Cocaine

Summary

• Mix of substance use disorders and mental health disorders
• Treatment should be well planned and client-centered

The term co-occurring disorders or COD means having at least one mental illness along with one or more substance use disorder. But there is nothing simple about having this condition. The two or more disorders will negatively impact each other. This requires that each disorder be treated separately but also at the same time. Recovery is not an easy process, but it is a goal that can be reached.

Types of COD

Substance use disorder can occur along with any mental illness. Some of the more common mental health issues linked with COD include:

• Depression
• Anxiety
• Schizophrenia
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)

Other disorders related to mood, anxiety, sleep, eating, and personality also often occur with COD.

Some common classes of substance use disorders include:

• Alcohol
• Nicotine
• Caffeine
• Cannabis
• Cocaine
• Amphetamines
• Sedatives
• Opioids

People with COD can have any mixture of substance use disorders and mental health disorders, but at least one of each.

Risks of COD

People with COD have certain higher risks than people with a single disorder. They also tend to be in poorer health and have a greater chance of relapse. Some of this is due to not taking or responding to treatment as well. The time and cost involved in this treatment is also higher.

Among these increased risks are:

• Violence
• Physical illness
• Psychosis
• Hospitalization
• Homelessness
• Unemployment
• Incarceration
• HIV/AIDS

Screening for COD

About half of all people with severe mental illnesses also have substance use disorders. The rate of people with substance use disorders who have mental illnesses is even higher. Despite these facts, screening for COD can be a challenge. A mental health service may not be able to spot substance use disorder. A substance use treatment center may not be able to spot mental illness. The screening process should decide whether or not the person needs to be further assessed. This assessment is then performed by a mental health doctor or other trained health care worker.

Treatment and recovery

Treatment for COD must target each disorder by itself and at the same time. This may occur in one setting or a number of settings. Treatment should be well planned and client-centered. This means the person with COD needs to be involved with all aspects of care. The type of care will depend on the types of substance use and mental disorders. It should also be tailored to the person’s unique needs and goals.

COD takes a toll on those who have it and on those around them. Coping skills must be taught to the individual as well as to her support group. Progress may be slow and sometimes hard to measure. The chance of relapse seems to always be right around the corner. Setbacks should be met with support rather than blame. The person will respond to praise much more than to guilt. Recovery is a long process that will require a group effort. It is not an easy task but it is well worth it.

Resources

Alcoholics Anonymous
www.aa.org

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2022 Carelon Behavioral Health

Summary

• Even a small amount can cause a toxic reaction that could be life-threatening.
• Extreme behavior changes are telltale signs of a toxic reaction.
• Cocaine and alcohol, used together, are especially dangerous.

Cocaine is a stimulant that changes how a person feels, thinks, and acts. Even using it one time can cause a toxic response that could be life-threatening. Next to alcohol, cocaine continues to be a widely found cause of drug-linked emergency room visits. Cocaine and alcohol mixed is the most common two-drug mixture that results in death.

According to the Centers for Disease Control and Prevention (CDC), there is an emerging trend in the presence of Fentanyl mixed with purchased cocaine. The use of Fentanyl increases the risk for overdose death due to a person’s lack of opioid tolerance. Additionally, Narcan© reversal options might not be as readily accessed for cocaine users, as it would be for opioid users in the general public of the medical treatment setting.

Dr. Richard Clark, an emergency medicine doctor and toxicologist at University of California, San Diego, describes toxic reactions to cocaine and when to get help right away.

What is a toxic reaction to cocaine?

Sometimes, a person’s body responds differently to cocaine than it normally would, resulting in an extreme or toxic reaction. When this happens, the person goes into a state of excited delirium, meaning the person may hallucinate, lose touch with reality, and be overly excitable. The body also can get dangerously hot, and the heartbeat can become irregular.

When is a toxic reaction to cocaine life-threatening?

There are two main life-threatening problems that can result from a toxic reaction. One involves a disruption of the normal heart rhythm. It starts out as a rapid heartbeat, which happens to anybody who uses cocaine, but then the heartbeat becomes irregular and can go into ventricular tachycardia or ventricular fibrillation, which are potentially fatal heart rhythms. The second is convulsion, or seizure. If a person convulses for a long period of time, the brain can swell, which can cause death.

Toxic reaction also can cause serious problems for other organ systems, some of which are long-lasting or life-threatening. For instance, if body temperature exceeds 104°F or 105°F, all sorts of organ damage can occur, such as brain damage, liver damage, and kidney damage.

Is a toxic reaction the same thing as overdose?

No. You don’t need to overdose—or take too much cocaine—to get this type of reaction. We don’t know why this reaction occurs in some people some of the time. Some research suggests that people who have experienced a toxic reaction may have more of certain brain cells that are affected by cocaine.

How can you tell if a person is having a toxic reaction that needs emergency care?

Extreme behavior changes are a telltale sign. For example, a person may hallucinate, act inappropriately or violently, or do unusual things. Paranoia is commonly seen with this type of reaction. Seizure, high fever, profuse sweating, chest pain, shortness of breath, and vomiting are also clear physical signs that emergency care is needed.

Are there warning signs leading up to a toxic reaction?

Toxic reaction usually happens fairly quickly after using cocaine. Typically, a person will behave oddly at first. But a life-threatening problem, like a seizure or abnormal heartbeat, can begin fairly quickly and unexpectedly.

What is the danger of mixing cocaine with alcohol?

Cocaine and alcohol when mixed in the body forms a compound called cocaethylene. This compound is especially dangerous because it is longer-lasting and more toxic to the heart and brain than either cocaine or alcohol alone.

What advice do you have for family members or friends of people who use cocaine?

Call 911 or get emergency care right away if someone appears to be having a bad reaction to cocaine. Don’t wait to see if symptoms improve.

