Cocaine

4.88K views
cocaine

Cocaine

Cocaine also known as Coke, Coca, Crack, Crank, Flake, Snow, Blow, Powder, Charlie, Rock or Soda Cot is a very addictive white powdery substance made from leaves of the coca plant (Erythroxylon coca) found in South America that is mainly used as a recreational drug that stimulates your brain (central nervous system) that can make you feel like you have more energy, more alertness and a sense of euphoria (a feeling or state of intense excitement and happiness) 1, 2, 3, 4, 5. But in some cases, cocaine can cause very serious health problems such as a heart attack, stroke, or coma. Cocaine can also make you feel restless, irritable, anxious, and paranoid. Large amounts of cocaine can lead to bizarre, unpredictable, and violent behavior. Cocaine’s effects appear almost immediately and disappear within a few minutes to an hour. How long the effects last and how intense they are will depend on how the person used it. Cocaine is very rarely used as a prescription drug as local anesthesia for some eye, ear, and throat surgeries 6, 7. Topical cocaine has an anesthetic effect similar to local anesthetics such as lidocaine from sodium channel blockade and interference with action potential propagation 2.

Cocaine is a Drug Enforcement Administration (DEA) Schedule 2 drug, which means that it has high potential for misuse that can only be administered by a doctor for medical uses 8, 9, 3, 10..

Cocaine is mostly available as an illegal drug that some people use to get high. Street dealers sometimes mix it with cornstarch, talcum powder, or flour to make it look like they have more cocaine. That way dealers can make more money. Street dealers may also mix cocaine with other illegal drugs. Another form of cocaine is crack cocaine. Crack cocaine has been heated to make it into a rock crystal.

Cocaine is most commonly snorted through the nose or rub it into the gums, but can also be smoked also known as “freebasing” or dissolved in water and injected into the bloodstream. Some people inject a combination of cocaine and heroin called a “speedball”.

When cocaine use is stopped or when a binge ends, a crash follows almost right away. The cocaine user has a strong craving for more cocaine during a crash. Other symptoms include fatigue, lack of pleasure, anxiety, irritability, sleepiness, and sometimes agitation or extreme suspicion or paranoia.

The “high” associated with ongoing cocaine use may become less and less pleasant. Cocaine can produce fear and extreme suspicion rather than euphoria (a feeling or state of intense excitement and happiness). Even so, cocaine cravings may remain powerful.

Cocaine use ranges from occasional to repeated or compulsive use, with a variety of patterns between these extremes. Any route of administration can potentially lead to absorption of toxic amounts of cocaine, causing heart attacks, strokes, or seizures, all of which can result in sudden death 11, 12.

Cocaine’s effects appear almost immediately and disappear within a few minutes to an hour. How fast you feel the effects and how long the effects last of cocaine depends on how it is used:

  • Smoking: Effects start right away, are intense and last 5 to 10 minutes.
  • Injecting into a vein: Effects start within 15 to 30 seconds and last 20 to 60 minutes.
  • Snorting: Effects start in 3 to 5 minutes, are less intense than smoking or injecting, and last 15 to 30 minutes.

Cocaine’s effects on your body may include 13:

  • your heart beats faster
  • your body temperature rises
  • the pupils in your eyes get bigger
  • you move more quickly than usual
  • you are less hungry
  • you get headaches
  • you feel dizzy
  • you have chest pain
  • you have a heart attack
  • you have seizures or convulsions (fits)
  • you overdose.

Cocaine’s psychological effects. You may:

  • feel good and confident
  • be excited or upset
  • feel numb
  • take more risks than usual
  • want to have sex
  • feel alert and energetic
  • feel overly assertive or aggressive
  • feel restless
  • become violent or aggressive
  • find it hard to concentrate
  • not feel like doing anything
  • lose interest in sex
  • have psychosis – a serious psychological problem when you hear voices, imagine things, get frightened that others want to hurt you.

Cocaine’s Long-Term Effects. If you use cocaine often and for a long time you may:

  • become dependent
  • become aggressive, violent or have more arguments than usual
  • have relationship, work, money, legal or housing problems
  • impair your capacity as a parent/primary carer of children.

