Psychology and Cocaine.

I’m sure many readers have a beautiful array of plants in their homes and gardens. However, Erythroxylon coca is certainly not a plant you’d be willing to plant in your back garden. That is, of course, unless you’re a drug cultivator and happen to have the correct conditions to grow it. If you haven’t already guessed, Erythroxylon coca is the plant that produces Cocaine.

So what exactly is Cocaine?

Well, if this was a Chemistry blog, I might have told you that Cocaine is methyl (1R,2R,3S,5S)-3- (benzoyloxy)-8-methyl-8-azabicyclo[3.2.1] octane-2-carboxylate (or Benzoylmethylecgonine) for short…

Nope, I didn’t understand that either.

For the interests of Psychology, Cocaine is simply a powerful Central Nervous System (CNS) stimulant. It is extracted from the leaves of coca plants, and was first used in 1844 as a local anaesthetic (although South Americans were using it many centuries before to decrease hunger and fatigue). Sigmund Freud even prescribed the drug to patients, until they started to become addicted. Cocaine is a Class A drug, meaning it is illegal to possess, deal or use in the United Kingdom. Although it can be injected, rubbed into gums or ingested, the most common method is smoking – the drug reaches the brain in 5-10 seconds this way (much faster than the other methods mentioned).

If this makes you drool, book into rehab. Now.

So, what are the short term effects?

Here is a list of the most common effects:

• A state commonly described by users as “euphoria”
• Lack of sensitivity to pain
• A boost to sexual appetite
• An increase of confidence
• Significantly increased sense of energy and attentiveness
• Reduced hunger
• Excitement
• Feelings of power.

The effects usually last from between 15-30 minutes, which leads to a “crash”.
However, an overdose of cocaine can lead to an onslaught of undesirable effects:

• Chills
• Nausea
• Insomnia
• Extreme paranoia
• Psychological breakdowns
• Vivid and horrifying hallucinations. A common one being “coke bugs”, which are hallucinations of insects crawling under the skin.

IMG 1: Cocaine abuse can lead to the degradation of the nasal septum, as seen here with Daniella Westbrook.

The smallest amount of Cocaine can lead to cardiac arrest and even death. It doesn’t matter if you’re a Cocaine “pro”, or you’ve never used the drug before. The chances of death are all the same whether you’ve used it once or a million times. Laurence (2000) conducted research which showed that:

1. Young people using Cocaine are increasing their chances of having fatal strokes.
2. The use of Cocaine may lead to deformed blood vessels in the head. This mixed with a surge in blood pressure from using Cocaine can lead to Cerebral Aneurysms – and ultimately death.

How about the long term effects?

Chronic use of Cocaine leads to further unpleasant effects:

• Altering of personality; Cocaine users often have damaged social relationships, high levels of irritability, paranoia and insomnia.
• Constriction (thinning) of blood vessels, leading to increased heart rate and blood pressure. Inevitably, this will lead to further heart complications (myocardial infarctions, strokes and impaired effectiveness of heart muscle).
• As seen in the image above (IMG 1), the nasal septum may become perforated or disappear entirely.
• Psychosis may also occur. Manschrenck et al (1988) found that when levels of Cocaine abuse in the Bahamas increased, so did levels of psychotic reactions lasting from a few days to a few weeks.

For further symptoms, see the diagram below.

Chronic effects of Cocaine abuse.

So how does Cocaine “work”?

Cocaine inhibits the brain’s re-uptake of the hormones Dopamine (probably responsible for the euphoric feeling), Noradrenaline (probably responsible for the increased feeling of energy) and Serotonin. This means that when the hormones are released normally, Cocaine molecules bind with receptors that would usually “re-absorb” the hormones – leaving them active in Neural Synapses. This leads to the effects of the hormones still occurring when they should have actually stopped. This keeps the brain stimulated, leading to a state of psychological arousal. The so called “crash” occurs when these excess neurotransmitters are depleted suddenly.

Because the Cocaine molecules prevent re-uptake, it means the transmission is facilitated (the neurotransmitters are more active than they would be normally). This means that Cocaine is what’s known as an AGONIST in drug psychology. As mentioned, agonistic drugs just expedite transmission from neurotransmitters. Simples.

However, extensive use of Cocaine leads to the shortage of the 3 aforementioned neurotransmitters. As their re-uptake is inhibited, it means they are not “recycled” as such, and therefore cannot be used later when needed. This shortage therefore replaces feelings of euphoria and energy with anxiety and fatigue.