Resources

National Institute on Drug Abuse
www.drugabuse.gov

National Institute on Drug Abuse Research Dissemination Center
http://drugpubs.drugabuse.gov/

Substance Abuse Treatment Services Locator
(800) 622-4357
www.findtreatment.samhsa.gov

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: Interview with Richard F. Clark, M.D., Professor of Clinical Medicine, University of California San Diego (UCSD) School of Medicine Department of Emergency Medicine and Director, UCSD Division of Medical Toxicology and Medical Director, San Diego Division, California Poison Control System; The Drug Abuse Warning Network. Highlights of the 2010 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Substance Abuse and Mental Health Services Administration, http://www.samhsa.gov/data/2k12/DAWN096/SR096EDHighlights2010.pdf; “Cocaine: Abuse and Addiction.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/research-reports/cocaine-abuse-addiction; www.npr.org/sections/health-shots/2018/03/29/597717402/fentanyl-laced-cocaine-becoming-a-deadly-problem-among-drug-users; www.drugabuse.gov/drugs-abuse/emerging-trends-alerts; http://triblive.com/local/valleynewsdispatch/13340474-74/fentanyl-cocaine-combo-taking-lives-in-western-pa; www.dea.gov/druginfo/fentanyl-faq.shtml

Reviewed by Philip Gianelli, M.D., D.A.B.P.N., F.A.B.A.M., Medical Director, Beacon Health Options

Summary

• There is a high rate of depression and alcohol use.
• Bipolar disorder and marijuana use co-occur frequently.
• Schizophrenia and tobacco use is very common.

Co-occurring disorders (COD) means having at least one mental illness and one or more substance use disorder. The substance use can be any drug or drugs. The mental illness can be any mental disorder. There are many types of COD. Some, though, are more common than others.

Depression and alcohol use

Depression is a mental illness that is often ignored. Sometimes it is from some other health issue. Symptoms can be weight loss, lack of sleep and lack of energy.

A third of people with low spirits also have a substance or alcohol use disorder. Many people drink as a way of dealing with depression. While it may give short-term help, drinking makes things worse in the long run. It can even cause a person to feel even lower. Alcohol use often hinders a person’s mental health care. The person who is drinking is less likely to stick to her doctor’s plan. She may forget to take her pills and miss doctor visits.

Alcohol use has its own set of risk factors. Short-term can include bad judgment and motor skills as well as more risk taking. This can lead to alcohol-linked car crashes, injuries and death. Long-term issues can include liver and heart disease.

Bipolar disorder and marijuana use

A person with bipolar disorder has mood swings that get in the way of his normal life. These mood shifts can cause problems at home, at school, or at work. The low stages are much like states of depression. The difference is that people with bipolar disorder also have high stages called mania. Mania symptoms include high energy, rapid thoughts and speech, and reckless actions.

As with depression, there is a high rate of alcohol use among people who have bipolar disorder. Studies show an even higher rate of marijuana use among these same people. Marijuana is believed to be a trigger for those who are prone to the disease. It is not known if marijuana is a cause of the illness. It does appear to make the risk of getting such disorders higher.

Schizophrenia and tobacco use

Schizophrenia is a long-term mental illness that touches millions of adults. It upsets a person’s thinking, which can cause strange outward actions. People with the illness often hear voices. They may also see things that aren’t really there. These voices and visions are very real to the person. This can cause great fear within the person. It can also cause other people to be fearful of them and to stay away from them.

It is very common for people with schizophrenia to also use tobacco. Smokers with this illness have a greater dependence and a harder time quitting. When they do stop smoking, the withdrawal symptoms are worse than for those without the disease. The link between these disorders is thought to be the central nervous system. People with schizophrenia can have a hard time with memory and staying focused. Nicotine may make them feel better, but the long-term hazards of smoking greatly offsets any benefit.

Treating COD

No matter what type of COD you have, you should be treated for each issue separately. This is because one will affect the other. Treatment will most likely be talk therapy as well as taking meds. A 12-step program might be needed for substance use issues. Treatment may be long-term, but if you stick with it, you will get better.

Resources

Alcoholics Anonymous
www.aa.org

Depression and Bipolar Support Alliance
www.dbsalliance.org

Mental Health America
www.mentalhealthamerica.net

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: National Center for Biotechnology Information, www.ncbi.nlm.nih.gov/pmc/articles/PMC2215390/ www.ncbi.nlm.nih.gov/pmc/articles/PMC2811144/ and www.ncbi.nlm.nih.gov/pubmed/21288470; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml; National Alliance on Mental Illness, www.nami.org; Mental Health America, www.nmha.org/conditions/co-occurring-disorders-and-depression

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• Treatment should be client-centered.
• You may also need help with housing, child care, or finding a job.
   

Having a mental illness or a substance use disorder can be hard to deal with. Having both is even harder. Studies show that people with co-occurring disorders (COD) are less likely to comply with or respond to treatment. This puts them at a greater risk for relapse. They are also more likely to become violent, experience homelessness, or go to jail. The risk of getting AIDS and other illnesses is higher as well.

There is hope though. You can improve with proper treatment. This means being treated for both issues separately but at the same time. This is because the disorders not only co-exist, but they also co-affect each other. For instance, someone with depression may drink alcohol to try to feel better. A person who drinks may do so because he feels depressed. If only one issue is being addressed, the other issue can disrupt its treatment.

Before you can begin feeling better, you must first realize the need for treatment. You may not want to admit to your family or yourself that you have a mental illness. You may be afraid to tell your doctor or your boss about your substance use. You may be trying to hide one or both issues from your friends or co-workers. Maybe you simply are not sure if you have any serious issues or not.

Signs of mental illness

The symptoms of mental illness will vary depending on the disease. Often a person may not realize she is impaired. This is true whether it is the onset of a disease or a relapse. It is therefore good to have friends or family nearby looking out for you.