The way a person takes cocaine can also cause some problems:

  • Snorting cocaine can lead to nosebleeds, sinus problems and sometimes permanent damage inside the nose.
  • Injecting cocaine with unsterile injecting equipment makes you more likely to contract blood borne viruses such as HIV, hepatitis B and C, and get blood poisoning (septicaemia) and skin abscesses (sores with pus). NEVER share fits (needles and syringes), spoons, water, filters, alcohol swabs or tourniquets.
  • Injecting cocaine can result in:
    • blocked blood vessels (caused by the things sometimes mixed with cocaine) leading to serious damage to the body’s organs such as the liver, heart, brain
    • inflamed blood vessels and abscesses
    • a person picking at their own skin, sometimes resulting in serious damage that needs skin grafts (operations) to heal
  • Smoking freebase cocaine (crack) can cause breathing difficulties, a long-term cough, chest pain and lung damage.

Mixing cocaine with other drugs can have unpredictable effects and increase the risk of harm:

  • Cocaine and psilocybin/LSD/cannabis: can intensify anxiety, paranoia, confusion, or thought loops.
  • Cocaine and opioids/GHB (gamma hydroxybutyrate)/GBL (gamma butyrolactone): can increase the risk of heart strain and respiratory arrest.
  • Cocaine and methamphetamine: can increase the risk of heart strain.
  • Cocaine and ketamine: can impair thinking, coordination and increase blood pressure depending on amount taken.
  • Cocaine and alcohol: can feel less intoxicated due to the stimulant effect of cocaine and lead to drinking more.
  • Cocaine and MDMA: increases the risk of heart strain, heart attack and psychosis. Cocaine can also reduce desirable effects of MDMA.

Cocaine can harm your body in many ways and lead to 14, 11, 12:

  • Heart problems, such as fast heart rate, irregular heartbeat and increased blood pressure.
  • Heart attack.
  • Heart failure.
  • High blood pressure.
  • Stroke. This is when a blood clot blocks a blood vessel that brings blood to the brain, or when a blood vessel in the brain bursts open resulting in bleeding in the brain.
  • Seizures.
  • Respiratory failure. This is when too little oxygen passes from your lungs into your blood or when your lungs can’t remove carbon dioxide from your blood.
  • Loss of appetite.
  • Severe weight loss.
  • High body temperature and skin flushing.
  • Loss of smell. This can happen when cocaine is snorted.
  • Infections like HIV, hepatitis B or hepatitis C. Infections can happen when cocaine is injected through a dirty or shared needle. Other risky behaviors that can be linked to drug use, such as having unsafe sex, can also increase the chance of becoming infected with one of these diseases.
  • Psychotic disorder or psychosis. Possible symptoms include delusions, hallucinations, talking incoherently and agitation. The person with the condition usually isn’t aware of his or her behavior.
  • Memory loss, problems thinking clearly, and strokes
  • Anxiety, mood and emotional problems, aggressive or violent behavior, and hallucinations
  • Restlessness, tremors, seizures
  • Sleep problems
  • Kidney damage
  • Death.
  • Cocaine can cause birth defects when taken during pregnancy and is not safe during breastfeeding.
  • Using cocaine can lead to addiction. This means your mind is dependent on cocaine. You are not able to control your use of it and need (crave) it to get through daily life.

Using too much cocaine can cause an overdose. This is known as cocaine intoxication. Symptoms can include enlarged pupils of the eye, sweating, tremors, confusion, and sudden death.

Cocaine withdrawal often has no visible physical symptoms, such as the vomiting and shaking that accompany withdrawal from heroin or alcohol.

Cocaine withdrawal symptoms may also be associated with suicidal thoughts in some people. Stopping long-term heavy use of cocaine can cause craving and depression that can last for months.

Cocaine addiction is difficult to treat, and relapse can occur. Cocaine addiction treatment should start with the least restrictive option. Outpatient care is as effective as inpatient care for most people. Withdrawal from cocaine may not be as unstable as withdrawal from alcohol. However, the withdrawal from any long-term cocaine use can be very serious. There is a risk of suicide or overdose.

People who have cocaine withdrawal will often use alcohol, sedatives, hypnotics, or anti-anxiety medicines to treat their symptoms. Long-term use of these drugs is not recommended because it simply shifts addiction from one substance to another. Under proper medical supervision, however, short-term use of these medicines may be helpful in recovery.

Cocaine addiction treatment begins with recognizing there is problem. Once you decide you want to do something about your cocaine use, the next step is to get help and support. Cocaine addiction treatment programs use behavior change techniques through counseling (talk therapy). The aim is to help you understand your behaviors and why you use cocaine. Involving family and friends during counseling can help support you and keep you from going back to using (relapsing) the drug.

If you have severe withdrawal symptoms, you may need to stay at a live-in treatment program. There, your health and safety can be monitored as you recover.

At this time, there is no medicine that can help reduce the craving for cocaine by blocking its effects. But, scientists are researching such treatments.

