ARTICLE OVERVIEW: Cocaine is one of the most addictive substances. Crack, one of its derivatives, is highly addictive and comes with terrible consequences to health. This article will teach you how people get addicted, its main effects on the brain, and how addiction is treated.
TABLE OF CONTENTS:
- What Is Crack?
- Psychoactive Effects
- Drinking on Crack
- Crack in the Brain
- Addictive Potential
- Understanding Addiction
- Negative Effects
- Does Treatment Work?
- Main Options For Treatment
- Stages of Treatment
- Relapse Prevention
- Aftercare Plan
- The First Step
- Who Is At Risk
- How To Help Someone
What Is Crack?
Crack is made by converting cocaine hydrochloride to a chemical base by cooking it using ammonia or baking soda and water. When the substance hardens, it is placed in molds to dry and cut into chips or “rocks.” Crack is off-white in color and resembles slivers of soap or chips of cracked paint.
Cocaine itself is a powerful stimulant drug made from the leaves of the South American coca plant. Is a nervous system stimulant that has the appearance of small, irregularly shaped chunks of a whitish solid. Cocaine can be snorted while in the powered form, injected into the veins after dissolving in water, or smoked.
Cocaine has two main pharmacological actions. It is both a local anesthetic and a central nervous system stimulant, being the only drug known to possess both of these properties. The psychoactive effects – the effects to the mind – experienced in the early stages of use include a generalized state of euphoria in combination with feelings of increased:
- mental alertness
- sexual arousal
As users come down from the high, some experience temporary, unpleasant reactions and after effects, which may include restlessness, anxiety, agitation, irritability, and insomnia. With continued, escalating use of cocaine, the user becomes progressively tolerant to the positive effects while the negative effects, such as a dysphoric, depressed state, steadily intensify.
Using crack may also result in overdose and death.
Prolonged use of crack may result in adverse physiological effects involving the respiratory, cardiovascular, and central nervous systems.
Drinking on Crack
Research has revealed a potentially dangerous interaction between crack and alcohol. Taken in combination, the two drugs are converted by the body to cocaethylene. Cocaethylene has a longer duration of action in the brain and is more toxic than either drug alone.
NOTE HERE: The mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.
Crack in the Brain
In the normal process of pleasure and reward in the brain, dopamine is released by a neuron into the synapse (the small gap between two neurons), where it binds to specialized proteins called dopamine receptors on the neighboring neuron. In this way, dopamine acts as a chemical messenger, carrying a signal from neuron to neuron. Another specialized protein called a transporter removes dopamine from the synapse to be recycled for further use.
But crack interrupts this process.
According to the National Institute on Drug Abuse, drugs of abuse like crack can interfere with this normal communication process. In particular, cocaine prevents dopamine from recycling, causing excessive amounts to build up between nerve cells. This flood of dopamine ultimately disrupts normal brain communication and causes the high you feel when you take crack. Smoking it accelerates the process, making the high even more high…but fast, and short-lived.
Today, crack cocaine is a DEA enforced Schedule II drug, which means that it has high potential for abuse, but, can be administered by a doctor for legitimate medical uses, such as local anesthesia for some eye, ear, and throat surgeries. Still, according to the Manual of Adolescent Substance Abuse Treatment, crack is the most addictive form of cocaine and one of the most addictive forms of any drug.
Because it takes only eight seconds to reach the brain, the effects of crack are felt swiftly. This also is why dependence develops so quickly. The drug stimulates key pleasure centers within the brain and causes extremely heightened euphoria.
Compulsive use develops soon after the person starts using, because the substance is usually smoked and enters the blood stream rapidly. As tolerance develops quickly, a person soon fails to achieve the same high experienced earlier from the same amount of crack cocaine. While dependence and tolerance alone do not 100% indicate addiction, they are red flags that can signal a drug problem, for sure!
So, how does addiction occur?
Crack cocaine is super effective as a drug. When first used, crack produces feelings of intense pleasure and euphoria. It stimulates the brain to release abnormal dopamine amounts at once. However, with repeated use, dopamine amounts in the brain decrease and when you rely on cocaine for feelings of pleasure, you will do almost anything you can to get it.
Over time, crack will:
- Damage a person’s ability to experience pleasure at all.
- Damage the brain’s ability to transfer and produce dopamine.
- Impair brain neuron communication.
Soon after regular use, compulsion and loss of control occur. This state of mind is also known as the state of “addiction”. It is, in fact, a chronic, relapsing brain disorder. Addiction affects multiple areas of the brain that control decision making, impulse control, and pleasure.