Some of the signs that could indicate a mental illness include:

• Extreme moodiness
• Depression
• Nervousness
• Paranoia
• Withdrawal
• Apathy
• High-risk taking
• High sensitivity
• Extreme irritation
• Inattention
• Trouble with eating or sleeping
• Sexual dysfunction

Signs of substance use disorder

Substance use disorder can have some of the same symptoms of mental illness. Some other signs that you may have a substance use disorder include:

• Getting drunk or high regularly
• Drinking or doing other drugs by yourself
• Driving while drunk or high
• Building up a tolerance to alcohol or other drugs
• Hiding or lying about drinking or taking other drugs
• Withdrawing from friends or hobbies to get drunk or high
• Going to work or school high or drunk
• Missing work or school because of drugs or alcohol
• Passing out or being hung over often

If you think your drinking or drug use may be an issue, get help right away. Do not try to carry the burden all by yourself. Seek out a trusted friend or loved one. Speak to a pastor or counselor. Then find a substance use treatment center and get involved in a 12-step program.

Client-centered treatment

To be successful, both disorders should be treated at the same time. Once you have reached out for help, you must stay involved in the treatment process. This means being active in the planning and decision making. Other people can give you advice but you should make your own choices. This will help empower you to better promote your own recovery.

Talk therapy will be a big part of your treatment. This may include one-on-one, group and family counseling. A 12-step program may be needed for help with substance use issues. Social skills and stress coping skills should be addressed. You may also need help with housing, child care or finding a job. Though you have the lead role, you will need the support of many others. Welcome the input from your doctor or health care worker, as well as family and friends. Realize that they all want what is best for you.

Be aware that recovery may take months or even years. Your progress may be slow at times and there could be setbacks. Do not lose hope. Instead, focus on short-term goals and ask for extra support. Distance yourself from negative influences and surround yourself with positive people. Believe that if you stay on course with your treatment, you can and will get better.

By Kevin Rizzo

©2014-2021 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; National Alliance on Mental Illness, www.nami.org; Mental Health America, www.mentalhealthamerica.net/conditions/co-occurring-disorder-and-youth

Summary

• Attend doctor appointments and support group meetings.
• Help her establish daily routines for eating, sleeping, and taking pills.
• Praise her successes and don’t dwell on her failures.

No one likes to see someone they care about go through hard times. A friend with a substance use disorder is hard to be around. A child with a mental illness is tough on the whole family. If you know someone with both issues, then you know it is even harder. As taxing as it may be, your support is a vital part of their recovery.

Identify the issues

The first step is to realize there is a co-occurring disorder (COD). Your friend or loved one may be in denial about her own situation. Her doctor or health care worker may not be aware of the other issue either. Therefore, the person is only getting treated for one issue. This is less than ideal since the two conditions affect each other. For instance, someone being treated for depression may drink alcohol to try to feel better. A person attending Alcoholics Anonymous meetings may continue drinking because she feels depressed. If only one issue is being addressed, the other issue can get in the way of its treatment. For treatment to work, it must be given for both disorders at the same time.

You may know your friend or loved one better than anyone. Therefore, you may be the first one to notice when he isn’t acting like himself. Watch out for sudden changes that may indicate mental illness or substance use or both.

Some of these changes may include:

• Extreme moodiness, touchiness or irritation
• High-risk drinking
• Violence
• Depression
• Apathy
• Inattention
• Nervousness
• Paranoia
• Withdrawal
• Eating, sleeping, or sexual troubles

Ways to promote recovery

When someone you care about has COD, you may feel helpless. This is a normal feeling, but it is far from the truth. Not only can you help, but your friend or loved one needs your help. Helping does not mean taking on the burden yourself. It does not mean you become the person’s enabler or watchdog either. A person with COD has to first be willing to get help. Recovery is hard work and no one can do the work for her. Your job is to show your support throughout the process. This means during both the good times and the bad times.

Sometimes, the best way to help someone with COD is just to be there for him. This allows your friend or loved one to open up about his struggles. You don’t need to have all the answers. You just need to give encouragement and support. Listen to him, and let him know he is not alone.

Here are other ways to help a friend or loved one recover:

• Go with her to doctor appointments.
• Attend support group meetings.
• Help her establish daily routines for eating, sleeping, and taking pills.
• Praise her successes and don’t dwell on her failures.
• Be patient with her.
• Encourage her by staying positive yourself.
• Invite her to partake in healthy activities.
• Stay informed about the disorders.
• Don’t ignore thoughts of suicide—call their doctor or 911.

Resources

Alcoholics Anonymous
www.aa.org

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; National Institute of Mental Health, www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• Screening for both issues can be difficult
• Certain mental illnesses occur more commonly with substance use disorders
• Alcohol and nicotine are common drugs linked with COD

Checking for a mental illness is often fairly clear-cut. That is because a lot of research has been done to make this process better. The same can be said for substance use disorders. We now know a great deal more about this field than we ever did before.

It is harder to screen for more than one issue at the same time. One reason for this is a lack of dual training. A mental health service may not be able to spot a substance use disorder. A substance use treatment center may not be able to spot a mental illness. So just how does one know if he has a co-occurring disorder (COD)?

COD means having at least one mental illness and one or more substance use disorder. The substance use can be any drug or drugs. The mental illness can be any mental disorder, but some are more common with COD.

Depression and COD

Depression is a mental illness that is often ignored. Sometimes it is the result of another health matter. Symptoms can be weight loss, lack of sleep, and lack of energy. These signs are also common among other health issues. Studies show that a third of people with depression also have a substance use disorder.

Bipolar disorder and COD

Roughly 60 percent of people with bipolar disorder also have a substance use issue. It is thought that these two disorders affect the same chemicals in the brain. Studies suggest that people with this illness may try to medicate themselves through alcohol use. It is also believed that bipolar disorder may be a risk factor for substance use. Marijuana use can be very common with this disorder.

Schizophrenia and COD

Substance use disorder happens quite often with schizophrenia. Drinking and drug use can also mask some of its symptoms. This is true both during times of use as well as times of withdrawal. Marijuana use can even make the symptoms worse.

