic variations may increase the likelihood of someone developing an addiction.

• Environmental and social factors: Environmental and social factors can also contribute to cocaine addiction. For example, individuals who are exposed to high levels of stress, trauma, or negative life events may be more likely to turn to drugs to cope. Peer pressure and social influences can also play a major role in the initiation and maintenance of drug use.

• Mental health conditions: Individuals who struggle with mental health conditions such as depression, anxiety, or PTSD may be more susceptible to cocaine addiction. Cocaine can temporarily alleviate symptoms of these conditions, making it more appealing to those who are struggling. We regularly see cocaine-addicted clients with an ADHD diagnosis (often undiagnosed) who are possibly unconsciously self-medicating for their condition.

Cocaine use disorder, like most substance use disorders, is a complex condition. We see it being influenced by a variety of biological, environmental, social and psychological factors. It is not a moral failing by the user. It is important we approach cocaine use disorder with compassion and understanding. Pretty much nobody, when they make a choice to take cocaine for the first time, thinks it will end in dependency. Once a dependency has developed, due to the compulsive nature of addiction, individuals have limited control over their using, and often start to behave in ways that are not in line with their own values.

What are the warning signs of Cocaine Dependency?

The warning signs of cocaine dependency can vary from person to person, but here are some common signs to look out for:

• Physical signs: Cocaine use can cause physical changes such as dilated pupils, weight loss, and a runny or bloody nose. It can also lead to disrupted sleep patterns and decreased appetite.

• Mood swings: Cocaine use can cause dramatic mood swings, such as euphoria followed by depression, irritability, or anxiety. Users may also become paranoid or experience hallucinations.

• Social changes: Individuals struggling with cocaine dependency may start to withdraw from social activities and relationships or exhibit erratic behaviour and changes in personality. They may also experience financial difficulties and legal problems.

• Tolerance: Over time, cocaine use can lead to tolerance, meaning that individuals require increasingly higher doses to achieve the same effects.

• Cravings: People with cocaine dependency may experience intense cravings for the drug, leading to compulsive drug-seeking behaviours.

• Withdrawal symptoms: When someone is dependent on cocaine and then stops using the drug, they may experience withdrawal symptoms such as depression, anxiety, fatigue, and cravings for the drug.

One or two of these signs alone may not necessarily indicate cocaine dependency, but if you notice several of these signs together, it may be a cause for concern. If you feel that someone you know is struggling with cocaine dependency, encourage them to seek professional help.

Other substances and behaviours

We often see clients with cocaine use disorder also have a history of using other substances and behaviours alongside cocaine. There may be a relationship between alcohol and cocaine. They are often mixed. People might take cocaine to alleviate the symptoms of alcohol or take alcohol to ease the uncomfortable symptoms of taking too much cocaine. There can be a strong link between the two substances. In fact, when cocaine is used alongside alcohol, it combines in the body to create cocaethylene, which is a substance more dangerous than either substance on its own. Where this strong link does occur, in order to successfully stop taking cocaine, it may be advisable to stop drinking alcohol as it can become a huge relapse trigger.

High doses of cocaine can and often do lead to a very uncomfortable state of mind. Paranoia, hallucinations and short-term drug-induced psychosis are all associated with heavy cocaine use. People may take medications to help bring themselves down from these intense experiences. Benzodiazepines such as Xanax or Valium help to bring the high down to what feels like a more manageable level to enable sleep or rest.

It is common to hear from people with cocaine use disorder that they have been engaged in high-risk or intense sexual activity. Cocaine increases the sex drive and lowers inhibitions. There becomes a highly charged cycle of behaviour which adds fuel to the risk of dependency and becomes a difficult cycle to escape. Much like alcohol, it can also be a challenge for recovery as the two activities become fused in the mind.

How can I support a loved one who has a cocaine use disorder?

When a friend or family member develops an addiction, everyone feels the pain. This includes the addict themselves, and all the people who love and care for them. Helping a loved one with a cocaine addiction can be challenging. If love were enough, it would be simple, but it is a difficult process that involves many factors, and often takes a lot of time, with a lot of ups and downs. It's important to remember that love, support and understanding can make a significant difference in their recovery process. Here are some steps you can take to support your loved one:

• Educate yourself: Learn more about cocaine addiction and how it affects individuals physically and psychologically. Understanding the addiction can help you be more compassionate and empathetic towards your loved one.

