Cocaine dependence

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Cocaine dependence
Classification and external resources
Specialty psychiatry
ICD-10 F14.2
ICD-9-CM 304.2
eMedicine med/3116
MeSH D019970

Cocaine dependence is a psychological desire to use cocaine regularly. Cocaine overdose may result in cardiovascular and brain damage, such as: constricting blood vessels in the brain, causing strokes and constricting arteries in the heart; causing heart attacks.[1]

The use of cocaine creates euphoria and high amounts of energy, much like caffeine. If taken in large, unsafe doses, it is possible to cause mood swings, paranoia, insomnia, psychosis, high blood pressure, tachycardia, panic attacks, cognitive impairments and drastic changes in personality.

The symptoms of cocaine withdrawal (also known as comedown or crash) range from moderate to severe: dysphoria, depression, anxiety, psychological and physical weakness, pain and compulsive craving.

Signs and symptoms[edit]

Cocaine is a powerful stimulant known to make users feel energetic, happy, talkative, etc. In time, negative side effects include increased body temperature, irregular or rapid heart rate, high blood pressure, increased risk of heart attacks, strokes and even sudden death from cardiac arrest.[2] Many habitual abusers develop a transient, manic-like condition similar to amphetamine psychosis and schizophrenia, whose symptoms include aggression, severe paranoia, and tactile hallucinations; which can include the feeling of insects under the skin (formication), also known as "coke bugs", during binges.[3]


A study was conducted using 1,081 U.S. residents who had first used cocaine within 24 months prior to assessment. It was found that the risk of becoming dependent upon cocaine within two years of first use was 5–6%; becoming dependent within 10 years after first use increased to 15–16%. These were the aggregate rates for all types of use considered, such as smoking, snorting, and injecting. Among recent-onset users, the individual rates were higher for smoking (3.4 times) and much higher for injecting. Women were 3.3 times more likely to become dependent, compared with men. Users who started at ages 12 or 13 were four times as likely to become dependent, compared to those who started between ages 18 and 20.[4][5][6]

However, a study of non-deviant[nb 1] users in Amsterdam found "relative absence of destructive and compulsive use patterns over a ten year period" and concluded that cocaine users can and do exercise control. "Our respondents applied two basic types of controls to themselves: 1) restricting use to certain situations and to emotional states in which cocaine's effects would be most positive, and 2) limiting mode of ingestion to snorting of modest amounts of cocaine, staying below 2.5 grams a week for some, and below 0.5 grams a week for most. Nevertheless, those whose use level exceeded 2.5 grams a week all returned to lower levels".[7]


On 14 February 2011, two Swiss psychologists published two years of trials and research which demonstrates that gambling along with psychotherapy is the best method to alleviate cocaine dependence. Further research is being conducted on long term relapse rates.[8][9][medical citation needed]

Withdrawal symptoms[edit]

After using cocaine on a regular basis, some users will become addicted. When the drug is discontinued immediately, the user will experience what has come to be known as a "crash" along with a number of other cocaine withdrawal symptoms, including paranoia, depression, exhaustion, anxiety, itching, mood swings, irritability, fatigue, insomnia, an intense craving for more cocaine, and in some cases nausea and vomiting. Some cocaine users also report having similar symptoms to schizophrenia patients and feel that their mind is lost. Some users also report formication: a feeling of a crawling sensation on the skin also known as "coke bugs". These symptoms can last for weeks or, in some cases, months. Even after most withdrawal symptoms dissipate most users feel the need to continue using the drug; this feeling can last for years and may peak during times of stress. About 30–40% of individuals with cocaine dependence will turn to other substances such as medication and alcohol after giving up cocaine. There are various medications on the market to ease cocaine withdrawal symptoms.