Obsessive-compulsive disorder and post-traumatic stress disorder also happen often with COD. Other disorders linked to mood, anxiety, sleep, eating, and personality can be common as well.

Substance use disorders and COD

Any drug can be the source of a substance use disorder. This can range from caffeine and nicotine to cocaine and heroin. When the drug use causes harm or makes normal living hard it is a disorder. Social, legal, and physical problems are often the result.

Alcohol and nicotine are among the most common drugs linked with COD. These types of addictions are very hard to break, but it can be done. Recovery requires a strong support group. Substance use must be treated apart from, but at the same time as, mental disorders.

Signs of substance use disorder

Substance use disorder has a broad range of symptoms based on the drug or drugs. Many of these are the same as those for a mental illness. Here is a list of some of the more common signs to look for:

• Moodiness
• Nervousness
• Touchiness
• Low spirits
• Numbness
• Forgetfulness
• High-risk taking
• Withdrawal

You may not realize that your drinking or substance use is an issue. You may be in denial about your need for help. Here are some other signs that you may have a substance use disorder:

• Getting drunk or high all the time
• Drinking or doing other drugs by yourself
• Driving while drunk or high
• Building up a tolerance to drinking or other drugs
• Hiding or lying about drinking or taking other drugs
• Withdrawing from friends or hobbies to get drunk or high
• Going to work or school high or drunk
• Missing work or school because of drugs or drinking
• Passing out or being hung over often

Get treatment

If you think you may have COD you should tell your doctor right away. You can then be evaluated to see if you need to be looked at further. If you do have COD, early care will help with your recovery. You should also notice feeling much better when you are being treated for both issues. With the right help and support, people can and do recover.

Resources

Alcoholics Anonymous
www.aa.org

Depression and Bipolar Support Alliance
www.dbsalliance.org

Mental Health America
www.mentalhealthamerica.net

Narcotics Anonymous
www.na.org

National Alliance on Mental Illness
www.nami.org

National Institute of Mental Health
www.nimh.nih.gov

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

By Kevin Rizzo

©2014-2019 Carelon Behavioral Health

Source: Substance Abuse and Mental Health Services Administration; Mental Health America, www.nmha.org/conditions/co-occurring-disorders-and-depression and www.mentalhealthamerica.net/conditions/co-occurring-disorder-and-youth; National Alliance on Mental Illness, www.nami.org; National Institute of Mental Health, www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml

Reviewed by Sanjay Vaswani, M.D., C.M.Q., D.F.A.P.A., Regional Medical Director, Beacon Health Options

Summary

• Cocaine affects individuals and families, and contributes to societal problems.
• There are effective ways to approach people about getting help.
• You can contribute to a person’s cocaine problem by enabling.

If you have a friend or family member who uses cocaine, you have cause for concern. Cocaine is a powerful drug that is highly addictive. Even occasional use can quickly turn to overuse and addiction. People who use it risk losing everything, including their family, friends, career, money, and even their lives.

Cocaine use also affects communities. Drug use plays a major role in these societal problems:

• Crime and homicide
• Family violence and child abuse
• Homelessness
• Drugged driving
• Workplace absenteeism, lost productivity, and accidents
• Higher health care costs

For all these reasons, approaching a loved one or friend about cocaine use—even casual use—is worth any awkwardness or conflict that may result. If you have any concerns, now is the time to act.

How can I tell if someone I care about has a problem with cocaine?

Clues that your friend or loved one may have a problem with cocaine use include:

• Neglecting or loss of interest in school, work, family, and longtime friends
• Hanging out with a new set of friends
• Problems at school or at work
• Mood swings
• Weight loss, sleep problems, or frequent nosebleeds
• Not being able to stop or cut back on cocaine use
• Ongoing use of cocaine despite the problems it causes

Remember, no amount of cocaine use is risk-free. Even a single use can cause heart attack, stroke, seizures, too-high body temperature, and other health emergencies.

How can I approach a friend or loved one with a cocaine problem?

Share your concern and desire for the person to stop using in a loving and nonjudgmental way. Do this when the person is drug-free and clearheaded. Give examples of problems in the person’s life that are caused by cocaine use. Offer to help your loved stop using or seek treatment.

Keep in mind that your friend or loved one may not see the problem like you do or deny a problem even exists. Addiction is a long-term and progressive brain disease. This means that cocaine use actually changes the structure of the brain and how it works. These brain changes reinforce ongoing drug use while reducing a person’s self-control and ability to resist the urge to use again and again.

Holding a formal intervention may be the only way to reach a friend or loved one who has a cocaine problem and resists help. During an intervention, family members, friends, and concerned others join forces to confront the problem and to ask the person to accept help. A plan for treatment is arranged before the intervention so that it can begin as soon as the person agrees to accept help. Interventions must be carefully planned to go off well. Some people hire an intervention or drug addiction specialist to help plan and facilitate it.

Could I be contributing to a friend or family member’s problem with cocaine?

Many people don’t realize the role they play in a person’s continued use of cocaine. Here are some examples of enabling:

• Allowing a person who uses cocaine to live in your home
• Giving a person who uses cocaine money, or paying her bills
• Covering for or making excuses for problems caused by cocaine use, such as missing school or work
• Providing emotional support, through sex or friendship, despite continued drug use

It can be hard to tell the difference between enabling and being supportive and loving to a person in need. A family therapist can help you spot enabling behaviors and set boundaries and limits. Support groups for family and friends of those with substance use disorder also can help you learn ways to cope with a loved one’s addiction and recovery.

Resources

Association of Intervention Specialists
www.associationofinterventionspecialists.org

National Council on Alcoholism and Drug Dependence
www.ncadd.org

Co-Anon Family Groups
www.co-anon.org

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: “Drugs, Brains, and Behaviorﾗthe Science of Addiction.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/science-addiction; “Cocaine: Abuse and Addiction.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/research-reports/cocaine-abuse-addiction; “NIDA Info Facts: Cocaine.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/drugfacts/cocaine; “What Is Intervention?” Association of Intervention Specialists, http://www.associationofinterventionspecialists.org/what-is-intervention/

Reviewed by Philip Gianelli, M.D., D.A.B.P.N., F.A.B.A.M., Medical Director, Beacon Health Options

Summary

Before forming an opinion about someone with substance use problems, consider these common myths.

