Despite the good news that the number of people using and becoming addicted to cocaine has decreased in recent years, there are still hundreds of thousands of people in the United States who need help to stop using the drug.

Cocaine is a highly addictive stimulant drug made from the coca plant in South America. The initial rush of the high is accompanied by racing heart beat, high blood pressure and then heavy anxiety. Aside from the occasional users, there are two types of more severe situations that require intervention and treatment. These are the binge users – people who go for a few days at a time but may have days or weeks in between binges – and also the daily cocaine users.

Cocaine is either snorted, smoked or injected, and it comes in either a powdered form or a crystalline-rock substance known as crack.

The intensity and duration of cocaine’s effects depend on the way it is used. Injecting or smoking cocaine delivers the drug rapidly into the bloodstream and brain, producing a quicker and stronger but shorter-lasting high than snorting. The high from snorting cocaine may last 15 to 30 minutes; the high from smoking may last 5 to 10 minutes.

The intense but short rush from cocaine is why it is so addictive, and why so many people who are addicted to cocaine and crack wind up spending hundreds of dollars per day or more for the drug.

Cocaine and the Brain

Cocaine increases levels of the neurotransmitter dopamine in brain circuits regulating pleasure and movement, as seen in this diagram above*.

Normally, dopamine is released by neurons in these circuits in response to potential rewards (like the smell of good food) and then recycled back into the cell that released it, thus shutting off the signal between neurons. Cocaine prevents the dopamine from being recycled, causing excessive amounts to build up in the synapse, or junction between neurons. This amplifies the dopamine signal and ultimately disrupts normal brain communication. It is this flood of dopamine that causes cocaine’s characteristic high.

With repeated use, cocaine can cause long-term changes in the brain’s reward system as well as other brain systems, which may lead to addiction. With repeated use, tolerance to cocaine also often develops; many cocaine abusers report that they seek but fail to achieve as much pleasure as they did from their first exposure. Some users will increase their dose in an attempt to intensify and prolong their high, but this can also increase the risk of adverse psychological or physiological effects.

Health Effects of Cocaine

Cocaine affects the body in a variety of ways. 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, chronic users can become malnourished as well.

Most seriously, people who use cocaine can suffer heart attacks or strokes, which may cause sudden death. Cocaine-related deaths are often a result of the heart stopping (cardiac arrest) followed by an arrest of breathing.

People who use cocaine also put themselves at risk for contracting HIV, even if they do not share needles or other drug paraphernalia. This is because cocaine intoxication impairs judgment and can lead to risky sexual behavior.

Some effects of cocaine depend on the method of taking it. Regular snorting of cocaine, for example, can lead to loss of the sense of smell, nosebleeds, problems with swallowing, hoarseness, and a chronically runny nose. Ingesting cocaine by the mouth can cause severe bowel gangrene as a result of reduced blood flow. Injecting cocaine can bring about severe allergic reactions and increased risk for contracting HIV, hepatitis C, and other blood-borne diseases.

Binge-patterned cocaine use may lead to irritability, restlessness, and anxiety. Cocaine abusers can also experience severe paranoia—a temporary state of full-blown paranoid psychosis—in which they lose touch with reality and experience auditory hallucinations.

Cocaine is more dangerous when combined with other drugs or alcohol (poly-drug use). For example, the combination of cocaine and heroin (known as a “speedball”), carries a particularly high risk of fatal overdose

Recent discoveries about the inner workings of the brain and the harmful effects of cocaine offer us unprecedented opportunities for addressing this persistent public health problem.

According to NIDA director Dr. Nora Volkow, “Genetic studies continue to provide critical information about hereditary influences on the risk of addiction to psychoactive substances, including cocaine. But genetic risk is far less rigid than previously thought. More recent epigenetic research has begun to shed light on the power of environmental factors (e.g., nutrition, chronic stress, parenting style) to influence gene expression and thus, genetic risk. Furthermore, sophisticated imaging technologies have allowed scientists to visualize the brain changes that result from chronic drug exposure or that occur when an addicted person is exposed to drug-associated “cues” that can trigger craving and lead to relapse. By mapping genetic factors, epigenetic mechanisms, and brain regions responsible for the multiple effects of cocaine, we are gaining fundamental insights that can help us identify new targets for treating cocaine addiction.”

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