Cocaine mechanism of action

There are 2 chemical forms of cocaine: the water-soluble hydrochloride salt and the water-insoluble cocaine base or freebase cocaine. Cocaine hydrochloride is a powder that is injected or sniffed through the nose (snorted). Freebase cocaine also known as alkaloidal cocaine is created by processing cocaine with ammonia or sodium bicarbonate (baking soda) and water, then heating it to remove the hydrochloride to produce a smokable substance. Crack cocaine is a type of freebase cocaine sold in the form of small crystals or rocks, which refers to the crackling sound of the rock as it’s heated. Crack cocaine can also be used by sprinkling it on marijuana or tobacco and smoking it.

Cocaine is typically used orally, intranasally, intravenously, or by inhalation. When snorted (intranasal use), cocaine powder is inhaled through the nostrils, where it is absorbed into the bloodstream through the nasal tissues. People may also rub the drug onto their gums (oral use). Dissolving cocaine in water and injecting it (intravenous use) releases the drug directly into the bloodstream and heightens the intensity of its effects. When people smoke cocaine (inhalation), they inhale its vapor or smoke into the lungs, where absorption into the bloodstream is almost as rapid as by injection.

Cocaine produces its effects by causing your brain to release higher than normal amounts of some chemicals. Cocaine powerfully activate reward and reinforcement mechanisms in the brain. Reward refers to the euphoria or high produced when taking the drug equivalent to “liking”; reinforcement refers to the desire to take the drug again also called “wanting” 15, 16.

The mechanisms of drug euphoria or reward are only somewhat understood but are now believed to involve several dispersed brain structures called “hedonic hotspots” that produce especially intense pleasure when activated simultaneously 15, 16. Their activation involves several different chemical messengers including the body’s naturally occurring opioids. Reinforcement is much better understood, and it mainly involves the neurotransmitter dopamine.

The brain’s mesolimbic dopamine system sometimes called the reward pathway, is stimulated by all types of reinforcing stimuli, such as food, sex, and many drugs, including cocaine 3. This pathway originates in a region of the midbrain called the ventral tegmental area and projects to other brain areas including the nucleus accumbens, where one of the brain’s hedonic hotspots is also located 17. Besides reward and reinforcement, this circuit also regulates emotions and motivation 18.

In the normal communication process, dopamine is released by a neuron into the synapse (the small gap between two neurons), where it binds to specialized proteins called dopamine receptors on the neighboring neuron. By this process, dopamine acts as a chemical messenger, carrying a signal from neuron to neuron. Another specialized protein called a transporter removes dopamine from the synapse to be recycled for further use 17.

Drugs can interfere with this normal communication process 3. For example, cocaine acts by binding to the dopamine transporter, blocking the removal of dopamine from the synapse. Dopamine then accumulates in the synapse to produce an amplified signal to the receiving neurons 3. This dopamine surge, simultaneous with the euphoric effects of cocaine, teaches the brain that this reward is desirable and to seek it again. This reinforcement sets in motion the addiction cycle 19, 20.

Use of cocaine can induce long-term changes in the brain 3. Animal studies show that cocaine exposure can cause significant neuroadaptations in neurons that release the excitatory neurotransmitter glutamate 21, 22. Animals chronically exposed to cocaine demonstrate profound changes in glutamate neurotransmission—including how much is released and the level of receptor proteins—in the reward pathway, particularly the nucleus accumbens 3. The glutamate system may be an opportune target for anti-addiction medication development, with the goal of reversing the cocaine-induced neuroadaptations that contribute to the drive to use cocaine 21.

Although researchers have focused on adaptations in the brain’s reward system, drugs also affect the brain pathways that respond to stress 3. Stress can contribute to cocaine recurrence, and cocaine use disorders frequently co-occur with stress-related disorders 3. The stress circuits of the brain are distinct from the reward pathway, but research indicates that there are important ways that they overlap. The ventral tegmental area seems to act as a critical integration site in the brain that relays information about both stress and drug cues to other areas of the brain, including ones that drive cocaine seeking 3. Animals that have received cocaine repeatedly are more likely to seek the drug in response to stress, and the more of the drug they have taken, the more stress affects this behavior 3. Research suggests that cocaine elevates stress hormones, inducing neuroadaptations that further increase sensitivity to the drug and cues associated with it 23.

