Cocaine (benzoylmethylecgonine) is extracted from the leaves of the coca plant through a complicated processing method. The drug is a stimulant substance that still retains some medical uses and therefore is classified by the United States Drug Enforcement Administration (DEA) in the Schedule II controlled substances category.
Abuse of cocaine has waxed and waned over the years. Its abuse spiked in the 1970s and 1980s, and then began to decline when other substances like opioids became less expensive and more popular.
Cocaine can be abused in numerous forms, but it is most often illicitly distributed as a powder that can be snorted, injected, or used orally. It also comes in forms that can be smoked, such as crack cocaine.
Chronic use of cocaine can result in many physical, emotional, and cognitive problems. Individuals are typically not prescribed cocaine products for medical use because medicinal forms of cocaine are often limited to use in clinics and medical settings. Thus, anyone possessing cocaine, using it privately, or distributing it is most likely doing so illegally. Anyone regularly using cocaine products should be suspected of having a stimulant use disorder as a result of abusing cocaine; a stimulant use disorder is the clinical designation for substance abuse or addiction when the drug being abused is a stimulant like cocaine.
Issues Associated with Chronic Cocaine Use
Continued use of cocaine is associated with numerous detrimental effects.
People who regularly snort cocaine will often have damage in their nasal passages, particularly the septum (the dividing wall between the nostrils). This damage can be significant and result in serious infections. They also commonly suffer from nasal congestion, bleeding, and loss of smell.
Those who regularly snort or smoke cocaine often have problems with their teeth that include the deterioration of the enamel on the teeth, susceptibility to cavities and tooth decay, and/or significant tooth loss. This behavior can increase susceptibility to various forms of oral cancers. In addition, those who regularly snort or smoke cocaine are subject to the development of various respiratory issues, such as:
- Respiratory infections
- Chronic issues with the airways in the lungs
- An increased potential to develop cancer in the respiratory system
- Significant damage to the lungs and air passages
Because cocaine is a stimulant, chronic use affects the cardiovascular system (the arteries, veins, capillaries, and heart). Increased susceptibility to numerous cardiovascular problems can occur as a result of cocaine use, such as:
- Chronic issues with high blood pressure, which can lead to other health issues
- Issues with veins and arteries from injecting cocaine, which can include scarring, blockages, and an increased potential to contract blood-borne diseases
- Issues with heart rhythm
- Heart attack
Chronic use of cocaine can put a burden on the liver, resulting in an increased potential to develop liver damage, cirrhosis, and other issues like hepatitis. It is associated with kidney damage and disease; decreased immune functioning, increasing vulnerability to many different types of infection; and an increased risk to develop various forms of cancer. Cocaine abuse also affects brain function and can result in significant brain damage that can have lasting effects.
The central nervous system is comprised of the brain and spinal cord. Chronic use of cocaine has been associated with numerous cognitive issues that can develop as a result of altered functioning of the pathways in the brain. Cocaine increases the availability of certain neurotransmitters, and this can result in brain damage over time. Cognitive issues that have been associated with chronic use of cocaine include:
- Significant changes in a person’s ability to concentrate and pay attention to environmental stimuli
- Significant decreases in a person’s ability to control impulsive actions, often associated with damage to the frontal lobe of the brain
- A decline in the ability to form new memories
- Issues with expressive and receptive language that are the result of brain alterations
- Significant issues with rational thinking and making judgments, particularly more complex judgments
- Significant issues with the ability to think in abstract terms (e.g., thinking outside the box)
- Issues with movement, including the development of tremors
Chronic use of cocaine is associated with higher rates of mortality across all ethnic backgrounds, age groups, and social statuses.