“Those who overuse substances have a moral flaw.”

“People with alcohol and substance use disorders don’t want to quit—if they did, they would just stop using.”

“Locking up all the people who overuse substances will solve the problem.”

These and many other myths about drug use add to the problem. The stigma tied to drug use discourages treatment for addiction and limits chances for work, housing, and social relationships. Although drug use has a deep, harmful impact on society, it is not an insurmountable problem. Become part of the answer by helping to stop stigma.

Identifying the problem

Most American families have been touched in some way by a loved one with problems with drugs or drinking. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use & Health, 24.6 million Americans aged 12 or older said they had used an illicit drug during the month before the survey.

Unfortunately, many people who have problems with drug use will come across stigma that hinders them from integrating back into society. Police, the legal system, ER staff, and even family members and friends can keep the stigma going, and stigma limits the attention and resources dedicated to solving problems linked to substance use. “Stigma is about discrimination,” says Ivette Torres, Director of Consumer Affairs for SAMHSA’s Center for Substance Abuse Treatment.

Separating myth from fact

Stigma comes from the myths about drug use. Before forming an opinion about someone with substance use problems, think over these common myths:

Myth: Those who overuse substances have a moral flaw—they could will themselves to stop using if they wanted to quit.

Fact: One common and false stereotype about people with substance use disorders is that they are all social misfits and outcasts. “Stigma can also get at the idea that the person is weak of character or untrustworthy,” explains Jim Beek, a SAMHSA information officer. In reality, “normal” people deal with drug use issues, which can touch whole families. Drug and alcohol dependence meet the standards for treatable, chronic health issues; dependence is not simply a matter of choice. “One of the biggest and most pervasive myths is that … a user can stop using alcohol or drugs by willing themselves to,” agrees Torres. “Society at large has to accept addiction treatment and begin to look at it as a public health issue.”

Myth: Addiction is not reversible: Once an addicted to a substance, it is always that way.

Fact: Many people don’t realize how helpful programs and services can be in treating substance use disorder. In fact, drug addiction treatment works as well as established medical treatments for other illnesses such as diabetes and asthma, the Physician Leadership on National Drug Policy has reported. Another study found that for each dollar invested in treatment, taxpayers saved $7 in future costs, according to the National Institute on Drug Abuse.

Unfortunately, the shame tied to being labeled or viewed negatively by others can keep people from seeking care. “Stigma is a factor,” Torres notes. “That’s why you see so many individuals speaking out, saying, ‘Recovery is possible. I am an example of that.’’’ And luckily, new choices, such as the prescription addiction treatment drug buprenorphine, can help stop the stigma linked to lining up outside a clinic.

Myth: Harsher criminal penalties for using drugs or increasing efforts to cut off the drug supply will solve the problem.

Fact: This common wisdom is at odds with research showing the effectiveness of treatment. And, keep in mind that there is no “silver bullet” when it comes to solving drug use problems. While a blend of things such as treatment, parental influence, and education programs can help, taken alone, “get tough” approaches don’t address the underlying social and family issues linked to drug use.

You can help

While views about people with drug problems and treatments have gotten better, we still have a long way to go toward skillfully addressing these issues. You can help by facing your own attitudes. If you know someone who may have a drug problem, treat him with concern, dignity, and respect. Rather than turning your back or getting angry, offer your support.

Resources

National Institute on Drug Abuse
www.drugabuse.gov

Physician Leadership on National Drug Policy
www.plndp.org

Substance Abuse and Mental Health Services Administration
www.samhsa.gov/

By Kristen Knight

©2022 Carelon Behavioral Health

Summary

• Treatment can help people stop using cocaine and prevent relapse.
• Recovery from cocaine problems is a long-term process.
• Support, such as self-help groups, can help you stay drug-free.

If you are trying to stop using cocaine, or even cutting down on its use, and have been unable to do so, you may doubt your ability to beat it. But treatment can and does work. It can help you stop using cocaine and also stay clean and sober. It also can help you get back to work, fix broken relationships, and restore meaning to your life. Read on to learn about effective treatments for cocaine problems, what recovery means, and the importance of ongoing support.

Treatment can help you stop using

Cocaine problems are treated in a variety of settings. Residential programs are good for people with severe cocaine problems or people who lack a strong support network and/or stable living or work situations. Outpatient programs are an option for people who have less severe drug problems, want to get treatment and have supportive friends and family. Some people are able to work during the day and get treatment at night, for example, or go to treatment during the day and return home at night.

When you enter treatment, a program counselor will design a plan based on your specific needs. This plan specifies:

• Your treatment goals
• Actions you will take to help meet your goals
• A timeframe for meeting your goals
• Ways to tell if your goals have been met

This plan is flexible and may change over the course of your treatment.

Behavioral therapy through one-on-one counseling is a key part of any useful treatment plan. Some plans also involve group counseling. Behavioral therapy can help you stop using and stay clean by helping you to:

• Build on your readiness to quit using
• Recognize emotions, people, places, and situations in which you are likely to use
• Develop ways to cope with cravings so you don’t relapse
• Identify and deal with painful emotions that underlie drug use
• Change harmful ways of thinking and destructive patterns that lead to drug use
• Develop life skills, such as stress management, to help you handle hard times in the future
• Create a drug-free lifestyle

The best treatment plans address the whole person, not just cocaine use. So, your treatment plan might also involve, for example:

• Mental health treatment, such as for depression
• Family counseling
• Learning job skills and career counseling
• Parenting instruction
• Social or legal services

Most people need at least three months in treatment to stop drug use, but the best outcomes come with much longer care. Once you have reached your treatment goals, you may need follow-up care for a year or longer to help you stay clean.

