Cocaine dependence

Cocaine dependence is a psychological desire to use cocaine regularly. Cocaine overdose may result in cardiovascular and brain damage, such as: constricting blood vessels in the brain, causing strokes and constricting arteries in the heart; causing heart attacks.[1]

Cocaine dependence
Specialty	Psychiatry

The use of cocaine creates euphoria and high amounts of energy. If taken in large doses, it is possible to cause mood swings, paranoia, insomnia, psychosis, high blood pressure, a fast heart rate, panic attacks, cognitive impairments and drastic changes in personality.

The symptoms of cocaine withdrawal (also known as comedown or crash) range from moderate to severe: dysphoria, depression, anxiety, psychological and physical weakness, pain, and compulsive cravings.

Signs and symptoms

Cocaine is a powerful stimulant known to make users feel energetic, cheerful, talkative, etc. In time, negative side effects include increased body temperature, irregular or rapid heart rate, high blood pressure, increased risk of heart attacks, strokes and even sudden death from cardiac arrest.[2] Many habitual abusers develop a transient, manic-like condition similar to amphetamine psychosis and schizophrenia, whose symptoms include aggression, severe paranoia, restlessness, confusion[3] and tactile hallucinations; which can include the feeling of something crawling under the skin (formication), also known as "coke bugs", during binges.[4] Users of cocaine have also reported having thoughts of suicide, unusual weight loss, trouble maintaining relationships, and an unhealthy, pale appearance.[3]

Withdrawal symptoms

After using cocaine on a regular basis, many users will become addicted. When the drug is discontinued immediately, the user will experience what has come to be known as a "crash" along with a number of other cocaine withdrawal symptoms, including paranoia, depression, exhaustion, anxiety, itching, mood swings, irritability, fatigue, insomnia, an intense craving for more cocaine, and in some cases nausea and vomiting. Some cocaine users also report having similar symptoms to schizophrenia patients and feel that their mind is lost. Some users also report formication: a feeling of a crawling sensation on the skin also known as "coke bugs". These symptoms can last for weeks or, in some cases, months. Even after most withdrawal symptoms dissipate most users feel the need to continue using the drug; this feeling can last for years and may peak during times of stress. About 30–40% of individuals with cocaine dependence will turn to other substances such as medication and alcohol after giving up cocaine. There are various medications on the market to ease cocaine withdrawal symptoms.

Risk

A study consisting of 1,081 U.S. residents who had first used cocaine within the previous 24 months was conducted. It was found that the risk of becoming dependent on cocaine within two years of first use was 5–6%. The risk of becoming dependent within 10 years of first use increased to 15–16%. These were the aggregate rates for all types of use considered, such as smoking, snorting, and injecting. Among recent-onset users individual rates of dependency were higher for smoking (3.4 times) and much higher for injecting. Women were 3.3 times more likely to become dependent, compared with men. Users who started at ages 12 or 13 were four times as likely to become dependent compared to those who started between ages 18 and 20.[5][6][7]

However, a study of non-deviant[nb 1] users in Amsterdam found a "relative absence of destructive and compulsive use patterns over a ten year period" and concluded that cocaine users can and do exercise control. "Our respondents applied two basic types of controls to themselves: 1) restricting use to certain situations and to emotional states in which cocaine's effects would be most positive, and 2) limiting mode of ingestion to snorting of modest amounts of cocaine, staying below 2.5 grams a week for some, and below 0.5 grams a week for most. Nevertheless, those whose use level exceeded 2.5 grams a week all returned to lower levels".[8]

Treatment

Therapy

Twelve-step programs such as Cocaine Anonymous (modeled on Alcoholics Anonymous) have been widely used to help those with cocaine addiction. Cognitive behavioral therapy (CBT) combined with motivational therapy (MT) have proven to be more helpful than 12 step programs in treating cocaine dependency.[9] However, both these approaches have a fairly low success rate. Other non-pharmacological treatments such as acupuncture[10][11] and hypnosis have been explored, but without conclusive results.[12][13]

