Cocaine Use Disorder

________________________________________________________________________

KEY POINTS

• Cocaine use disorder is a pattern of using cocaine that leads to serious personal, family and health problems. Cocaine is a type of drug called a stimulant that can increase your alertness and energy.
• Cocaine use disorder can be treated. For any treatment to be successful, you must want to stop using cocaine. Your healthcare provider may prescribe a medicine that will help you get through withdrawal symptoms. Self-help groups such as Cocaine Anonymous, support groups, and therapy may be helpful.
• The best way to help yourself is to see your healthcare provider and make plans to stop using cocaine.

________________________________________________________________________

What is cocaine use disorder?

Cocaine is made from the leaves of the coca plant, which grows in South America. It is a type of drug called a stimulant, which means it can increase alertness and energy. Cocaine can be inhaled through the nose in powder form ("snorting"), injected into a vein, or smoked. Crack, a less expensive form of cocaine that is smoked, has made cocaine a widespread problem.

Cocaine use disorder is a pattern of using cocaine that leads to serious personal, family, and health problems. The more of these statements that apply to you, the more severe your cocaine use disorder is.

1. You use more or use cocaine for longer than you planned.
2. You want to cut down or quit, but are not able to do so.
3. You spend a lot of time and energy getting drugs, using drugs, and getting over the effects.
4. You crave cocaine so much that you have trouble thinking about anything else.
5. You have problems at work or school, or stop taking care of people who depend on you.
6. You have relationship problems because you don’t keep your promises, or you argue or get violent with other people.
7. You stop doing things that used to matter to you, such as sports, hobbies, or spending time with friends or family, because of your cocaine use.
8. You use cocaine even when it is dangerous, such as while driving or operating machinery.
9. You keep using cocaine even though you know that it is hurting your physical or mental health.
10. You need to use more and more of the drug, or use it more often to get the same effects. This is called tolerance.
11. You have withdrawal symptoms when you stop using.

Cocaine use disorder may also be called drug abuse, substance abuse, dependence, or addiction.

What is the cause?

The brain makes chemicals that affect thoughts, emotions, and actions. Cocaine changes the balance of these chemicals in your brain. When you use cocaine regularly, your brain starts to get used to it. As a result you don't feel good unless you use cocaine. When you stop using cocaine suddenly, the balance of chemicals in your brain changes, which causes the symptoms of withdrawal.

You have a higher risk of becoming dependent on drugs if you:

• Have a family history of drug or alcohol abuse
• Have abused alcohol or drugs in the past
• Are easily frustrated, have trouble dealing with stress, or feel like you aren’t good enough
• Are regularly around people who use alcohol or drugs
• Have a mental health problem
• Have constant pain

What are the symptoms?

The symptoms of cocaine use disorder depend on how much and how often you take the drug. The symptoms can be mild to severe, such as:

• Being overexcited, nervous, or having angry outbursts
• Runny nose, bloody nose, hoarseness, and reduced sense of smell
• Having belly pain, nausea, or loss of appetite
• Talking and thinking fast, called "speeding"
• Having a fast heartbeat or sweating
• Nausea and vomiting
• Large, dilated pupils
• Seeing, hearing, or feeling something that is not there
• Thinking that others are out to get you when they are not

If you snort cocaine, you may have:

• Sores or broken skin in or around your nose
• Nosebleeds
• A constant runny nose

If you smoke cocaine, you may have symptoms such as a cough or mucus in your lungs.

You may also have symptoms of new or worse health problems caused by cocaine use. Cocaine may cause:

• Eating and sleeping disorders
• Chest pain or cardiac arrest (the heart suddenly stops beating)
• Kidney failure
• Stroke
• Seizures
• Trouble breathing or stopping breathing

The symptoms of cocaine withdrawal can be mild to severe. You may have some of these symptoms when you stop taking cocaine:

• Nervousness and restlessness
• Feeling very tired
• Depression
• Cravings for cocaine
• Sleep problems

The feelings that you get from cocaine only last a short time. This causes you to crave more cocaine to get the feelings back. You may binge, which means you take large amounts of cocaine for several days. The binge is followed be a "crash," where you feel very sad and depressed. Then you start all over again. This pattern of cocaine use can lead to an overdose. A cocaine overdose can be life threatening.

Pregnant women using cocaine are at high risk of having a miscarriage premature baby, or low birth weight baby. Babies born to cocaine-dependent mothers are addicted at birth. The baby will be jittery and will not respond well to people. Cocaine dependent babies have to go through the painful process of withdrawal.

How is it diagnosed?

Your healthcare provider will ask how much and how often you use cocaine. Be honest about your drug use. Your provider needs this information to give you the right treatment. He will also ask about your symptoms and medical history and examine you. You may have blood or urine tests. Your provider may also check for heart problems with an ECG (also called an EKG or electrocardiogram), which measures and records your heartbeat.

How is it treated?

Cocaine use disorder can be treated. For any treatment to be successful, you must want to stop using cocaine. When you stop using cocaine, your healthcare provider may prescribe medicine to help you get through withdrawal symptoms. Do not try to use alcohol and other drugs to reduce withdrawal symptoms.

If you want to quit, get help.

Self-help groups such as Cocaine Anonymous, support groups, and therapy may be helpful. Kinds of therapy may include:

• Cognitive-Behavioral Therapy (CBT). CBT helps you look at your thoughts, beliefs, and actions, and understand which ones cause problems for you. Then you learn to change unhealthy ways of thinking and acting.
• Family therapy. Often people with substance use disorders don’t realize they have a problem or aren’t ready to accept treatment. This leaves loved ones frustrated and confused. Family therapy treats all members of the family rather than working with one person alone. It helps the whole family understand each other better and make changes.
• Substance use disorder treatment programs. Your healthcare providers and counselors will work with you to develop a treatment program. You may be able to go to therapy a few times a week (outpatient therapy). Or you may need treatment in a hospital or rehab center. You may need to stay there for several weeks, or you may be able to go to a clinic or hospital each day.

Recovery is a long-term process. Many people with substance use disorders try to quit more than once before they finally succeed. Don't give up. You can quit and quit for good. Get help and try again. Follow-up treatment is very important so that you don’t go back to using cocaine.

If you have overdosed, or are having severe withdrawal symptoms you will need to be treated in a hospital.

How can I take care of myself?

The best way to help yourself is to see your healthcare provider and make plans to stop taking cocaine. If you are already seeing a healthcare provider, it is important to take the full course of treatment he or she prescribes.

• Get support. Talk with family and friends. Consider joining a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Don’t use alcohol or drugs. Exercise according to your healthcare provider's instructions.
• Avoid situations where people are likely to use alcohol or drugs.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all the medicines, natural remedies, vitamins, and other supplements that you take.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

People and resources in your community that can help you include your healthcare providers, therapists, support groups, mental health centers, and alcohol or substance abuse treatment programs. You may want to contact:

• National Council on Alcoholism and Drug Dependence
  800-622-2255
  https://www.ncadd.org/
• The Addiction Recovery Guide
  http://www.addictionrecoveryguide.org/resources/recovery/