Still, addiction can be halted. It is a medical condition that can be treated.
Addiction is not a disease influenced by a single factor. On the contrary, it is a complex disease influenced by: genetics, environment, physical and/or emotional trauma. These factors combined together determine the possibility about whether a person will develop a substance abuse disorder or not.
So, who typically uses crack? Historically, the use of crack cocaine reached epidemic proportions in the United States at the end of the 1980s. Due to the unique characteristics associated with crack addiction and the populations that use it, the epidemic created a host of problems for the public health and drug treatment communities.
Believe it or not, The National Drug Intelligence Center suggests that crack use is not tied to any age group or demographic. What is significant about this fact is that there has been a massive increase in the use of crack cocaine by almost all age demographics in recent decades.
According to the National Survey on Drug Use and Health (NSDUH), crack cocaine use has remained relatively stable since 2009. In 2014, there were an estimated 1.5 million current (past-month) crack cocaine users aged 12 or older (or 0.6 percent of the population). In that year, about 913,000 Americans met the Diagnostic and Statistical Manual of Mental Disorders criteria for dependence or abuse of cocaine (in any form) during the past 12 months.
Still, one age group seems to be ahead of the trend: adults aged 18 to 25 years have a higher rate of current crack cocaine use than any other age group, with 1.4 percent of young adults reporting past-month crack cocaine use.
And still other demographics report downward trends in use. For example, the 2015 Monitoring the Future survey, which annually surveys teen attitudes and drug use, reported a significant decline in 30-day prevalence of powder cocaine use among 8th, 10th, and 12th graders from peak use in the late 1990s. In 2014, 1.1 percent of 12th graders and only 0.8 percent of 10th and half a percent of 8th graders reported using crack cocaine in the past month.
Negative Side Effects
Repeated use of crack can produce addiction and other adverse health consequences. It can also cause overdose. For example:
Data from the 2011 Drug Abuse Warning Network (DAWN) report showed that crack cocaine was involved in 505,224 of the nearly 1.3 million visits to emergency departments for drug misuse or abuse. This translates to over one in three drug misuse or abuse-related emergency department visits (40 percent) involving crack.
Additionally, crack takes a wicked toll on the body. Medical complications of using cocaine can include the following.
- Cardiovascular effects such as disturbances in heart rhythm or even heart attacks.
- Respiratory effects like chest pain or respiratory failure.
- Neurological effects such as seizures and headaches.
- Gastrointestinal complications such as abdominal pain.
Crack has particularly been linked to many types of heart disease. Crack has been found to trigger chaotic heart rhythms, called ventricular fibrillation; accelerate heartbeat and breathing; and increase blood pressure and body temperature. Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions and coma.
Plus, different routes of cocaine administration can produce different adverse effects. Regularly snorting cocaine, for example, can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum, which can lead to a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow.
Further, persons who inject cocaine have puncture marks and “tracks,” most commonly in their forearms. Intravenous cocaine users may also experience an allergic reaction, either to the drug, or to some additive in street cocaine, which can result, in severe cases, in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine users lose their appetites and can experience significant weight loss and malnourishment.
Does Treatment Work?
Yes, addiction treatment works.
Getting professional help can lead you to a sober life with many benefits including:
- Better communication and relationship with others.
- Employment and career opportunities.
- Improved mental health condition.
- Reduced drug use.
Main Options For Treatment
If you are experiencing a drug problem, you have many options to choose from. Addiction treatment programs differ by three main factors:
- Duration of 30-60-90 days or longer.
- Inpatient or outpatient settings.
- Type of therapies offered.
Before you make a decision, be aware that there is no “one-size-fits-all” treatment program. In order to get the best treatment possible, you’ll need to be assessed. Then, a reputable treatment program should create a customized treatment plan for you.
A treatment plan is usually created based on the following elements:
- Quantity, length, and frequency of crack abuse.
- Your medical history.
- Your unique treatment goals.
- Past trauma.
- Possible co-occurring mental health issues.
Regardless of the variations in treatment, there are some therapies that should be offered at any reputable rehab facility. Be sure that the treatment program you choose includes elements of:
- Aftercare for maintaining health and sobriety.
- Education about the brain disease of addiction.
- Integrated or Dual-Diagnosis therapy.
- Medication assisted therapy.
- Psychological counseling.
- Relapse prevention training.
Stages of Treatment
What happens in treatment. When entering any addiction treatment center, you should expect the following three main treatment stages.