• Encourage your loved one to seek help: Encourage your loved one to seek professional help. This can include addiction treatment centres, therapists, and support groups. You can offer to take them or to support them to get to appointments.

• Offer emotional support: Be there for your loved one emotionally. Listen to their concerns and struggles without judgement and offer words of encouragement and support.

• Create a safe and supportive environment: Help create a safe and supportive environment for your loved one. Remove any triggers or temptations that could lead to relapse and create healthy habits and routines that support recovery.

• Take care of yourself: It's essential to take care of your own mental and emotional health. This can involve seeking support for yourself, setting boundaries, and practising self-care.

Remember that addiction recovery is a journey that takes time and effort. Your support and encouragement can make a significant difference in your loved one's recovery process.

What is the best treatment for cocaine use disorder?

The most effective treatment for cocaine use disorder usually involves a combination of behavioural therapies, relapse prevention counselling, psychotherapy and psychiatry to address underlying causes, and social support.

Behavioural therapies such as cognitive-behavioural therapy (CBT) and contingency management (CM) have been shown to be effective in reducing cocaine use and improving treatment outcomes. CBT focuses on changing negative thought patterns and behaviours associated with drug use, while CM provides positive reinforcement for abstinence.

Psychotherapy can help to identify and understand how adverse life experiences, trauma, and family and social dynamics may have contributed to the cocaine use disorder. Psychiatric support will help to identify and diagnose any co-existing mental health conditions that may be present. As both approaches help with the unconscious drivers that sit underneath the presenting behaviours, they improve the chances of achieving and sustaining change.

Social support, including involvement in support groups such as Cocaine Anonymous, can also be an important aspect of treatment. Support groups provide a safe and supportive environment where individuals can share their experiences and receive encouragement and guidance from others who have been through similar struggles.

Ultimately, the best treatment for cocaine use disorder will depend on the individual's specific needs and circumstances. It is important to seek professional help from a qualified addiction specialist or healthcare provider to develop an individualised treatment plan.

How do we treat Cocaine Use Disorder at The Kusnacht Practice?

At The Kusnacht Practice, we have developed our programme for the treatment of Cocaine Use Disorder based on effective evidence-based interventions, alongside our experience and expertise in working with clients who have a cocaine addiction. We believe in having a person-centred approach to our work. We understand that the relationship with the client can help form the foundation to recovery. We work with the client in establishing goals, treatment plans and boundaries, each step of the way.

The first steps of the programme will be with our dedicated Medical and Psychiatric Teams who will work to ensure that all current and potential medical issues and any existing mental health issues are diagnosed and addressed. They will plan an appropriate detox regime and setting - ensuring the safety of the client and managing withdrawal symptoms. This important phase of cocaine use disorder treatment creates a safe platform for the other teams - psychiatry, psychotherapy and BIO-R® nutrition and lifestyle - to engage with and support the client.

It is important for families and loved ones to know that there is no quick fix. Often, residential treatment is one of the early phases of a much longer continuum of care. We will work with our clients and their families to establish an aftercare programme to help maintain the gains made in treatment and to navigate the potential ups and downs on the recovery journey.

The Kusnacht Practice is renowned for its absolute, dedicated attention and precision, honesty, and transparency in a warm and empathetic environment for all. With the pure waters of Switzerland’s Lake Zurich lapping on its nearby shores and among nature and clean air, the treatment centre offers a holistic, 360-degree, mind, body and soul rebalancing and restoration approach. Its state-of-the-art facility combines Swiss standards of excellence, luxury and cutting-edge, innovative technology with world-renowned medical expertise, compassion, and sensitivity. Each patient is treated uniquely and privately in their own sumptuous, five-star residence and provided with the highest standards of professionalism, care, and discretion.

We have successfully treated many cocaine-dependent individuals. We will provide a safe, kind, and friendly environment where discretion and privacy are key. And our tranquil location and luxurious surroundings will help you relax and focus on your well-being; a place where we can concentrate on nothing more than improving your health and supporting you on a path of recovery.

Our experienced team of experts and professionals will seek to scratch beneath the surface to identify the roots of your issues. We wish to give you back control of your life and to learn coping strategies for a more content future - for you and your loved ones. Our treatment plans are unique and absolutely personalised, but simply opening up about your problem to a discreet professional is a big first step - alongside other therapies, naturally. We will organise everything for you with no detail overlooked.