Chronic cocaine exposure affects many other areas of the brain too 3. Animal research indicates that cocaine perturbs the function of the orbitofrontal cortex (OFC), which appears to underlie the poor decision-making, inability to adapt to negative consequences of drug use, and lack of self-insight shown by people addicted to cocaine 24. A study using optogenetic technology, which uses light to modulate the activity of specific, genetically-modified neurons, found that stimulating the orbitofrontal cortex (OFC) restores adaptive learning in animals. This result suggests that strengthening orbitofrontal cortex (OFC) activity may be a good therapeutic approach to improve insight and awareness of the consequences of drug use among people who use cocaine 25.

Cocaine short-term effects

Cocaine’s effects appear almost immediately after a single dose and typically disappear within a few minutes to an hour 3. Small amounts of cocaine usually make people feel euphoric, energetic, talkative, and mentally alert 5. Cocaine can also temporarily decrease the need for food and sleep 26, 27. Some people find that cocaine helps them perform simple physical and intellectual tasks more quickly, although others experience the opposite effect 28.

The duration of cocaine’s euphoric effects depends upon the route of administration 3. The faster the drug is absorbed, the more intense the resulting high, but also the shorter its duration 3. Snorting cocaine produces a relatively slow onset of the high, but it may last from 15 to 30 minutes 3. In contrast, the high from smoking cocaine is more immediate but may last only 5 to 10 minutes 29.

Short-term physiological effects of cocaine use include constricted blood vessels; dilated pupils; and increased body temperature, heart rate, and blood pressure 14. Large amounts of cocaine may intensify the high but can also lead to bizarre, erratic, and violent behavior. Some people who use cocaine report feelings of restlessness, irritability, anxiety, panic, and paranoia 12. They may also experience tremors, vertigo, and muscle twitches 11.

Severe medical complications can occur with cocaine use. Some of the most frequent are cardiovascular effects, including disturbances in heart rhythm and heart attacks; neurological effects, including headaches, seizures, strokes, and coma; and gastrointestinal complications, including abdominal pain and nausea 12. In rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures 11.

Many people who use cocaine sometimes take other drugs at the same time to cope with some of the things cocaine does to their body. Some people take drugs such as minor tranquillisers, alcohol, marijuana or heroin to help them sleep. This can make you dependent on several drugs at once. For example, some people need cocaine each day to get them going and minor tranquillisers each night to get to sleep. This type of dependence can lead to many serious physical and psychological problems.

Mixing different drugs can also make you more likely to overdose. Combining cocaine with another illicit drug can be fatal. For example, people who use cocaine with alcohol is a dangerous combination. The cocaine and alcohol can react to produce cocaethylene, which may increase the toxic effects of cocaine and alcohol on your heart 30, 31. The combination of cocaine and opioids like heroin or fentanyl is also very dangerous. People combine these drugs because the stimulating effects of cocaine are offset by the sedating effects of an opioid; however, this can lead to taking a high dose of the opioid without initially realizing it. Because cocaine’s effects wear off sooner, this can lead to an opioid overdose 32, 33.

Cocaine long-term effects

People who use cocaine over the long term may develop health problems. Which problems they have will depend on how they used the cocaine:

  • Snorting cocaine can lead to a loss of sense of smell, nosebleeds, nasal damage, and trouble swallowing.
  • Smoking cocaine can cause a cough, asthma, trouble breathing, and a higher risk of infections like pneumonia.
  • Injecting cocaine with a needle can lead to skin or soft tissue infections, as well as scarring. It can cause collapsed veins. When a vein collapses, the blood cannot flow through it. Injecting cocaine also puts a person at higher risk of getting diseases such as HIV, hepatitis B and hepatitis C.
  • Other long-term effects of cocaine use may include malnutrition and movement disorders, including Parkinson’s disease.

Repeated use of cocaine can lead to tolerance. Tolerance means that you must take more of the drug to feel the same effects you used to have with lower amounts. At higher doses over time, the body becomes dependent on cocaine. Dependence on cocaine means that it takes up a lot of your thoughts, emotions and activities and can lead to a variety of health, money, legal, work and relationship problems. If someone who is dependent on cocaine stops using it, they will have withdrawal symptoms. Cocaine-dependent people may find it very hard to stop using or cut down because of withdrawal symptoms.

Cocaine withdrawal symptoms can include:

  • wanting cocaine very badly (cravings)
  • feeling angry or upset
  • feeling sick
  • fatigue
  • vomiting
  • shaking
  • tiredness
  • weakness
  • anxious
  • restlessness
  • slowed thinking
  • hunger or increased appetite
  • long but disturbed sleep
  • bad dreams and insomnia
  • muscle pain
  • depression (feeling very down or sad)
  • wanting to kill yourself

These withdrawal symptoms are usually fairly short-lived and most people don’t need medication. For those who develop neuropsychiatric symptoms, the recovery is often prolonged and may not be complete. If you are worried about cocaine withdrawal, contact your doctor.