Medications

Numerous medications have been investigated for use in cocaine dependence, but as of 2015, none of them were considered to be effective.[14] Anticonvulsants, such as carbamazepine, gabapentin, lamotrigine, and topiramate, do not appear to be effective as treatment.[14][15] Limited evidence suggests that antipsychotics are also ineffective for treatment of cocaine dependence.[16] Few studies have examined bupropion (a novel antidepressant) for cocaine dependence; however, trials performed thus far have not shown it to be an effective form of treatment for this purpose.[17]

The National Institute on Drug Abuse (NIDA) of the U.S. National Institutes of Health is researching modafinil, a narcolepsy drug and mild stimulant, as a potential cocaine treatment. Ibogaine has been under investigation as a treatment for cocaine dependency and is used in clinics in Mexico, the Netherlands and Canada, but cannot be used legally in the United States. Other medications that have been investigated for this purpose include acetylcysteine, baclofen,[18] and vanoxerine.[19] Medications such as phenelzine, have been used to cause an "aversion reaction" when administered with cocaine.[lower-alpha 1]

Epidemiology

In the United States, cocaine use results in about 5,000–6,000 deaths annually.[21]

Research

Kim Janda has been working for years on a vaccination that would treat cocaine use disorders[22] by limiting its rewarding effects.[23]

Transcranial magnetic stimulation (TMS) is being studied as a treatment for cocaine addiction. So far studies have been undertaken by Medical University of South Carolina (MUSC), National Institute on Drug Abuse (NIDA), and Mexican National Institute of Psychiatry.[24]

See also

• SB-277011-A – a dopamine D3 receptor antagonist, used in the study of cocaine addiction. Where cocaine reduces the threshold for brain electrical self-stimulation in rats, an indication of cocaine's rewarding effects, SB-277011-A completely reverses this effect.

Notes

1. The study's authors stated that they wanted to know which effects and consequences of cocaine use would become visible with persons who are mainstream citizens or as close to that social stratum as possible