The effects of cocaine on the brain can also lead to issues with emotional regulation and the potential development of issues with mental health disorders. Individuals who are diagnosed with any substance use disorder are far more likely to be diagnosed with some other mental health disorder than people who do not have substance use disorders. It is unclear whether this relationship reflects a cause-and-effect situation, such that chronically abusing a drug results in the development of some other form of mental illness, or that having some form of mental illness results in an increased vulnerability to abuse drugs and/or alcohol. Most likely, the relationship is very complicated and works both ways. It likely affects different individuals in different ways depending on their genetic makeup, experiences, and the interaction of these factors.
Certainly, the brain alterations that can occur as a result of chronic use of cocaine can contribute to numerous issues with emotional and psychological functioning. It is well documented that chronic use of cocaine is associated with a greater tendency to:
- Experience psychosis (having hallucinations and/or delusions)
- Experience or develop issues with depression that can be clinically significant, including developing suicidal thoughts and tendencies
- Be involved in physical or sexual abuse and to develop issues with trauma- and stressor-related disorders
- Develop issues with anxiety that can lead to clinically significant problems
- Develop some other substance abuse issue, such as an alcohol use disorder, etc.
It is important to remember that the chronic abuse of any drug is strongly associated with the development of nearly every mental health disorder that is categorized by the American Psychiatric Association (APA) in its Diagnostic and Statistical Manual of Mental Disorders. Moreover, the development of a substance use disorder by definition leads to significant issues with social functioning. This can occur as a result of the direct effects of cocaine in the brain, vulnerability to being a victim of abuse, and the effects of cocaine use like neglecting aspects of self-care or being associated with others who are involved in illegal activities.
The potential relationship and other social issues that can occur as a result of chronic cocaine abuse include:
- A failure to reach important goals in life
- Lasting negative effects and even a total dissolution of personal relationships
- Significant damage to one’s career
- An inability to reach or attain desired levels of educational achievement
- Significant financial issues that can be long-lasting and even permanent
- Involvement in the legal system that can result in incarceration as a result of being involved in illicit activities
- Increased potential to be the victim of a crime
Finally, chronic use of cocaine will increase the probability that one is diagnosed with a stimulant use disorder. By definition, a person with a stimulant use disorder is suffering from severe issues with their functioning and experiencing issues with impairment and distress in life. In addition to losing control over one’s life as a result of use of cocaine, one may develop issues with tolerance and withdrawal. Withdrawal issues can be extremely serious, and they can lead to depression, apathy, potential psychosis, and even the development of suicidal tendencies.
The Combination of Cocaine and Alcohol
Special mention should be made of the potential dangers of combining cocaine and alcohol. While there are significant dangers associated with combining cocaine with any other drug of abuse, the combination of cocaine and alcohol, which is a very common combination, can lead to the development of a unique substance in the liver known as ethylbenzoylecgonine or cocaethylene.
This substance develops as a result of the normal processes of metabolism associated with the liver’s function of removing waste products and breaking them down in the body. The process that the liver uses to break down alcohol and cocaine together leads to changes in the metabolism of cocaine when alcohol is present. About one-fifth of the cocaine present in the system is disrupted by alcohol, and this produces cocaethylene.
Cocaethylene is an extremely toxic substance that often results in:
- Increased potential to develop cardiovascular disease
- Increased potential to have a stroke
- Increased potential for liver damage
- Increased consumption of alcohol and/or cocaine
- Issues with increased impulsive and irrational behaviors
The National Institute on Drug Abuse (NIDA) reports that cocaine and alcohol is the most common two-drug combination that results in fatalities. Thus, individuals who chronically abuse cocaine are also very likely to have chronic issues with alcohol abuse; as a result, they significantly magnify the potential long-term effects of cocaine abuse.
Moreover, the chronic issues associated with polysubstance abuse are often far more difficult to detect, address, and treat. Individuals with polysubstance abuse issues often have significantly more serious comorbid (co-occurring) physical, social, and psychological issues than those who abuse a single substance. This complicates the person’s overall ability to return to a healthy level of functioning as well as the ability of the person to remain abstinent from drugs over the long run.