Repeated use of cocaine can also lead to cocaine use disorder also called cocaine addiction. This is more than physical dependence. It’s a long-lasting brain disorder. With repeated exposure to cocaine, the brain starts to adapt so that the reward pathway becomes less sensitive to natural reinforcers 34, 22. At the same time, circuits in your brain involved in stress become increasingly sensitive, leading to increased displeasure and negative moods when not taking the drug, which are signs of withdrawal 35. When someone has cocaine addiction, they continue to use cocaine even though it causes problems in their life. Cocaine addiction makes the affected individual more likely to focus on seeking cocaine instead of relationships, food, or other natural rewards. Some examples include health problems and not being able to meet responsibilities at work, school, or home. Getting and using cocaine becomes their main purpose in life.

With regular cocaine use, tolerance may develop so that higher cocaine doses, more frequent use of cocaine, or both are needed to produce the same level of pleasure and relief from withdrawal experienced initially 34, 22. At the same time, people can also develop sensitization, in which more cocaine is needed to reduce anxiety, convulsions, or other toxic effects 12. Tolerance to cocaine reward and sensitization to cocaine toxicity can increase the risk of overdose.

Some people take cocaine in binges, in which cocaine is used repeatedly and at increasingly higher doses 3. This can lead to increased irritability, restlessness, panic attacks, paranoia, and even psychosis, in which the individual loses touch with reality and experiences auditory and visual hallucinations 11. With increasing doses or higher frequency of use, the risk of adverse psychological or physiological effects increases 12, 11.

Specific routes of cocaine administration can produce their own adverse effects 3. Regularly snorting cocaine can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum leading to a chronically inflamed, runny nose 29. Smoking crack cocaine damages the lungs and can worsen asthma 11. People who inject cocaine have puncture marks called tracks, most commonly in their forearms and they are at risk of contracting infectious diseases like HIV and hepatitis C 18. They also may experience allergic reactions, either to cocaine itself or to additives in cocaine, which in severe cases can result in death 36.

Cocaine damages many other organs in your body 3. Cocaine reduces blood flow in the gastrointestinal tract, which can lead to tears and ulcerations 12. Many people who use cocaine chronically lose their appetite and experience significant weight loss and malnourishment 3. Cocaine has significant and well-recognized toxic effects on the heart and cardiovascular system 12, 37, 38. Chest pain that feels like a heart attack is common and sends many people who use cocaine to the emergency room 12, 38. Cocaine use is linked with increased risk of stroke, as well as inflammation of the heart muscle, deterioration of the ability of the heart to contract, and aortic ruptures 37, 38.

In addition to the increased risk for stroke and seizures, other neurological problems can occur with long-term cocaine use 12, 34. There have been reports of intracerebral hemorrhage or bleeding in the brain, and balloon-like bulges in the walls of cerebral blood vessels 12, 34. Movement disorders, including Parkinson’s disease, may also occur after many years of cocaine use 12. Generally, studies suggest that a wide range of cognitive functions are impaired with long-term cocaine use, such as sustaining attention, impulse inhibition, memory, making decisions involving rewards or punishments, and performing motor tasks 28.

Cocaine dependence

Cocaine is highly addictive, and users crave the same experience over and over again. Using cocaine daily, or almost every day, over a period of time, leads to physical and psychological changes in your body. Your body adapts or ‘gets used to’ having cocaine on a regular basis. This is called tolerance. People who are tolerant need more of the drug to achieve the same effects, but increasing the dose also increases the likelihood of unpleasant effects. The key feature of dependence is a loss of control over use. People who are cocaine dependent spend a lot of time thinking about drugs, obtaining and using drugs, and recovering from the effects. People who are dependent find it difficult to reduce or stop drug use, even when they are aware of problems related to their drug use.

Cocaine withdrawal

Cocaine withdrawal occurs when someone who has used a lot of cocaine cuts down or quits taking the drug. Giving up cocaine after a long time is challenging because your body has to get used to functioning without it. Symptoms of cocaine withdrawal can occur even if the user is not completely off cocaine and still has some cocaine in their blood. Cocaine withdrawal often has no visible physical symptoms, such as the vomiting and shaking that accompany withdrawal from heroin or alcohol. Please seek advice from a health professional.