STAGE 1: DETOX. The detoxification process can be the most difficult part of the treatment, but is a very important step toward recovery. As depression often follows after cocaine use, it is important to go through detox in a controlled environment. Emotional support is critical during this time and suicidal thinking is common. Additionally, short term use of antidepressants can address dopamine and serotonin imbalances in the brain.
STAGE 2: REHAB. Inpatient rehab is one of the best ways to successfully complete your recovery. A personalized treatment plan will be evaluated and prepared based on your condition. However, it will be mostly focused on your behavior and socialization. You should be prepared for the rehabilitation program to last between 30-90 days, or even longer in more severe cases.
STAGE 3: AFTERCARE. After rehab, the journey begins. You will need to address triggers. At the beginning, regular counseling may be required while identifying all risk factors. You may also benefit from living in a sober house and attending support group meetings. Finally, there are specially designed trainings which help you reintegrate into society without needing to adapt in the same behavioral patterns.
Currently, there are no medications that are FDA approved for the treatment of cocaine dependence. However, recent advances in the understanding of the processes involved in cocaine addiction have allowed researchers to identify several promising new candidate medications. Many of these have already shown promise in double-blind, placebo-controlled, clinical trials, and virtually all of them are undergoing confirmatory testing in one or more trials. It seems highly likely that in the near future there will be effective pharmacological treatments for cocaine dependence. These medications include:
Baclofen is GABA B agonist used as a muscle relaxant. As a GABA agonist, baclofen may reduce the amount of dopamine released into the nucleus accumbens as a result of cocaine stimulation or cocaine craving.
Disulfiram is a promising cocaine relapse prevention medication. Disulfiram is an established medicine used for the treatment of alcohol dependence. It causes a characteristic unpleasant reaction when alcohol is ingested due to blockade of the enzyme aldehyde dehydrogenase and the subsequent build-up of acetaldehyde. In addition to its effects on alcohol metabolism, disulfiram also blocks the enzymatic degradation of cocaine and dopamine and leads to extremely high cocaine and dopamine levels when cocaine is ingested. This does not increase the cocaine-induced high, as one might expect, but rather it makes the high less pleasant by increasing the associated anxiety.
Modafinil is a medication approved for the treatment of narcolepsy. It enhances glutamate-neurotransmission.
Propranolol is a beta-blocker, and appears to be promising for the treatment of persons who present for treatment with severe cocaine withdrawal symptoms. Beta blockers are primarily used to treat angina and hypertension, though they are often used to control anxiety and agitation.
Tiagabine is another GABAergic medication that may be promising for the treatment of cocaine dependence. Tiagabine is a selective blocker of the presynaptic GABA reuptake transporter type 1, and it is currently approved for the treatment of seizures.
Topiramate may be an excellent medication for relapse prevention based on its effects on both GABA neurotransmission and glutamate neurotransmission.
The last of the promising medication therapies to be discussed is not a medicine, but a vaccine capable of stimulating the production of cocaine-specific antibodies. The vaccine (TA-CD) works by stimulating the production of cocaine-specific antibodies that bind to cocaine molecules and prevent them from crossing the blood-brain barrier. Since cocaine is inhibited from entering the brain, its euphoric and reinforcing effects are reduced.
Inpatient vs Outpatient
Q: Can you try an outpatient center for crack addiction?
A: Yes, but most experts recommend inpatient clinics for this strong addiction.
Without doubt, the safest way to treat crack addiction is in a residential rehab facility. This is because cravings for cocaine can be intense and lead to relapse. In rehab, you will receive therapy and learn coping methods that will keep you off drugs. Plus, you’re under constant supervision to keep you safe from harm. Often, this is the best option for those who have a history of addiction, who have tried to get clean, and failed before.
Some people decide to change their home and work environment by removing triggering people and situations that can cause relapse. They try to change their lives…but many times end up in relapse. This is why it is recommended that you enroll in a treatment center that will monitor your progress to help improve your chances for success. Additionally, counselors recommend that you join a support group such as Narcotics Anonymous or Cocaine Anonymous.
Recovery from crack addiction has to be oriented towards psychosocial treatment, developing coping mechanisms to stress, and creating safe, non-triggering environments.
Most people focus on the first part of their recovery (completing residential treatment), since it considered the foundation for sobriety. However, rehab is only the beginning of a lifetime of happy recovery. Treatment provides people with the basics of a healthy drug free life (detox, medication treatment and aftercare) but the real challenges begin outside treatment.
Life after rehab is just as important as rehab itself. Recovery is not a temporary phase, but rather a process that requires continuous work. Even after completing rehab, many people continue to struggle with cravings. Aftercare programs aim to help people:
- Avoid high risk situations.
