Cocaine is the number one illicit drug requiring emergency department (ED) treatment. The Drug Abuse Warning Network (DAWN) report published that in 2011, over 500,000 people – or more than 40 percent of the illicit drug ED visits that year – visited the ED because of cocaine.
Cocaine is a stimulant drug that is highly addictive. It can raise blood pressure, body temperature and heart rate to dangerous levels, potentially causing strokes and cardiac arrest. Cocaine overdose deaths increased nearly 30 percent between 2001 and 2013 with over 5,000 overdose fatalities in 2013, according to the National Institute on Drug Abuse (NIDA).
What Is Cocaine?
Cocaine comes from the coca plant, and it is currently illegal in all forms in the United States. Cocaine is either abused as a white powder by snorting, smoking, or dissolving and injecting it, or in rock form called crack, which is generally smoked, although is sometimes inserted into bodily orifices.
Cocaine is quick to take effect, making users feel high. The drug increases energy levels and suppresses appetite and the need to sleep by flooding the brain with “happy cells” or dopamine. It also wears off rather quickly, resulting in a crash that may be indicated by periods of sleeping, depression, and generally feeling low. Users may seek to avoid this crash and continue to take the drug, or take it in binge patterns wherein more and more of the drug is taken at a time and in higher doses.
Regular abuse of cocaine changes the normal circulation and production of dopamine in the brain, making it harder and harder to feel pleasure without the drug. Chronic cocaine abuse may quickly lead to addiction. The National Survey on Drug Use and Health (NSDUH) reported that in 2013, approximately 855,000 Americans aged 12 and older were considered to have a cocaine abuse or dependency problem, while 1.5 million had used cocaine in the month prior to the survey.
Rehab may be either outpatient or residential, depending on the level of care desired, and both forms of treatment can be effective. Treatment for cocaine addiction may have several different components, and a comprehensive rehab program provides various successful tools for a long-lasting recovery.
Sides Effects of Use
The sudden removal of cocaine from the bloodstream may lead to some physical symptoms, such as abdominal cramps, muscle aches, nausea and/or vomiting, extreme fatigue, lethargy, and intense drug cravings. Due to its stimulant nature, cocaine withdrawal may include even more heightened emotional side effects, like agitation, anxiety, outbursts of anger, aggression or violence, severe depression, lack of motivation, inability to feel pleasure or emotional numbness, and paranoia.
While stimulant drug withdrawal is rarely life-threatening on its own, drug cravings and the emotional side effects may be intense, which may lead to suicidal thoughts or actions. The risk for attempting suicide within a person’s lifetime is six times greater for someone with a substance use disorder than someone without one.
Psychiatric Times reports that cocaine (as well as opioids and sedatives) may raise the risk for suicidal behaviors even more than the abuse of other drugs.
What Rehab Entails
Cocaine rehab may begin with a drug detox program that can provide around-the-clock medical supervision and monitoring to ensure the addict’s safety. There are currently no specific medications approved to treat cocaine dependency and addiction; however, medical detox programs may use pharmaceuticals to help manage specific symptoms. Antidepressants may be useful to combat depression, for example. Beta blockers like propranolol may be effective for reducing restlessness and anxiety as well as lowering the intensity of drug cravings and helping achieve sobriety early on, a study published in Psychiatry found.
Cocaine is often abused with other drugs, as NIDA reports that 72 percent of those seeking treatment for a problem with cocaine abuse or dependency in 2007 abused more than one drug, a practice known as poly-drug abuse. This can complicate detox as other drugs may have different withdrawal side effects and require different treatments or medications to help manage the symptoms. A detailed evaluation and drug screening should be done upon entering a cocaine rehab or detox program.
After all drugs are fully removed from the bloodstream and initial stabilization is reached, rehab programs can move on to addressing the underlying or root cause of addiction and substance abuse to prevent a future relapse.
Research is ongoing as to medications to help with relapse prevention during aftercare for cocaine addiction. Several GABAergic pharmaceuticals, such as topiramate, tiagabine and baclofen, may be effective at reducing cocaine cravings or blocking the effects of cocaine if it is reintroduced to the system.
Maintaining Emotional Health
Behavioral therapies play a central role in both residential and outpatient cocaine rehab programs. Outpatient programs offer more flexible scheduling and may work best for someone with a supportive and involved network of family and friends who are all committed to the recovery plan. A more comprehensive approach, residential treatment programs provide 24/7 access to medical and mental health professionals within a structured and controlled environment.
Therapy sessions for both programs will likely include both group settings as well as individual sessions. Therapy provides educational opportunities and teaches new and healthy ways to manage drug cravings and the potential life stressors that may trigger those cravings. Cognitive Behavioral Therapy, or CBT, examines the relationship between thoughts, behaviors and actions, and then addresses ways to modify them in a positive manner.
Another technique often used during cocaine rehab is motivational interviewing (MI) or contingency management, which offers vouchers and prizes for clean urine samples or drug tests.
Lack of motivation can be a side effect of cocaine addiction and withdrawal, and MI can provide the motivation to remain abstinent. The National Institute of Health (NIH) published a study showing that at the end of 12 weeks, more than three times as many addicts who participated in an MI program were still drug-free as opposed to their peers who attended other programs.
Mental illness and substance use disorders commonly co-occur, with 7.7 million American adults aged 18 and older suffering from both in 2013, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Mental health is evaluated during cocaine rehab, and any mental health disorders that may co-occur with addiction are identified and treated accordingly.
Nutrition and overall physical well-being are also addressed, and structured sleep schedules as well as a diet plan and exercise program may be instituted during rehab in order to promote recovery and prevent relapse. Feeling better physically also enhances emotional health and elevates self-esteem levels.
Family counseling and 12-Step groups like Cocaine Anonymous can aid addicts in building a healthy support network to help maintain sobriety long-term. Sober living communities serve as an in-between step from a more in-depth cocaine rehab program and returning home. In sober living homes, groups of addicts are required to remain sober, submitting to random drug tests, and live together in a home for a period of time while attending meetings and therapy sessions. Many will return to work during this time as preparations are made to transition back into everyday life.
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