Symptoms of cocaine withdrawal may include:

  • cravings
  • feeling sick and/or vomiting
  • shaking
  • feeling angry and upset
  • agitation and restless behavior
  • general feeling of discomfort
  • increased appetite or intense hunger
  • feeling tired and/or weak
  • feeling anxious
  • feeling hungry
  • muscle pain
  • disturbed or restless sleep
  • vivid and unpleasant dreams
  • slowing of activity (psychomotor retardation)
  • having depression and suicidal thoughts.

These symptoms usually disappear quite quickly, but intermittent cravings for cocaine can last for months. Stopping long-term heavy use of cocaine can cause craving and depression that can last for months.

Complications of cocaine withdrawal include:

  • Depression
  • Craving and overdose
  • Suicide

During cocaine withdrawal symptoms may also be associated with suicidal thoughts in some people.

Symptoms of cocaine withdrawal usually disappear over time. If cocaine withdrawal symptoms are severe, a live-in treatment program may be recommended. Your health and safety can be monitored during your recovery. In live-in treatment facility, medicines may be used to treat cocaine withdrawal symptoms. Counseling or psychotherapy may also help end the addiction.

Phases of cocaine withdrawal

Cocaine withdrawal symptoms usually start around 6-12 hours after the last use.

Cocaine withdrawal usually happens in 3 phases:

  1. Crash – feelings of depression or anxiety, cocaine cravings, extreme tiredness (experienced in the first few days)
  2. Withdrawal – cocaine cravings, lack of energy, anxiety, agitation, disturbed sleep,and an inability to feel pleasure (can last for several weeks)
  3. Extinction – withdrawal symptoms can occur over several months, gradually subsiding) 39.

Cocaine and pregnancy

Cocaine is a very dangerous and addictive drug. Cocaine can be deadly if you take too much or if you mix it with other drugs. If you use cocaine during pregnancy, it can cause serious harm to your baby. Cocaine crosses through the placenta and into your baby. It also takes longer for a developing baby or newborn to get cocaine out of their system than it does an adult. Using cocaine during pregnancy may cause serious problems for your baby, before and after birth. These problems can include:

  • Placental abruption. This is a serious condition in which the placenta separates from the wall of the uterus before birth. The placenta supplies the baby with food and oxygen through the umbilical cord. Placental abruption can cause very heavy bleeding and can be deadly for both mother and baby.
  • Preterm birth. This is birth that happens too early, before 37 weeks of pregnancy.
  • Low birthweight. This is when a baby is born weighing less than 5 pounds, 8 ounces.
  • Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
  • Neonatal abstinence syndrome also called NAS. This is a group of conditions a newborn can have if his mother is addicted to drugs during pregnancy. Neonatal abstinence syndrome happens when a baby gets addicted to a drug before birth and then goes through drug withdrawal after birth. Symptoms usually begin shortly after birth and can last several weeks. Symptoms of neonatal abstinence syndrome include tremors (shaking), increased irritability, trouble sleeping and excessive crying.

Cocaine use during pregnancy is associated with migraines and seizures, premature membrane rupture, and separation of the placental lining from the uterus prior to delivery 40. Pregnancy is accompanied by normal cardiovascular changes, and cocaine use intensifies these sometimes leading to serious problems with high blood pressure (hypertensive crises), spontaneous miscarriage, preterm labor, and difficult delivery 41.

Women who use cocaine and are pregnant must receive appropriate medical and psychological care—including addiction treatment—to reduce these risks.

Cocaine use can also cause long-term health problems for your baby, including:

  • Behavior problems
  • Learning difficulties
  • Problems paying attention
  • Vision and hearing problems.

Babies exposed to cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are shorter in length than babies who are not exposed to cocaine during pregnancy 41, 42, 43.

Scientists find that exposure to cocaine during fetal development may lead to subtle, yet significant, later problems in some children 44, 45. These include behavior problems and learning difficulties 45, 46. Some problems persist into the later years, with prenatally exposed adolescents showing increased risk for subtle problems with language and memory 47. Brain scans in prenatal cocaine exposure affected teens suggests that at-rest functioning of some brain regions including areas involved in attention, planning, and language may differ from that of non-exposed peers 48.

Cocaine overdose

It’s possible to overdose on cocaine. Cocaine overdose happens when a person uses so much cocaine that it causes a life-threatening reaction or death. Some people use cocaine along with other drugs or alcohol. This can increase their risk of an cocaine overdose.

Cocaine overdose is more likely to occur in people with pre-existing heart conditions or who are older. Even small amounts may cause overdose with some people who have an especially strong reaction to it.