- Develop the coping skills to achieve long-term recovery.
- Recognize potential triggers.
To have a strong aftercare plan, we suggest that you:
1. Participate in on-going therapy sessions.
2. Know your triggers. A variety of environmental, social and psychological factors can trigger a return to crack (ab)use such as:
- Flashbacks of abusive situations.
- Job loss.
- Sudden death of a loved one.
- Unexpected emotion or sensation.
These are just an example of triggers that might push you back to old patterns. Because the return to independent living can often trigger new problems, identifying and understanding these triggers is a key part of aftercare.
3. Learn how to cope with stress. After rehab, individuals may face many stressful situations. This is why aftercare services incorporate stress coping skills in their programs and teach people how to handle cravings. Attending support groups provides important structure to your life, as well… so when stress occurs, you can simply access this supportive structure and reduce their risk for relapse.
4. Plan what to do in cases of relapse. Addiction recovery is a repeated cycle of ups and downs. Relapse is a common part of people’s failed attempts to quit crack. But this does not mean lost chances of recovery. It simply signifies that you have to learn from your mistakes and try again.
A key component to every aftercare plan is a “what to do” strategy when relapse occurs. This strategy includes reviewing your relapse outcomes and creating a plan to address each slip.
The First Step
Q: What’s the first step to getting better?
A: Decide to quit.
Addiction to a strong drug like crack can be very difficult to cope with, as the need to use can be overwhelming. However, the first and most important step toward recovery is your decision to seek help.
Still, a dedication to regaining control over your life can be difficult. Rehab can help. People who are struggling with a habit need to be surrounded by others who understand addiction. This is why rehabs focus on providing support and motivation during recovery that help people stay clean.
Who Is At Risk?
Although anybody, regardless of age, sex or social status can potentially become addicted to crack, there are certain factors which may increase the risk:
Attachment: Young people who do not have a strong attachment to their parents and siblings have a higher risk of becoming addicted to something one day, compared to people with deep family attachments.
Family: Anybody who has a close relative with an addiction problem has a higher risk of eventually having one themselves. It may be argued that environmental and circumstantial factors that close family members share are the prominent causes.
Gender: A significantly higher percentage of people addicted to a substance are male. According to the Mayo Clinic, males are twice as likely as females to have problems with crack.
Genes: Geneticists believe that the reason some people try cigarettes and do not become smokers, while others do so very quickly is probably linked to the type of genes we inherit from our parents. Some people can smoke once in a while, throughout their lives, and never seem to become addicted, while others are unable to stop smoking without experiencing the unpleasant withdrawal symptoms. It is most likely that the way the receptors on the surface of our brain nerve cells respond to nicotine is influenced by our genes.
Mental Health: People with depression, high stess levels, ADHD (attention-deficit hyperactivity disorder), low self esteem, and several other mental conditions/illnesses have a higher risk of eventually becoming addicted to crack.
How To Help Someone
People who are struggling with crack addiction often experience psychological struggles such as feeling unable to quit. Mood swings are also common.
So what can you do to help?
Show real support. The most important thing you can do is show your support. By making sure the person feels your love, he or she will understand that you are prepared to do whatever needed to help them in their struggle with crack addiction. A support from their home environment makes a huge difference in recovering addict’s life.
Avoid the blame-game at all costs. While your loved one is going through a hard struggle, the last thing they need is someone to throw a blame on them…or yourself…or another family member. Addiction affects one in three American families. You are not alone. The more you learn about addiction, the more you can look into causes: genetics, environment, and trauma.
Stay positive! You can discuss successful recovery stories and communicate the high chances of overcoming addiction via treatment programs. Look into statistics and check out addiction advocacy groups like NCADD, Facing Addiction in America, and the Center on Addiction Studies at Columbia University for support.
Learn what you can about addiction. Always take into consideration that some things will be hard for you to understand regarding crack issues. What you can do is educate yourself about how crack works in the brain and how addiction develops.
Investigate evidence based family counseling. Finally, the Community Reinforcement and Family Training (CRAFT) program is an effective method of training with a therapist in order to prepare yourself to convince your close one to get help. It will help you learn how to cope with stress, motivate the addicted person to seek help, and support them during treatment.
References Sources: DEA: Cocaine
MEDLINE PLUS: Cocaine
NDIC: Crack Cocaine fast facts
NIDA: Cocaine https://www.drugabuse.gov/publications/drugfacts/cocaine
NYC HEALTH: Cocaine abuse & addiction
All of the information on this page has been reviewed and verified by a licensed medical professional.