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cocaine-related disorders

Alternative Names
cocaine addiction, cocaine abuse, cocaine intoxication, cocaine-induced psychosis, cocaine-induced mood disorders, cocaine-induced anxiety disorders, cocaine sleep disorders, cocaine withdrawal, cocaine dependence, crack addiction, psychoactive substance use disorder (PSUDs)

Definition
Cocaine comes from the leaves of the coca plant, which grows mostly in South America. Cocaine has the ability to constrict blood vessels and causes noticeable changes in mental processes and moods. Some forms of cocaine are used in medications, such as anaesthetics, which dull or block pain sensations. When cocaine is boiled with sodium bicarbonate, it is converted into a freebase form called crack cocaine. This can then be smoked and results in a brief, intense high. Crack is relatively cheap and extremely addictive.

What is going on in the body?
Cocaine can be taken orally, inhaled in powder form through the nose, (snorting), or injected directly into a vein (mainlining). The effects of cocaine can be felt within seconds. Cocaine provides a dramatic "high" that lasts 3 to 5 minutes with crack cocaine. The high lasts for up to 30 to 60 minutes when cocaine is snorted or injected. Afterwards, the user feels an intense craving for the drug. Dependency can develop in less than 2 weeks. Some research indicates that a psychological dependency may develop after a single dose of high- potency cocaine.

What are the signs and symptoms of the condition?
The signs and symptoms of cocaine abuse include:
  • loss of weight
  • anxiety and depression
  • large amount of time spent in activities associated with getting cocaine
  • neglected daily routine
  • inability to give up cocaine use, despite awareness of its real or possible negative effects on health, personal life and work
  • paranoid thinking and problems with reality testing
  • tolerance to the drug so that more and more of the drug is needed to produce the desired effect
  • withdrawal symptoms, including severe depression, anxiety, irritability, isolation, tremors, lethargy, fatigue, nightmares, headache, sweating, muscle and stomach cramps and intense hunger
What are the causes and risks of the condition?
Cocaine is an extremely dangerous drug with powerfully addictive properties. Snorted, injected, and crack cocaine have both acute and chronic complications.
  • damage to the heart, nose and throat, seizures, and sudden death.
  • mental problems, including cocaine psychosis.
  • a rise in emergency room admissions for cocaine overdose.
  • frequent exposure to social situations that encourage drug abuse.
  • childhood history of having one or both parents dependent on a mood-altering substance. In this case, both learning and genetics may contribute to the risk.
What can be done to prevent the condition?
More education is needed for people at high risk of dependence on cocaine. This education needs to begin in childhood so that people can form healthy attitudes and understand the risks of drug use. Reducing society's tolerance of drug abuse can also help to deter cocaine use.

How is the condition diagnosed?
Cocaine abuse may be suspected when a person is hyperactive, pupils are dilated, and the heart rate is increased. Blood or urine tests can confirm cocaine use.

What are the long-term effects of the condition?
Serious physical decline will occur with long-term cocaine use. These effects may be due to the drug itself, or to the lifestyle associated with the cocaine use. People who inject cocaine are at a much higher risk for some diseases if they share needles with others. Long-term effects can include:
  • paranoid thinking and decreased reality testing, isolation
  • nutritional problems as a result of poor eating
  • heart problems
  • depression, sleeplessness, anxiety and suicide
  • development of a psychotic disorder
  • infection with the AIDS virus
  • hepatitis, particularly hepatitis C
  • overdose, which can result in seizures, coma and death
  • increased risk of infection
  • brain haemorrhage, high blood pressure and stroke
  • intense craving for the drug
  • seizures
  • violence
What are the risks to others?
  • Babies may be born dependent on cocaine.
  • Babies may also have a low weight at birth, or be born prematurely. Infants can be stillborn, or have birth defects.
  • People who use drugs have poor judgment, lack of control over impulses, and reduced motor control. They put themselves and others at increased risk for accident or emotional injury each time they use drugs.
What are the treatments for the condition?
Treatment begins with helping the person to recognise that there is a problem. People who are dependent on cocaine tend to deny the severity of the problem and to refuse to admit it to others.

Once the person has recognised and admitted a problem, the goal is complete abstinence from the drug. Some people may need to be monitored for any medical problems that result from the cocaine use.

Recovery programs are helpful for many people after they are medically stable. These programs help people to learn new coping skills and strategies to manage their lives without cocaine. Self-help groups like Narcotics Anonymous, and Cocaine Anonymous have been very effective in helping thousands of people stay free of drugs.

Severe depression is common after stopping cocaine use, and may last for months or years after the last use of the drug. The use of antidepressants for this depression is common.

What are the side effects of the treatments?
Side effects vary depending on the medication used to treat the depression associated with cocaine abuse.

What happens after treatment for the condition?
Those who complete treatment often continue with counselling or self-help groups. It is very important for the person to avoid situations that may lead to returning to cocaine use.

How is the condition monitored?
This condition is monitored by counsellors, family and friends.

Author:
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Contributors
Potential conflict of interest information for reviewers available on request


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