Cocaine overdose may be caused by:

  • Taking too much cocaine, or taking a too-concentrated a form of cocaine
  • Using cocaine when the weather is hot, which leads to more harm and side effects due to dehydration
  • Using cocaine with certain other drugs.

Symptoms of cocaine intoxication include:

  • Feeling high, excited, talking and rambling, sometimes about bad things happening
  • Anxiety, agitation, restlessness, confusion
  • Muscle tremors, such as in the face and fingers
  • Enlarged pupils that don’t get smaller when a light shines into the eyes
  • Increased heart rate and blood pressure
  • Lightheadedness
  • Paleness
  • Nausea and vomiting
  • Fever, sweating

With higher doses of cocaine or cocaine overdose, more severe symptoms can occur, including:

  • Stroke
  • Bleeding in the brain
  • Seizures
  • Irregular heartbeat (arrhythmia)
  • Heart attack
  • Heart failure
  • Loss of awareness of surroundings
  • Loss of urine control
  • High body temperature, severe sweating
  • High blood pressure, very fast heart rate or irregular heart rhythm
  • Bluish color of the skin
  • Fast or difficulty breathing
  • Death.

Cocaine is often cut (mixed) with other substances. When taken, additional symptoms can occur.

Cocaine overdose can cause permanent damage which may cause:

  • Seizures, stroke, and paralysis
  • Chronic anxiety and psychosis (severe mental disorders)
  • Decreased mental functioning
  • Heart irregularities and decreased heart function
  • Kidney failure requiring dialysis (kidney machine)
  • Destruction of muscles, which can lead to amputation

If cocaine overdose is suspected, your doctor may order the following tests:

  • Cardiac enzymes to look for evidence of heart damage or heart attack
  • Chest x-ray
  • CT scan of the head, if head injury or bleeding is suspected
  • ECG (electrocardiogram, to measure electrical activity in the heart)
  • Toxicology (poison and drug) screening
  • Urinalysis

There is no specific medicine to treat a cocaine overdose. Doctors usually focus on treating the specific health problems caused by cocaine overdose.

Your doctor will measure and monitor your vital signs, including temperature, pulse, breathing rate, and blood pressure.

Symptoms will be treated as appropriate. You may receive:

  • Breathing support, including oxygen, a tube down the throat, and ventilator (breathing machine)
  • IV fluids (fluids through a vein)
  • Medicines to treat symptoms such as pain, anxiety, agitation, nausea, seizures, and high blood pressure
  • Other medicines or treatments for heart, brain, muscle, and kidney complications

Long-term treatment requires drug counseling in combination with medical therapy.

Cocaine overdose treatment

There is no specific medicine to treat a cocaine overdose. Doctors usually focus on treating the specific health problems caused by cocaine overdose. Based on a large systematic review, cardiovascular toxicity and agitation are best-treated first-line with benzodiazepines to decrease central nervous system (brain and spinal cord) sympathetic outflow 49. However, there is a risk of over-sedation and respiratory depression with escalating and numerous doses of benzodiazepines, which is often necessary. Non-dihydropyridine calcium channel blockers such as diltiazem and verapamil have been shown to reduce hypertension reliably, but not tachycardia 14. Dihydropyridine agents such as nifedipine should be avoided, as reflex tachycardia may occur 14. The alpha-blocker phentolamine has been recommended but only treats alpha-mediated hypertension and not tachycardia. It is a rarely-used drug, and most clinicians are unfamiliar with its use and limited titratability 14. Nitroglycerin and nitroprusside are effective at lowering blood pressure, but the risk of reflex tachycardia should be recognized. The mixed beta/alpha blocker labetalol has been shown to be safe and effective for treating concomitant cocaine-induced hypertension and tachycardia without any “unopposed alpha-stimulation” adverse events recorded 14. The use of labetalol is approved by an American College of Cardiology Foundation/American Heart Association guideline for cocaine and methamphetamine patients with unstable angina/non-STEMI 50.

Agitated patients are best treated with benzodiazepines, but antipsychotics such as haloperidol and olanzapine may also be useful. Combination treatment with benzodiazepines and antipsychotics has been shown to be more efficacious than monotherapy 51. Diphenhydramine is often added to enhance sedation and as prophylaxis against dystonia and akathisia. A common example of this is the “B-52,” with its combination of haloperidol (5 mg), diphenhydramine (50 mg), and lorazepam (2 mg) 14. Lidocaine and intravenous lipid emulsion have been successfully used for serious ventricular tachydysrhythmia in several case reports 14. Hyperthermia from cocaine toxicity is best treated with external cooling measures. Tepid water misting with convection cooling from a fan is the easiest and safest method to accomplish this in the field and all emergency departments 49.