Addiction:

Certainly a more psychological principle, addiction is a serious problem amongst many drug users – and obviously not just with Cocaine. Scientifically referred to as “substance dependence”, the World Health Organisation (WHO) defined it as such in 1957:

Drug addiction is a state of periodic or chronic intoxication produced by the repeated consumption of a drug (natural or synthetic). Its characteristics include: (i) an overpowering desire or need (compulsion) to continue taking the drug and to obtain it by any means; (ii) a tendency to increase the dose; (iii) a psychic (psychological) and generally a physical dependence on the effects of the drug; and (iv) detrimental effects on the individual and on society.

Although there have been many other suggestions and alterations to a definition, it is basically the feeling of “needing” a drug in order to feel psychologically or physically ‘normal’.

Even in those without a diagnosed addiction, the “crash” from Cocaine use can lead to the desire to have more, simply to counter the depressive feelings afterwards. The withdrawal symptoms of Cocaine can be merciless, including depression, anxiety, paranoia, exhaustion and more. Cocaine is also highly reinforcing. This means that when animals are provided with Cocaine, they’ll give up food and water – even withstand electric shocks – just to get hold of some Cocaine.

There is a tough battle for first time users as they weigh the consequences and “benefits” of drug abuse, which will usually lead to an addiction:

“Benefits”	Negative Consequences
Increase confidence	Anxiety response to drug abuse
Increase feeling of strength	Loss of control in ones life
Feelings of euphoria	High cost of drug
Temporary depression relief	Drug availability
Feelings of calmness and relief of anger	Social and legal problems

Gawin (1991) suggested that people’s positive response to a users new energy and happiness may be another reinforcing factor.

It has also been suggested however that Cocaine users are able to lose their addiction without professional help or rehab – Hamersley (1999).

Cocaine abstinence:

Gavin and Kleber have suggested that symptoms of abstinence from Cocaine occur in three stages:

CRASH Phase:

• Within 15-30 minutes of a final Cocaine dose, dysphoria occurs (agitation, anxiety, intense craving etc.)
• The craving stops after about 1 hour of Cocaine abstinence.
• The user feels an intense need to sleep or rest – this may lead to hypersomnolence (sleeping for many hours or days).
• The sleep may be disrupted by hyperphagia (hunger “pangs”).
• After the long rest, the Cocaine cravings have totally resided.

WITHDRAWAL Phase:

• Begins with several hours/a few days of a normal mood state (euthymic mood), normal sleeping patterns and low/no Cocaine cravings.
• Followed by feelings of boredom, anergia (low energy), anhedonia (low environmental stimulation/pleasure) and anxiety (surprise surprise?)
• Anything in the environment which is a reminder of Cocaine or has associations to the user will provoke intense cravings to use the drug again. At this point, the user is extremely sensitive to relapse.

EXTINCTION Phase:

• If the user continues to resist relapsing to Cocaine use again, there will be feelings of normality and a happy mood without the need for the drug. However, the user is still sensitive to environmental cues, which may eventually trigger a relapse.

Gawin & Kleber reported a cycle which occurs in many Cocaine users: 6-36 hours of Cocaine ‘binging’; 1-2 days in the crash phase; 1-2 days of normalisation; 1-2 days of resistance, then eventually, a relapse.

**If you’re interested in an evaluation for Gawin & Kleber’s model, feel free to e-mail me.**

The dreaded relapse:

Firstly, what exactly is relapse? According to this website:

“The actual use of chemicals (drugs or alcohol) after a period of abstinence, recovery planning.”

So, when a drug user stops (abstains) from the drug, they’ll often experience many withdrawal symptoms (as mentioned above for Cocaine). This can lead to severe cravings and eventually they may give in to the pressure and cravings. This is relapse.

The main theory as to why Cocaine users experience relapses is the “dopamine depletion hypothesis”, set out by Dackis & Gold (1985). They suggest that the high level of dopamine is critical for euphoria during the period of intoxication, and when the Cocaine is stopped the depletion leads to a lack of dopamine. This, as mentioned above, leads to dysphoria. The unpleasant experience of dysphoria leads to a strong desire to use the drug again, to feel the energy and euphoria once more.

**This model is hard to evaluate, but if you need me to explain it, feel free to e-mail me.**

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So there you have it! Almost everything you’ll need to know about Cocaine with regards to the basic psychology. If you have any further questions, feel free to e-mail me!

Sam Eddy.