Twelve-step programs such as Cocaine Anonymous (modeled on Alcoholics Anonymous) have been widely used to help those with cocaine addiction. Cognitive Behavioral Therapy (CBT) combined with Motivational Therapy (MT) have proven to be more helpful than 12 step programs in treating cocaine dependency.[10] However, both these approaches have a fairly low success rate. Cocaine vaccines are in clinical trials that will limit the rewarding effects from cocaine.[11] The National Institutes of Health of US, particularly National Institute on Drug Abuse (NIDA) is researching modafinil, a narcolepsy drug and mild stimulant, as a potential cocaine treatment. Ibogaine has been under investigation as a treatment for cocaine dependency and is used in clinics in Mexico, the Netherlands and Canada, but cannot be used legally in the USA. Non pharmacological treatments such as acupuncture[12][13] and hypnosis[14][15] have been explored, but without conclusive results. Cocaine addiction continues to be the most difficult to manage behind heroin.[16][17]


Medications that have been investigated include acetylcysteine,[18][19][20] baclofen,[21][22] bupropion,[23] vanoxerine,[24] and vigabatrin.[21] Kim Janda has been working for years on a vaccination that would treat cocaine use disorders.[25] Furthermore, the anti-depressant desipramine, as well as the stimulants methylphenidate & pemoline, have been used to treat cocaine from the perspective of its abuse liability corresponding to a 'premorbid coexisting psychiatric disorder'; whereas the anti-convulsant drug "carbmazepine" (sic), as well as "dopamimetic agents, L-dopa/carbidopa; amino acids, tyrosine and tryptophan" have been used to treat withdrawal and craving. Finally, drugs have been used to cause an "aversion reaction" when administered with cocaine, namely phenelzine.[a]


In the United States, cocaine use results in about 5,000–6,000 deaths annually.[27]

See also[edit]

  • SB-277011-A - a dopamine D3 receptor antagonist, used in the study of cocaine addiction. Where cocaine reduces the threshold for brain electrical self-stimulation in rats, an indication of cocaine's rewarding effects, SB-277011-A completely reverses this effect.


  1. ^ The study's authors stated that they wanted to know which effects and consequences of cocaine use would become visible with persons who are mainstream citizens or as close to that social stratum as possible


