Cocaine use disorder
|Cocaine use disorder|
|Other names: Cocaine dependence, cocaine addiction, cocaine misuse, cocaine abuse|
|Symptoms||Taking more than was intended, ongoing desire to use, use resulting in work or school issues, not stopping despite health problems|
|Complications||Heart disease, HIV/AIDS, hepatitis C, muscle breakdown, homelessness|
|Risk factors||Adult ADHD, schizophrenia, antisocial personality disorder, other substance use disorders, unstable home environment|
|Diagnostic method||Urine drug screen|
|Treatment||Contingency management programs, cognitive behavioral therapy|
|Frequency||0.4% of adults|
Cocaine use disorder (CUD) is cocaine use in a manner that results in significant impairment. This may involve taking more than was intended, ongoing desire to use, use resulting in work or school issues, and not stopping despite health problems from such use. Other symptoms may include those of cocaine intoxication, cocaine withdrawal, psychosis, and weight lose. Complications may include heart disease, HIV/AIDS, hepatitis C, muscle breakdown, and homelessness. Use is associated with anxiety disorders and depression.
Risk factors included adult ADHD, with 10% being affected, schizophrenia, antisocial personality disorder, other substance use disorders, and an unstable home environment. The severity can be divided into mild, moderate, and severe. Diagnosis may be supported by a urine drug screen, which may remains positive 3 days after a single use and 12 days after heavy use.
The evidence for specific treatments is limited. Efforts may include contingency management programs, which provides vouchers for avoiding use, and cognitive behavioral therapy. No medications have been approved for this use. Evidence for providing other stimulants is insufficient as of 2020.
About 19 million people used cocaine in 2018 (0.4% of adults). Use is most common in Australia, North America and Europe. About a million people in the United States have cocaine use disorder. In Uruguay 43% of people who used cocaine were considered to have cocaine use disorder. Young adults are most commonly affected. In the United States, in 2019, nearly 16,000 overdose deaths involved cocaine.
Signs and symptoms
Cocaine is a stimulant known to make users feel energetic, cheerful, 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. Many habitual abusers develop a transient, manic-like condition similar to amphetamine psychosis and schizophrenia, whose symptoms include aggression, severe paranoia, restlessness, confusion and tactile hallucinations; which can include the feeling of something crawling under the skin (formication), also known as "coke bugs", during binges. Users of cocaine have also reported having thoughts of suicide, unusual weight loss, trouble maintaining relationships, and an unhealthy, pale appearance.
After using cocaine on a regular basis, many 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.
A study consisting of 1,081 U.S. residents who had first used cocaine within the previous 24 months was conducted. It was found that the risk of becoming dependent on cocaine within two years of first use was 5–6%. The risk of becoming dependent within 10 years of 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 individual rates of dependency 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.
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. However, both these approaches have a fairly low success rate. Other non-pharmacological treatments such as acupuncture and hypnosis have been explored, but without conclusive results.
Numerous medications have been investigated for use in cocaine dependence, but as of 2015[update], none of them were considered to be effective. Anticonvulsants, such as carbamazepine, gabapentin, lamotrigine, and topiramate, do not appear to be effective as treatment. Limited evidence suggests that antipsychotics are also ineffective for treatment of cocaine dependence. Few studies have examined bupropion (a novel antidepressant) for cocaine dependence; however, trials performed thus far have not shown it to be an effective form of treatment for this purpose.
The National Institute on Drug Abuse (NIDA) of the U.S. National Institutes of Health 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 United States. Other medications that have been investigated for this purpose include acetylcysteine, baclofen, and vanoxerine. Medications such as phenelzine, have been used to cause an "aversion reaction" when administered with cocaine.[lower-alpha 1]
In the United States, cocaine use results in about 5,000–6,000 deaths annually.
Transcranial magnetic stimulation (TMS) is being studied as a treatment for cocaine addiction. So far studies have been undertaken by Medical University of South Carolina (MUSC), National Institute on Drug Abuse (NIDA), and Mexican National Institute of Psychiatry.
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