Cocaine use patterns

August 6, 2011

Conviction for possession or use of any amount or form of cocaine in this country constitutes a felony. As a consequence, it is difficult, if not impossible, to truly discuss low risk or “social” use of cocaine at present. Thus for practical purposes, all cocaine use in American communities must be viewed as being cocaine abuse. From historical reports, experience of other countries, and even National Institutes of Health (NIH) research, it is clear that not all cocaine users develop addiction to the drug. In fact it appears that a minority, perhaps as low as 15-20%, of cocaine abusers in our community develop cocaine addiction, while the majority remain abusers or move toward abstinence. Estimates are that as many as 40 million Americans have experimented with or intermittently used cocaine.

There is a qualitative and quantitative difference between a cocaine abuser who does not have chemical dependence and a cocaine abuser who is addicted. Abusers tend to use occasionally, in social settings, for brief periods and in low amounts. They fail to meet three (or usually even one) of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for addiction. I.V. use or smoking of “crack” or freebase is generally not seen among abusers and is a strong indicator of addiction. Individuals with cocaine addiction demonstrate intermittent repetitive loss of control over their cocaine use resulting in adverse consequences in their lives. They tend to use it in a pattern of escalating binges—sometime using cocaine for up to 4 days at a time with little to eat, drink, or sleep during that period. Cocaine-dependent people will primarily either smoke the cocaine or use it l.V.

Typically chemical dependence or addiction with cocaine as the drug of choice involves a bingecrash-”honeymoon”-binge-crash… pattern. This is due to the pharmacology of the drug cocaine and complex interactions with the brain of an addicted person. This pattern involves the binge phase: several hours to a few days of compulsive repetitive self-administration of cocaine. Because of the development of tolerance during a binge, patients experience less and less euphoria or “high,” and increasing amounts of dysphoria or “low” feelings—often progressing to frank paranoia. This binge is followed by a crash phase: a period of several hours to up to a day and a half of marked increase in sleeping, eating, depressive feelings, and remorse for the actions during the binge. In fact, the behaviors during the crash phase are really the opposite of those during the binge phase. The crash phase is followed by the “honeymoon” phase where people can go for a few to several days promising to never binge again and being relatively unaffected by the drug. Unfortunately, this phase is routinely followed, often on the next payday, by another binge-crash cycle. Many patients who are well into this pattern think that they are not addicted since they do not use every day. Nothing could be further from the truth.

Sadly, judgment is exceedingly sensitive to cocaine effects. As high doses are ingested during a binge, the erratic behavior associated with cocaine addiction can become horrifying, with unspeakable family, legal, and job-related consequences. During a cocaine epidemic, there is typically a marked community rise in violent crime, drive-by shootings, domestic violence, child abuse and neglect, sexually transmitted disease, and unanticipated pregnancy.

SEE ALSO: Addiction, Addiction ethics, Chemical dependence, Heroin, Injection drug use

Category: Cocaine