Many people are surprised to learn that the drug cocaine (benzoylmethylecgonine) is still considered to have some medicinal uses, such as being used by dentists and physicians as a local anesthetic. Because it is still used medicinally in some instances, the controlled substance classification of cocaine is in the Schedule II category, indicating that the drug can be used for medical purposes but is tightly controlled. It is not routinely prescribed to individuals but is typically used in a clinic or hospital setting.
Abusers of cocaine most often use it in its powdered form and snort it, but the drug can also be smoked and injected. Crack cocaine, an extremely potent form of cocaine, is typically smoked. Its use has decreased significantly since the 1980s and 1990s when it was a popular drug of abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports the following regarding cocaine abuse:
- In 2015, 638,000 individuals were estimated to use some form of cocaine; in 2016, this number was 613,000.
- About 192,000 individuals were estimated to report past-year use of cocaine in 2015; in 2016, this number was 175,000.
- Individuals estimated to have used cocaine in the month prior to the survey numbered 128,000 in 2015 and 120,000 in 2016.
- Individuals admitting any lifetime crack cocaine use in 2015 were estimated to be about 305,000; in 2016, this number was estimated to be 302,000.
- In 2015, 93,000 individuals were estimated to use crack cocaine over the previous year; in 2016, this number was estimated to be 88,000.
- In both 2015 and 2016, the number of individuals estimated to have used crack cocaine during the month prior to the survey was 64,000.
Compared to other drugs of abuse, particularly drugs like cannabis and opiates (prescription and nonprescription), the number of individuals admitting to cocaine use or misuse is significantly lower.
The Signs of Cocaine Use and Abuse
The American Psychiatric Association (APA) sets the diagnostic criteria for the formal diagnosis of any substance use disorder. A substance use disorder that occurs as a result of cocaine abuse would be formally designated as a stimulant use disorder because cocaine is a powerful central nervous system stimulant. There are no formal medical tests, such as blood tests, other laboratory tests, imaging tests, etc., that can definitively diagnose a substance use disorder in anyone. Instead, a formal diagnosis of a substance use disorder is made on the basis of a certain behavioral diagnostic criteria.
A formal diagnosis of a stimulant use disorder as a result of cocaine abuse would be made based on an individual displaying at least two of a number of diagnostic indicators that occur over the period of a year. Only a trained clinician can make a definitive and formal diagnosis of a stimulant use disorder as a result of someone’s use of cocaine. Overall, the diagnostic criteria cover the following:
- The individual takes cocaine for nonmedical reasons, such as for its psychoactive effects (the high or “buzz”).
- The use of the drug leads to stress or impairments in functioning.
- The person continues to use the drug in spite of experiencing numerous areas of impairment and dysfunction. These can include issues with relationships, physical health, emotional or psychological health, or other important areas of functioning.
- The person gives up important activities and/or does not fulfill personal commitments as a result of drug use.
- A person often displays significant difficulty controlling their use of the drug. These issues can occur over several different situations.
- The person has significant cravings to use the drug.
- The person develops tolerance to the drug.
- The person displays withdrawal symptoms when they cannot use the drug or get enough of it.
There are 11 formal diagnostic symptoms that can be used to diagnosis a stimulant use disorder, and the severity of the disorder is determined by the number of symptoms the person displays. Most individuals will recognize that someone with a potential substance use disorder is having significant difficulty controlling their use of the drug, is suffering negative ramifications as a result of the use, and their behavior is spiraling out of control, even though the person may not realize this; however, again, only licensed mental health clinicians can make a formal diagnosis.
There are other potential signs of person may be abusing cocaine that are not part of the formal diagnostic criteria for stimulant use disorder. Some of these can include:
- Finding drug paraphernalia, such as straws, rolled-up paper money, mirrors with residue, pipes, syringes, etc.
- A constant runny or even bloody nose
- Significant problems with teeth, such as broken teeth, cavities, missing teeth, etc.
- Periods of heightened energy and even hyperactivity that alternate with periods of lethargy, depression, apathy, etc.
- Appearing overheated, sweating, etc.
- A significant loss of appetite alternating with significant food binges
- The development of extremely suspicious and even paranoid behaviors
- Burns on the lips, face, or fingers from smoking crack
In addition, individuals with cocaine abuse problems often resort to extreme means to get money to pay for their cocaine. This can mean borrowing money, selling possessions, or illegal behavior, such as stealing, prostitution, etc. They may be very defensive or angry when someone mentions they may have a problem with cocaine.
Abuse of cocaine is not without costs. There are indicators that result from serious issues related to chronic and heavy cocaine use.
- Cardiovascular issues and disease are common results of chronic cocaine abuse. These can include high blood pressure, arteriosclerosis, heartbeat irregularities, heart attack, and stroke.
- Damage to other organs, such as the liver, kidneys, and even lungs, may occur due to an increased potential to develop respiratory infections or damage.
- An increased risk to develop cancer is common.
- Neurological issues can also be the result of chronic cocaine abuse. Some of these include increased seizure risk potential, problems with attention and concentration, difficulty forming new memories, problems with controlling impulses, issues with movement and/or tremors, and problems with reasoning and judgment.
- Chronic cocaine abusers often have decreased appetites that can result in significant weight loss and related health issues.
- Cocaine use either via snorting or smoking often seriously affects an individual’s dentition due to the acidic nature of the drug.
- There is an increased risk to become a victim of a crime or be involved in criminal activities.
- There is an increased risk to develop mental health issues, including potential suicidality.
- Significant neurological issues can include the development of seizures, and the risk for this is increased if an individual abuses other drugs, such as alcohol, in conjunction with cocaine. Damage can occur in areas of the brain that have to do with movement, decision-making, judgment, attention, and memory.
- While the withdrawal syndrome associated with discontinuing cocaine is not considered to be potentially hazardous, individuals who become emotionally distraught are at risk for self-harm or accidents.
In addition, individuals who suffer distressing withdrawal symptoms are at risk for a number of issues associated with their need to get cocaine immediately to stop these symptoms. They may take desperate measures to get money, such as engaging in activities that are illegal or potentially hazardous.
Addressing the Issue
The most productive way to address an issue with a substance use disorder is to get involved in a formal treatment program. There is an overall approach to treating substance use disorders, and the approach should be followed in a manner that allows for alterations to fit the specific needs of the person. Because withdrawal from cocaine is primarily emotional/psychological in nature, most individuals who are recovering from cocaine abuse will not need to be placed in an intensive medical detox (withdrawal management) program in the same way that someone recovering from alcohol abuse might need a formal inpatient admission for withdrawal. However, some individuals who have severe cocaine abuse issues, multiple relapses, abusive living situations, or other toxic issues in their environment may require initial inpatient treatment in order to get them started on the road to recovery.
- A professional evaluation at multiple levels, including assessing issues with substance abuse, other psychiatric problems, physical health, and social functioning
- A treatment plan that addresses the problematic areas identified in the evaluation
- Use of medications to deal with cravings, other mental health problems, and other issues that need to be addressed
- Behavioral interventions that include substance use disorder therapy, 12-Step group or other support group participation, and other forms of therapy
- Other important supports that contribute to overall recovery, such as tutoring for school, vocational training, physical or occupational therapy, etc.
- Commitment and continued participation in treatment in order to ensure that the individual develops the skills needed to live a life that is free from drugs and/or alcohol