Cocaine was involved in nearly 16,000 overdose deaths in the US in 2017 and the UN estimates between 14 million and 21 million people use cocaine worldwide. Cocaine use can have a number of dangerous side effects, including heart attack, stroke, hyperthermia, stimulant psychosis, and tissue damage, especially to the nose and nasal cavity. While only about nine percent of marijuana users will develop a serious addiction and 15 percent of alcohol drinkers will develop an addiction, about 17 percent of cocaine users will develop addiction. It’s less than the 23 percent of heroin users who will become addicted, but it’s still pretty serious. What makes cocaine so addictive?

Dopamine Response

The effects of cocaine in the brain are better understood than those of any other other drug. Cocaine primarily affects a part of the brain called the mesolimbic dopamine system. Commonly called the brain’s reward pathway, this system begins in the ventral tegmental area and extends to the nucleus accumbens, which is one of the brain’s reward areas. This system is involved in reward, emotional regulation, and motivation.

What cocaine does is bind to dopamine transporters, preventing them from clearing dopamine from the synapses between neurons. The dopamine starts to build up in the synapse, amplifying the signals between neurons in the area involved with reward, motivation, and emotional regulation. This is what causes euphoria and the keyed up feeling people get from cocaine. This euphoria motivates repeated use.

However, eventually the brain adapts to the excess dopamine in the synapses. Your brain stops making so much dopamine and you need more cocaine to get the same effect.

Dopamine also has an important effect on memory. The limbic system, which is powerfully stimulated by dopamine, includes the hippocampus and amygdala, which are involved in memory formation and help us remember the cues leading to pleasurable–or painful–experiences. When these regions are stimulated by cocaine use, they remember the circumstances surrounding the euphoria, which creates triggers for later use. Eventually, the prefrontal cortex, which is typically involved with decision making, gets cut out of the loop, and a trigger can lead directly to compulsive cocaine use.

Short Half Life

Cocaine is a short-acting drug, meaning it starts working quickly and stops working quickly, usually within a few hours. This leads to a cycle of binging and crashing, followed by more limited use. So you might do a lot of cocaine over the weekend, crash on Sunday night and find you need just a little to get through Monday. Having to use a substance to get back to normal is a clear early warning sign that recreational use is transitioning into a substance use disorder.

Priming Effect

If you do develop a serious cocaine addiction, then manage to quit, your dopamine system pretty much returns to normal after a while. However, it only takes one hit to make your dopamine system return to the state it was in at the height of your addiction. A recent study allowed rats to binge on cocaine for six hours a day until they became addicted. They were then restricted from using cocaine for either 14 days or 60 days. At the end of this period, their dopamine systems appeared normal, no different to the rats that only received saline instead of cocaine.

However, when they received one dose of cocaine after a long period of abstinence, their dopamine systems immediately returned to peak addiction levels. It made no difference whether the rats had been abstinent for 14 days or 60 days. The rats that hadn’t received any cocaine, were given a dose as well but it didn’t have the same effect as in the rats that had been ‘primed’ by earlier addiction. This study suggests that once you develop a cocaine addiction, it may be permanently imprinted on your limbic system. The good news is that it also suggests your limbic system can return to functioning normally, even after heavy use, assuming you don’t slip up.

Combination with Alcohol

Cocaine is often used in combination with alcohol. Mixing alcohol with other drugs is often dangerous as alcohol enhances the depressive effects of opioids, benzodiazepines, and barbiturates, leading to an increased risk of overdose. Mixing alcohol with cocaine causes different problems. For one, the mixture actually creates a new substance in the liver called cocaethylene, which is more potent than cocaine itself. It can lead to a more intense and longer lasting high. Unfortunately, it is also more toxic, with a greater risk of heart attack and stroke.

The common association between alcohol and cocaine also makes it harder to quit cocaine. Just as you can have an alcohol use disorder despite not drinking every day, or perhaps only binging on weekends, you can develop a cocaine use disorder even from weekend use. People who realize their cocaine use is getting out of hand often have trouble quitting because they don’t stop drinking at the same time. They’ll say, ‘Right, no more cocaine for a while’, but then have drinks with friends and end up using cocaine again. Alcohol is a powerful trigger and it diminishes your foresight and willpower. It’s very hard to beat a cocaine addiction if you don’t stop drinking too.

Difficult Withdrawal

Cocaine withdrawal isn’t typically dangerous, like alcohol or benzodiazepine withdrawal, and it’s not typically painful like opioid withdrawal. It can, however, completely crush your mood. Typical symptoms include depression, extreme fatigue, inability to concentrate, inability to feel pleasure, lack of motivation, slow movements, slow thinking, intense cravings, and suicidal thoughts. These typically decline considerably after a week or two, but symptoms may linger for as long as two years.

If you or someone you love is struggling with cocaine addiction or mental illness, The Dawn Medical Rehab and Wellness center can help. We are one of Thailand’s most respected addiction treatment and wellness centers. We use cutting-edge treatment modalities, including TMS and CBT to provide personalized care to treat addiction, depression, anxiety, bipolar disorder, personality disorders, PTSD, and executive burnout. See our contact page to reach us by phone or email.