References

1. Cocaine Use and Its Effects
2. Walsh, Karen (October 2010). "Teen Cocaine Use". Archived from the original on 13 February 2018. Retrieved 12 December 2013. Cite journal requires |journal= (help)
3. LeVert, Suzanne (2006). Drugs: The Facts About Cocaine. New York: Marshall Cavendish Benchmark. pp. 41, 76.
4. Gawin, F.H. (1991). "Cocaine addiction: Psychology and neurophysiology". Science. 251 (5001): 1580–6. Bibcode:1991Sci...251.1580G. doi:10.1126/science.2011738. PMID 2011738. S2CID 26660048.
5. Tierney, John. "The Rational Choices of Crack Addicts". New York Times. Retrieved 16 September 2013.
6. Wagner, FA (2002), "From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine, and alcohol", Neuropsychopharmacology, 26 (4): 479–88, doi:10.1016/S0893-133X(01)00367-0, PMID 11927172
7. O'Brien MS, Anthony JC (2005). "Risk of becoming cocaine dependent: epidemiological estimates for the United States, 2000–2001". Neuropsychopharmacology. 30 (5): 1006–1018. doi:10.1038/sj.npp.1300681. PMID 15785780.
8. Cohen, Peter; Sas, Arjan (1994). Cocaine use in Amsterdam in non deviant subcultures. Addiction Research, Vol. 2, No. 1, pp. 71-94.
9. "Cognitive behavioural therapy reduced cocaine abuse compared with 12 step facilitation". ebmh.bmj.com. 17 January 2008. Retrieved 25 August 2012.
10. Margolin, Arthur; et al. (2 January 2002). "Acupuncture for the treatment of cocaine addiction: A randomized controlled trial". The Journal of the American Medical Association. 287 (1): 55–63. doi:10.1001/jama.287.1.55. PMID 11754709.
11. Otto, Katharine C.; Quinn, Colin; Sung, Yung-Fong (Spring 1998). "Auricular acupuncture as an adjunctive treatment for cocaine addiction: A pilot study". The American Journal on Addictions. 7 (2): 164–170. doi:10.1111/j.1521-0391.1998.tb00331.x. PMID 9598220.
12. Page, R.A.; Handleya, G.W. (1993). "The use of hypnosis in cocaine addiction". American Journal of Clinical Hypnosis. 36 (2): 120–123. doi:10.1080/00029157.1993.10403054. PMID 8259763.
13. Potter, Greg (2004). "Intensive therapy: Utilizing hypnosis in the treatment of substance abuse disorders". American Journal of Clinical Hypnosis. 47 (1): 21–28. doi:10.1080/00029157.2004.10401472. PMID 15376606. S2CID 42943267.
14. Minozzi, S; Cinquini, M; Amato, L; Davoli, M; Farrell, MF; Pani, PP; Vecchi, S (April 2015). "Anticonvulsants for cocaine dependence". Cochrane Database of Systematic Reviews (Systematic Review & Meta-Analysis). 17 (4): CD006754. doi:10.1002/14651858.CD006754.pub4. PMID 25882271.
15. Singh, M; Keer, D; Klimas, J; Wood, E; Werb, D (August 2016). "Topiramate for cocaine dependence: a systematic review and meta-analysis of randomized controlled trials". Addiction (Systematic Review & Meta-Analysis). 111 (8): 1337–46. doi:10.1111/add.13328. PMID 26826006. S2CID 34637139.
16. Indave, BI; Minozzi, S; Pani, PP; Amato, L (March 2016). "Antipsychotic medications for cocaine dependence". Cochrane Database of Systematic Reviews (Systematic Review and Meta-Analysis). 3: CD006306. doi:10.1002/14651858.CD006306.pub3. PMID 26992929.
17. Mariani, JJ; Levin, FR (June 2012). "Psychostimulant treatment of cocaine dependence". Psychiatric Clinics of North America (Review). 35 (2): 425–39. doi:10.1016/j.psc.2012.03.012. PMC 3417072. PMID 22640764.
18. Karila L, Gorelick D, Weinstein A, et al. (May 2008). "New treatments for cocaine dependence: a focused review". Int. J. Neuropsychopharmacol. 11 (3): 425–38. doi:10.1017/S1461145707008097. PMID 17927843.
19. Cherstniakova SA, Bi D, Fuller DR, Mojsiak JZ, Collins JM, Cantilena LR (September 2001). "Metabolism of vanoxerine, 1-[2-[bis(4-fluorophenyl)methoxy]ethyl]-4-(3-phenylpropyl)piperazine, by human cytochrome P450 enzymes". Drug Metab. Dispos. 29 (9): 1216–20. PMID 11502731.
20. "Chemistry, Design, and Structure-Activity Relationship of Cocaine Antagonists". Satendra Singh et al. Chem. Rev. 2000, 100. 925-1024. PubMed; Chemical Reviews (Impact Factor: 45.66). 04/2000; 100(3):925-1024 American Chemical Society; 2000, ISSN 0009-2665 ChemInform; May, 16th 2000, Volume 31, Issue 20, DOI: 10.1002/chin.200020238. Mirror hotlink.
21. "Unintentional Drug Poisoning in the United States" (PDF). Center for Disease Control. Archived from the original (PDF) on 27 August 2016. Retrieved 26 August 2016. Cite journal requires |journal= (help)
22. Douglas Quenqua (3 October 2011). "An Addiction Vaccine, Tantalizingly Close". The New York Times.
23. "Baylor Doctors are Working on Cocaine Vaccine". CocaineHelp.org. 17 January 2008. Archived from the original on 9 May 2008. Retrieved 11 September 2008.
24. Wadman, Meredith (29 August 2017). "Brain-altering magnetic pulses could zap cocaine addiction". Science Magazine. American Association for the Advancement of Science. Retrieved 1 September 2017.

Reference notes

1. [20] ←Page #928 (4th page of article) ¶4. §(1), (2) & (3); Lines 10—12 & 15—18 of aforementioned 4th ¶.

External links

Classification	D ICD-10: F14.2 ICD-9-CM: 304.2 MeSH: D019970
External resources	eMedicine: med/3116