Cocaine dependence

Cocaine dependence
Classification and external resources
Specialty
ICD-10	F14.2
ICD-9-CM	304.2
eMedicine	med/3116
Patient UK	Cocaine dependence
MeSH	D019970

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.

The use of cocaine creates euphoria and high amounts of energy, much like caffeine. If taken in large, unsafe doses, it is possible to cause mood swings, paranoia, insomnia, psychosis, high blood pressure, tachycardia, 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 craving.

Signs and symptoms

Cocaine is a powerful stimulant known to make users feel energetic, happy, 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. Many habitual abusers develop a transient, manic-like condition similar to amphetamine psychosis and schizophrenia, whose symptoms include aggression, severe paranoia, and tactile hallucinations; which can include the feeling of insects under the skin (formication), also known as "coke bugs", during binges.

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.

However, a study of non-deviant 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".

Treatment

On 14 February 2011, two Swiss psychologists published two years of trials and research which demonstrates that gambling along with psychotherapy is the best method to alleviate cocaine dependence. Further research is being conducted on long term relapse rates.

Withdrawal symptoms

After using cocaine on a regular basis, some 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.

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. However, both these approaches have a fairly low success rate. Cocaine vaccines are in clinical trials that will limit the rewarding effects from cocaine. The National Institutes of Health of US, particularly National Institute on Drug Abuse (NIDA) 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 USA. Non pharmacological treatments such as acupuncture and hypnosis have been explored, but without conclusive results. Cocaine addiction continues to be the most difficult to manage behind heroin.

Medications

Medications that have been investigated include acetylcysteine, baclofen, bupropion, vanoxerine, and vigabatrin. Kim Janda has been working for years on a vaccination that would treat cocaine use disorders. Furthermore, the anti-depressant desipramine, as well as the stimulants methylphenidate & pemoline, have been used to treat cocaine from the perspective of its abuse liability corresponding to a 'premorbid coexisting psychiatric disorder'; whereas the anti-convulsant drug "carbmazepine" (sic), as well as "dopamimetic agents, L-dopa/carbidopa; amino acids, tyrosine and tryptophan" have been used to treat withdrawal and craving. Finally, drugs have been used to cause an "aversion reaction" when administered with cocaine, namely phenelzine.

Epidemiology

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

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.