Some plans also offer motivational incentives whereby you earn points for testing drug-free. You can trade your points in for items that promote a drug-free lifestyle, such as a gym membership or movie tickets.

Right now, no medicine has been Food and Drug Administration (FDA)-approved for treating cocaine problems. Several health treatments under study show promise, and a recent clinical trial demonstrated that topiramate (Topamax®), a medication initially developed to treat seizures, can help individuals avoid using cocaine. Nevertheless, psychosocial therapies remain the main form of treatment for cocaine use.

Support can help you stay clean

Self-help recovery groups, such as Cocaine Anonymous, are very important to recovery. But self-help groups cannot take the place of treatment. Rather, they are a supportive fellowship of people also in recovery who meet regularly with the purpose of helping each other stay clean. Some groups, such as SMART Recovery, sponsor online meetings and chat rooms to obtain recovery support. Recovery groups often play an important role in a person’s recovery journey for many years.

Recovery is a process

Recovery is a process of change that begins once you stop using. Treatment is the first step. Then, you must put into practice the skills and new ways of thinking you learned in treatment and keep them up until they become second nature.

Returning to everyday life in the real world is hard, and you may be tempted to use or give in to cravings. Some people must enter treatment several times to stop using and learn new ways to cope with job stress, family problems, and social situations without using drugs. This does not mean that treatment does not work. Recovery is a healing process with both successes and setbacks. In time, maintaining the skills, habits, and ways of thinking that help you stay clean will make relapse unlikely.

Resources

Substance Abuse and Mental Health Services Administration
www.samhsa.gov

Cocaine Anonymous
www.ca.org

Narcotics Anonymous
www.na.org

SMART Recovery
www.smartrecovery.org/

Ending Addiction for Good: The Groundbreaking, Holistic, Evidence-Based Way to Transform Your Life by Richard Taite and Constance Scharff, PhD. Wheatmark, 2013.

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: “What Is Substance Abuse Treatment? A Booklet for Families.” Substance Abuse and Mental Health Services Administration, http://store.samhsa.gov/shin/content//SMA08-4126/SMA08-4126.pdf; “Cocaine: Abuse and Addiction.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/research-reports/cocaine-abuse-addiction; Principles of Drug Addiction Treatment: A Research Based Guide, 3rd edition. National Institute on Drug Abuse, http://www.drugabuse.gov/publications/principles-drug-addiction-treatment; “What is Cocaine Anonymous?’ Cocaine Anonymous World Services, www.ca.org; Ending Addiction for Good: The Groundbreaking, Holistic, Evidence-Based Way to Transform Your Life by Richard Taite and Constance Scharff, Ph.D. Wheatmark, 2013.

Reviewed by Philip Gianelli, M.D., D.A.B.P.N., F.A.B.A.M., Medical Director, Beacon Health Options

Summary

• Cocaine alters the brain’s reward pathway, which is why quitting is hard.
• Behavioral treatment can help people overcome cocaine problems.
• Stigma and misguided beliefs can keep people from seeking help.

I told myself no more. But I could never resist the urge to use one last time.

Have you used cocaine one last time, one time too many? If so, accepting that you have a problem with cocaine is the first step toward getting help. This article will tell you:

• Why quitting cocaine use is so hard
• How treatment can help you quit cocaine
• How to overcome barriers to seeking treatment

Cocaine can change the brain so you want to use more and more

Perhaps you think your problem with cocaine is a personal weakness. But science shows that cocaine use alters the brain’s reward pathway and how it works, teaching your brain to want it more and more. Science also shows that cocaine changes parts of the brain involved in:

• Decision-making
• Judgment
• Behavior control
• Learning
• Memory

These changes can impair your self-control and help explain, in part, why you may keep using despite your desire to quit and problems cocaine might have caused you.

The bottom line is that addiction to cocaine is a progressive and chronic brain disease that affects behavior. This is why few people with cocaine problems are able to quit using on their own. Read on to see how treatment can help you give up cocaine.

Treatment can help you quit using cocaine

Treatment can help you quit using cocaine. But treatment does not happen overnight. The urge to use cocaine can last for many months or longer after quitting. For this reason, long-term treatment offers the best chance for success.

Behavioral therapies are the most effective treatment for decreasing cocaine use and preventing relapse. They can involve:

• Providing incentives for not using and staying in treatment
• Developing skills to cope with triggers and resist cocaine
• Replacing cocaine use with productive and fulfilling activities
• Revealing and dealing with emotional factors that underlie addiction
• Changing negative ways of thinking and destructive patterns that contribute to drug use

Because addiction is a complex illness affecting many aspects of a person’s life, treatment may also involve:

• Learning job skills and career counseling
• Treatment for other illnesses, such as depression
• Family counseling
• Parenting instruction
• Social or legal services

Several medications have been studied to treat addiction to cocaine, but currently there are no medications approved by the Food and Drug Administration (FDA) for the treatment of addiction to cocaine. Some emerging evidence shows that topiramate (Topamax®) can help individuals addicted to cocaine decrease their use. Self-help groups, such as 12-step programs like Cocaine Anonymous or Narcotics Anonymous, can also help by providing a supportive network to help sustain drug-free living.

