Cocaine—extracted from the leaves of the coca plant—is a potent stimulant of the central nervous system—the most powerful stimulant of natural origin. It produces euphoric feelings, increased energy and mental alertness followed by dysphoric effects. Cocaine is highly physically and psychologically addictive.

If you or someone you know is addicted to cocaine, search Recovercorps.org's list of treatment centers for a facility near you.

Short History of Cocaine
For centuries, the indigenous people of South America chewed on the leaves of the cocoa plant and brewed the leaves in tea for refreshment and to relieve fatigue. When Europeans began to come to the continent, they too discovered the effects of the plant, carrying cocoa leaves back with them.

In 1860, a German Ph.D. student was the first to isolate cocaine from cocoa leaves. Pure cocaine was first used in the 1880s as a local anesthetic in eye surgery.

Cocaine became popular for its medicinal and recreational properties in the late 1800s with users such as Sigmund Freud and Ernest Shackleton. It was sold in drugstores in its pure form and as an additive to products like wine and Coca-Cola. But by the turn of the century, the public was becoming aware of the drug's addictive qualities.

Consequently, the Harrison Narcotics Tax Act of 1914 outlawed the sale and distribution of cocaine in the U.S. Because of its high potential for abuse, the Controlled Substances Act of 1970 listed cocaine as a Schedule II substance.

Cocaine use peaked in the 1980s though its relative crack cocaine picked up the slack into the 1990s. Today, over 36.8 million Americans have tried cocaine at least once, according to the National Survey on Drug Use and Health.  Fortunately, the number of first-time users declined from 1 million in 2002 to 722,000 in 2008.

How is Cocaine Abused?
Traffickers distribute illicit cocaine as a white crystalline powder, which is then diluted with a variety of substances. Cocaine is snorted, injected, or smoked. Snorted cocaine is absorbed into the bloodstream through nasal tissues. This takes three to five minutes for the cocaine to reach the brain.

Intravenous needle injection into the bloodstream produces a rush in 15 to 30 seconds. Smoked cocaine's effects are felt immediately and may last five to 10 minutes.

Because coming down off cocaine produces fatigue and depression, users will often binge, taking repeated doses to avoid these effects. And if used often enough, cocaine users can build up a tolerance to its effects, causing them to use more of the drug to get the same initial high. Repeated excessive doses can lead to heart failure.

How Does Cocaine Affect the Brain?
Cocaine increases the brain's levels of dopamine—the chemical responsible for pleasure and reward. Normally, dopamine is released from certain neurons in response to something pleasurable; it then recycles back to that neuron. Cocaine prevents the recycling causing large amounts of dopamine (and large amounts of pleasure) to build up.

Repeated use of cocaine can change the brain's reward system, "which may eventually lead to addiction," says the National Institute on Drug Abuse (NIDA). Repeated use also leads to a tolerance build up which leads the abuser to "chase" the original high with more and more cocaine.

Treatment for Cocaine Abuse
According to a report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), of the 2 million admissions to treatment facilities in 2009, 9% were for cocaine abuse, down from 14% over the prior decade. Those 180,000 Americans who sought treatment were introduced to a handful of treatment options, according NIDA, such as:

  • Cognitive Behavioral Therapy (CBT), a treatment that teaches patients to "recognize why they are using cocaine and determining what they need to do to either avoid or cope with whatever triggers their use." Patients learn new behaviors by role-playing with counselors.
  • Twelve-step programs like Cocaine Anonymous (CA) and Narcotics Anonymous (NA) "emphasize taking responsibility for behavior, making amends to others and self-forgiveness." As there is a spiritual grounding to all 12-step programs, some patients may want an alternative program like SMART. In SMART, "participants learn tools for addiction recovery based on the latest scientific research and participate in a world-wide community which includes free, self-empowering, secular and science-based, mutual-help support groups." SMART's 4-Point Program, for example, offers these tools
  1. Enhancing and Maintaining Motivation to Abstain
  2. Coping with Urges
  3. Managing Thoughts, Feelings and Behavior
  4. Balancing Momentary and Enduring Satisfactions

Conclusion
Though its popularity has waned in recent decades, cocaine will still be the drug of choice for thousands of Americans. If you know someone who is abusing cocaine, search Recoverycorps.org's database to find the nearest treatment center. For tips on selecting a treatment center, click here.

Sources:
http://www.justice.gov/dea/pubs/abuse/doa-p.pdf
http://www.nida.nih.gov/infofacts/cocaine.html
http://www.smartrecovery.org/
http://archives.drugabuse.gov/txmanuals/CBT/CBT4.html