  1. ^ Cocaine Use and Its Effects
  2. ^ Walsh, Karen (October 2010). "Teen Cocaine Use". 
  3. ^ Gawin, F.H. (1991). "Cocaine addiction: Psychology and neurophysiology". Science 251 (5001): 1580–6. Bibcode:1991Sci...251.1580G. doi:10.1126/science.2011738. PMID 2011738. 
  4. ^ Tierney, John. "The Rational Choices of Crack Addicts". New York Times. Retrieved 16 September 2013. 
  5. ^ Wagner, FA, From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine, and alcohol, American College of Neuropsychopharmacology, retrieved 26 April 2002 
  6. ^ O'Brien MS, Anthony JC; Anthony (2005). "Risk of becoming cocaine dependent: epidemiological estimates for the United States, 2000–2001". Neuropsychopharmacology 30 (5): 1006–1018. doi:10.1038/sj.npp.1300681. PMID 15785780. 
  7. ^ Cohen, Peter; Sas, Arjan (1994). Cocaine use in Amsterdam in non deviant subcultures. Addiction Research, Vol. 2, No. 1, pp. 71-94.
  8. ^ Der Standard: Stimulus to stimulus in the race (in German)
  9. ^ BlackJack Champ News: Swiss docs prove gambling cure for cocaine users
  10. ^ "Cognitive behavioural therapy reduced cocaine abuse compared with 12 step facilitation". 17 January 2008. Retrieved 25 August 2012. 
  11. ^ "Baylor Doctors are Working on Cocaine Vaccine". 17 January 2008. Retrieved 11 September 2008. 
  12. ^ Margolin, Arthur; et al. (2 January 2002). "Acupuncture for the treatment of cocaine addiction: A randomized controlled trial". The Journal of the American Medical Association 287 (1). 
  13. ^ Otto, Katharine C.; Quinn, Colin; Sung, Yung-Fong (Spring 1998). "Auricular acupuncture as an adjunctive treatment for cocaine addiction: A pilot study". The American Journal on Addictions 7 (2): 164–170. doi:10.1111/j.1521-0391.1998.tb00331.x. PMID 9598220. 
  14. ^ Page, R.A.; Handleya, G.W. (1993). "The use of hypnosis in cocaine addiction". American Journal of Clinical Hypnosis 36 (2): 120–123. doi:10.1080/00029157.1993.10403054. PMID 8259763. 
  15. ^ Potter, Greg (2004). "Intensive therapy: Utilizing hypnosis in the treatment of substance abuse disorders". American Journal of Clinical Hypnosis 47 (1): 21–28. doi:10.1080/00029157.2004.10401472. PMID 15376606. 
  16. ^ Schaler, Jeffrey A. (September–October 1991). "Drugs and free will". Society 28 (6): 42–49. doi:10.1007/BF02695758?LI=true (inactive 2015-01-11). 
  17. ^ Barbara, John; Morrison, June (January 1975). "If addiction is incurable, why do we try to cure it?: A comparison of control methods in the U.K. and the U.S". Crime & Delinquency 21 (1): 28–33. doi:10.1177/001112877502100104. 
  18. ^ Mardikian PN, LaRowe SD, Hedden S, Kalivas PW, Malcolm RJ; Larowe; Hedden; Kalivas; Malcolm (March 2007). "An open-label trial of N-acetylcysteine for the treatment of cocaine dependence: a pilot study". Prog. Neuropsychopharmacol. Biol. Psychiatry 31 (2): 389–94. doi:10.1016/j.pnpbp.2006.10.001. PMID 17113207. 
  19. ^ LaRowe SD, Myrick H, Hedden S, et al. (July 2007). "Is cocaine desire reduced by N-acetylcysteine?". Am J Psychiatry 164 (7): 1115–7. doi:10.1176/appi.ajp.164.7.1115. PMID 17606664. 
  20. ^ Gass JT, Olive MF; Olive (January 2008). "Glutamatergic substrates of drug addiction and alcoholism". Biochem. Pharmacol. 75 (1): 218–65. doi:10.1016/j.bcp.2007.06.039. PMC 2239014. PMID 17706608. 
  21. ^ a b Karila L, Gorelick D, Weinstein A, et al. (May 2008). "New treatments for cocaine dependence: a focused review". Int. J. Neuropsychopharmacol. 11 (3): 425–38. doi:10.1017/S1461145707008097. PMID 17927843. 
  22. ^ Ling W, Shoptaw S, Majewska D; Shoptaw; Majewska (May 1998). "Baclofen as a cocaine anti-craving medication: a preliminary clinical study". Neuropsychopharmacology 18 (5): 403–4. doi:10.1016/S0893-133X(97)00128-0. PMID 9536455. 
  23. ^ Margolin A, Kosten TR, Avants SK, et al. (December 1995). "A multicenter trial of bupropion for cocaine dependence in methadone-maintained patients". Drug Alcohol Depend 40 (2): 125–31. doi:10.1016/0376-8716(95)01198-6. PMID 8745134. 
  24. ^ Cherstniakova SA, Bi D, Fuller DR, Mojsiak JZ, Collins JM, Cantilena LR; Bi; Fuller; Mojsiak; Collins; Cantilena (September 2001). "Metabolism of vanoxerine, 1-[2-[bis(4-fluorophenyl)methoxy]ethyl]-4-(3-phenylpropyl)piperazine, by human cytochrome P450 enzymes". Drug Metab. Dispos. 29 (9): 1216–20. PMID 11502731. 
  25. ^ Douglas Quenqua (3 October 2011). "An Addiction Vaccine, Tantalizingly Close". The New York Times. 
  26. ^ Chemistry, Design, and Structure-Activity Relationship of Cocaine Antagonists. Satendra Singh et al. Chem. Rev. 2000, 100. 925-1024. PubMed; Chemical Reviews (Impact Factor: 45.66). 04/2000; 100(3):925-1024 American Chemical Society; 2000, ISSN 0009-2665 ChemInform; May, 16th 2000, Volume 31, Issue 20, DOI: 10.1002/chin.200020238. Mirror hotlink.
  27. ^ "Unintentional Drug Poisoning in the United States" (PDF). Center for Disease Control. 

Reference notes[edit]

  1. ^ [26] ←Page #928 (4th page of article) ¶4. §(1), (2) & (3); Lines 10—12 & 15—18 of aforementioned 4th ¶.