How to overcome barriers to seeking treatment

Don’t let these barriers and misguided beliefs about cocaine problems or treatment stand in the way of getting help:

• I feel ashamed. Treatment will help you accept addiction as a progressive brain disease and overcome guilt, shame, and other troubling feelings.
• I don’t feel up to it. Many people with cocaine problems have depression or other mental health problems and lack the mental or physical energy to seek treatment. Moreover, many people feel down and worn out while recovering from a cocaine binge. If you cannot get yourself to treatment, ask someone to take you. Only then, will you begin to feel better.
• Treatment doesn’t work. Addiction is a chronic disease, which means relapse and setbacks can and do happen for many people. Like treatment for diabetes, heart disease, and other life-long illnesses, no single treatment for drug problems is right for everyone and treatment is long-term. Your treatment plan may need to be modified over time. But make no mistake, treatment can and does work.
• I don’t have time. If you are using cocaine while working, running a household, caring for children or other obligations, it’s only a matter of time before your life will begin to fall apart. Keep in mind that some outpatient programs can be as effective as residential facilities and allow you, to some degree, to carry on with everyday life and responsibilities.
• I don’t know where to go to get treatment. Ask a good friend or loved one or your doctor to help you find a treatment facility that suits your treatment needs. Cocaine can be treated successfully in both live-in facilities and outpatient settings. The Behavioral Health Treatment Facility Locator also provides free substance use disorder referrals to programs and facilities near you. Call 1-800-662-HELP (4357).
• I have no money to pay for treatment. Some treatment programs and facilities offer sliding scale fees or financial assistance. The Behavioral Health Treatment Facility Locator is a good resource. Your state department of mental health and addiction services or substance use agency can also provide information.

Accepting that you have a problem is the first step toward a life without cocaine. Seeking treatment will help you to set and work toward goals, and attain them.

Resources

National Institute on Drug Abuse
www.drugabuse.gov/drugs-abuse/cocaine

Substance Abuse Treatment Facility Locator
www.findtreatment.samhsa.gov

Ending Addiction for Good: The Groundbreaking, Holistic, Evidence-Based Way to Transform Your Life by Richard Taite and Constance Scharff, PhD. Wheatmark, 2012.

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: “Drugs, Brains, and Behaviorﾗthe Science of Addiction,” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/science-addiction; “Cocaine: Abuse and Addiction,” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/research-reports/cocaine-abuse-addiction; Principles of Drug Addiction Treatment: A Research Based Guide, 3rd edition, National Institute on Drug Abuse, http://www.drugabuse.gov/publications/principles-drug-addiction-treatment; “Behavioral Health Treatment Facility Locator,” Substance Abuse and Mental Health Services Administration, http://www.samhsa.gov/treatment/index.aspx; Jaffe A., Shaheed, T. “Can’t get in: barriers to addiction treatment entry.” Psychology Today, March 20, 2012, http://www.psychologytoday.com/blog/all-about-addiction/201203/cant-get-in-barriers-addiction-treatment-entry

Reviewed by Philip Gianelli, M.D., D.A.B.P.N., F.A.B.A.M., Medical Director, Beacon Health Options

Summary

• Cocaine is sold on the street as a fine white powder or as small rock crystals known as crack.
• It is a fast-acting drug that causes a short-lasting euphoria.
• It alters the brain’s reward pathway.

Cocaine is a powerful stimulant that affects the brain. People who try it even once risk becoming addicted. Cocaine comes from leaves of the coca plant, which grows in South America. Cocaine is sold on the street as a fine, white powder or as small rock crystals known as crack. Cocaine goes by many slang or street names.

How do people use cocaine?

Cocaine is generally used in three ways:

• Snorted. Powdered cocaine is inhaled into the nose.
• Injected. Powdered cocaine is mixed with water and injected inside the veins using a needle.
• Smoked. Crack cocaine is heated, creating a smoke that is inhaled into the lungs. Crack gets its name from the crackling sound that occurs as it is heated.

Cocaine is fast-acting, reaching the brain within minutes of using it.

How does cocaine make people feel?

At first, a person high on cocaine will feel:

• Very happy
• Excited
• Carefree
• Wide awake and alert
• Full of energy
• Impulsive
• Fearless
• Invincible
• Less hungry than normal

Cocaine can also have unpleasant effects, such as feeling:

• Irritable
• Restless
• Anxious
• Aggressive
• Panicky
• Paranoid
• Shaky
• Rapid heartbeat
• Hot and sweaty
• Dizzy
• Sick to the stomach

The high from a single dose of cocaine is short-lived, wearing off within a few minutes to an hour. So, to make the high last, people often binge cocaine. This means using cocaine again and again in a short period of time and at higher and higher doses. After the binge, the person often feels tired and depressed for days.

How does cocaine work?

Cocaine, like most drugs that can be overused, activates the brain’s reward pathway. This pathway is designed to reward actions and behaviors needed for survival, such as eating, drinking, and sex. When the pathway is activated, dopamine is released. Dopamine is a chemical that produces pleasure, thereby serving as a reward. Dopamine is then recycled back into the nerve cells for later use. But, cocaine blocks the recycling or reuptake of dopamine, allowing it to build up. Excess dopamine causes the intense high people feel shortly after using the drug.

Dopamine reinforces behaviors that trigger its release. In other words, the brain’s reward pathway teaches us to repeat actions that feel good, which is one reason why cocaine is so addictive. Repeated cocaine use disrupts the brain’s reward pathway, making it less sensitive to natural reward triggers as well as to the drug itself. So, people need higher doses and more frequent use to get high, or even to feel “normal”—an effect known as tolerance. Repeated cocaine use can alter other brain circuits that contribute to addiction. For instance, environmental cues related to cocaine use can trigger severe cravings, even when the drug is not present.

Why do people try cocaine?

People who use cocaine give several reasons for first trying the drug. Some people are curious about how the drug will make them feel. Some people who are stressed out, anxious, or depressed think that cocaine will make them feel better. But using cocaine, even just once, is very risky. Cocaine use can lead to addiction and even death. No amount of cocaine use is safe.

Resources

National Institute on Drug Abuse
www.drugabuse.gov/drugs-abuse/cocaine

National Institute on Drug Abuse Research Dissemination Center
http://drugpubs.drugabuse.gov/

Substance Abuse Treatment Services Locator
(800) 622-4357
www.findtreatment.samhsa.gov

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: “Drugs Alter the Brain’s Reward Pathway.” University of Utah Genetic Science Learning Center, http://learn.genetics.utah.edu/content/addiction/drugs; “Drugs, Brains, and Behaviorﾗthe Science of Addiction.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/science-addiction; “Cocaine: Abuse and Addiction.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/research-reports/cocaine-abuse-addiction; “NIDA Info Facts: Cocaine.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/drugfacts/cocaine

Reviewed by Philip Gianelli, M.D., D.A.B.P.N., F.A.B.A.M., Medical Director, Beacon Health Options

Summary

• Cocaine is a powerful stimulant that is highly addictive.
• Cocaine use can harm your brain and body.
• People who use cocaine risk job loss, financial problems, and relationship problems.

I started using cocaine in my mid-20s. My job had been stressing me out. So, when I was offered cocaine at a party, I thought, “why not?” That was the worst decision of my life. From that point forward, getting high was all that mattered to me. I couldn’t feel normal without getting high. I lost my job, my savings, my marriage, and even came close to death. One night, I drank alcohol and used cocaine, a toxic mix that landed me in the emergency room. That was a wake-up call, and I got help. Today, I no longer use cocaine. But I still crave it, and I worry that I won’t be able to fight the urge to use it again.

This testimony shows the many dangers that go along with cocaine use. People who try cocaine even just once put their health and their lives at risk. That’s because cocaine is so addictive. People who try it cannot predict or control whether they will continue to use it. Read on to learn more about the risks of cocaine use.

Cocaine can hurt your brain

Cocaine is a powerful stimulant. Large amounts can lead to strange, unpredictable, and violent behaviors. Some people lose touch with reality and hear things (auditory hallucinations). Repeated cocaine use, especially smoking or injecting it, can lead to addiction. Addiction is a chronic, relapsing brain disease. It alters important brain structures and brain function. These long-lasting brain changes affect how people think, feel, and behave, and make it very hard to quit using. In some people, cocaine overuse can trigger mental illness, such as depression, paranoia, panic attacks, and hallucinations. People who use cocaine are more likely to try suicide.

Cocaine can hurt your body

Cocaine can harm many parts of the body. Here are some common health problems resulting from cocaine use:

• Heart problems. Cocaine makes the heart beat faster and stronger, raising blood pressure. It can cause heart attack and dangerous changes in heart rhythm.
• Nervous system problems. Cocaine use can cause headaches, seizures, stroke, and coma. It can make the body restless, which can cause it to overheat.
• Lung and respiratory problems. Snorting cocaine can damage the inside of the nose and sinuses, causing loss of smell, constant runny nose, and nosebleeds. The hot vapors inhaled from smoked cocaine can damage the airways and lungs. Cocaine use can also lead to lung failure.
• Digestive problems. Cocaine can cause stomach pain, upset stomach, and ulcers.
• Weight loss. Cocaine suppresses appetite. People who use cocaine may lose too much weight or become malnourished.
• Pregnancy problems. Pregnant women who use cocaine have a higher risk of miscarriage and other problems. When a pregnant woman uses cocaine, the cocaine is also ingested by the fetus. Babies exposed to cocaine in the womb are more likely to be born too early and/or too small, which can lead to life-long health problems. The baby might also be born addicted to cocaine.
• HIV and hepatitis B or C. People who use cocaine are at high risk of getting HIV (the virus that causes AIDS) and hepatitis B or C, which can cause chronic liver inflammation, leading to cirrhosis (scarring) of the liver and even liver cancer. People can get HIV by having unprotected sex or sharing needles. People can also get hepatitis B or C from unprotected sex or sharing needles. Cocaine makes people more likely to engage in risky behaviors that can lead to these diseases.

You can die from cocaine use, even with a small amount or one-time use. According to the Centers for Disease Control and Prevention (CDC), there is an emerging trend in the presence of Fentanyl mixed with purchased cocaine. The use of Fentanyl increases the risk for overdose death due to a person’s lack of opioid tolerance. Additionally, Narcan© reversal options might not be as readily accessed for cocaine users, as it would be for opioid users in the general public of the medical treatment setting.

Cocaine threatens lives and families

People who use cocaine risk losing control of their lives and everything that is important to them. If addiction develops, a person will spend a lot of time trying to get cocaine and getting high. All other aspects of life, including school or work, hobbies and interests, friendships, and family life become less important. After the high wears off, a person with cocaine problems may not have the drive or energy to take care of themselves or others. People who use cocaine risk:

• Work problems and job loss
• Family problems and divorce
• Money problems and debt
• Losing custody of children
• Exposure to violence
• Criminal behavior
• Trouble with the law

Not all people who try cocaine become addicted. But any cocaine use is risky and can cause long-lasting problems. The best way to avoid the dangers of cocaine is to never use it in the first place.

Resources

National Institute on Drug Abuse
www.drugabuse.gov/drugs-abuse/cocaine

National Institute on Drug Abuse Research Dissemination Center
http://drugpubs.drugabuse.gov/

Substance Abuse Treatment Services Locator
(800) 622-4357
www.findtreatment.samhsa.gov

By Christine Martin

©2013-2019 Carelon Behavioral Health

Source: “Drugs, Brains, and Behaviorﾗthe Science of Addiction.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/science-addiction; “Cocaine: Abuse and Addiction.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/research-reports/cocaine-abuse-addiction; “NIDA Info Facts: Cocaine.” National Institute on Drug Abuse, http://www.drugabuse.gov/publications/drugfacts/cocaine; Gorelick, D.A. “Cocaine abuse and dependence in adults.” www.npr.org/sections/health-shots/2018/03/29/597717402/fentanyl-laced-cocaine-becoming-a-deadly-problem-among-drug-users; www.drugabuse.gov/drugs-abuse/emerging-trends-alerts; http://triblive.com/local/valleynewsdispatch/13340474-74/fentanyl-cocaine-combo-taking-lives-in-western-pa; www.dea.gov/druginfo/fentanyl-faq.shtml

Reviewed by Philip Gianelli, M.D., D.A.B.P.N., F.A.B.A.M., Medical Director, Beacon Health Options