Cocaine addiction treatment

Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) to treat cocaine use disorder (CUD) 3, 1. But many behavioral treatments have proven to be effective in both residential and outpatient settings. Behavioral therapies are often the only available and effective treatments for many drug problems, including stimulant use disorders 52.

The most promising medications for treatment of cocaine use disorder include the use of dopaminergic agonists, such as long-acting amphetamine or drugs capable of influencing glutamatergic and GABAergic systems such as topiramate 53. The effectiveness of these treatments was evaluated in preliminary clinical trials. In the Netherlands, 73 patients with treatment-refractory heroin and cocaine dependence reported fewer days of cocaine use (45 days) after 12 weeks of oral administration of sustained-release dexamphetamine (60 mg/day) compared with placebo-treated patients (61 days) 54. Regarding the use of glutamatergic/GABAergic medications, 170 cocaine- and alcohol-dependent individuals treated with topiramate (300 mg/day for 13 weeks) were significantly more likely to achieve abstinence from cocaine during the last 3 weeks of treatment 55. Modafinil has also shown promising results in treating moderate cocaine use disorder, as it can weaken cocaine-induced euphoria in humans; however, it is not effective in reducing cocaine intake if the subjects have an alcohol dependence in conjunction with cocaine use disorder 56.

Contingency Management

One form of behavioral therapy that shows positive results in people with cocaine use disorders is contingency management also called motivational incentives 3. Contingency management programs use a voucher or prize-based system that offers patients who abstain from cocaine and other drugs with rewards 3. Contingency management may be particularly useful for helping patients achieve initial abstinence from cocaine and stay in treatment 52, 57, 58. This approach has been shown to be practical and effective in community treatment programs 57

Research indicates that contingency management benefits diverse populations of people who use cocaine 3. Studies show that pregnant women with cocaine use disorder and women with cocaine use disorder who have young children who participated in a contingency management program as an add-on to other substance use disorder treatment were able to stay abstinent longer than those who received an equivalent amount of vouchers with no behavioral requirements 59. Patients participating in contingency management treatment for cocaine use who also experienced psychiatric symptoms such as depression, emotional distress, and hostility showed a significant reduction in these problems, probably related to reductions in cocaine use 60.

Cognitive-behavioral therapy (CBT)

Cognitive-behavioral therapy (CBT) is another effective approach for treating cocaine addiction. Cognitive-behavioral therapy (CBT) helps people with cocain addiction develop critical skills that support long-term abstinence including the ability to recognize the situations in which they are most likely to use cocaine, avoid these situations, and cope more effectively with a range of problems associated with drug use 52. CBT can also be used in conjunction with other treatments, thereby maximizing the benefits of both 52.

Researchers have developed a computerized form of CBT (CBT4CBT) that patients use in a private room of a clinic 61, 62, 63. This interactive multimedia program closely follows the key lessons and skill-development activities of in-person CBT in a series of modules. Movies present examples and information that support the development of coping skills; quizzes, games, and homework assignments reinforce the lessons and provide opportunities to practice skills 61, 62, 63. Studies have shown that adding CBT4CBT to weekly counseling boosted abstinence43 and increased treatment success rates up to 6 months after treatment 62.

Therapeutic Communities

Therapeutic communities also known as drug-free residences in which people in recovery from substance use disorders help each other to understand and change their behaviors can be an effective treatment for people who use drugs, including cocaine 64. Therapeutic communities may require a 6- to 12-month stay and can include onsite job rehabilitation and other supportive services. Therapeutic communities can also provide support in other important areas—improving legal, employment, and mental health outcomes 64, 65.

Aftercare

Regardless of the specific type of substance use disorder treatment, it is important that patients receive services that match all of their treatment needs  3. For example, an unemployed patient would benefit from job rehabilitation or career counseling along with addiction treatment  3. Patients with marital problems may need couples counseling  3. Once inpatient treatment ends, ongoing support also called aftercare can help people avoid recurrence  3. Research indicates that people who are committed to abstinence, engage in self-help behaviors, and believe that they have the ability to refrain from using cocaine (self-efficacy) are more likely to abstain  3. Aftercare serves to reinforce these traits and address problems that may increase vulnerability to recurrence, including depression and declining self-efficacy 66.

Community-based recovery groups may also be helpful in maintaining abstinence 67.

As you recover from cocaine use, focus on the following to help prevent relapse:

  • Keep going to your treatment sessions.
  • Find new activities and goals to replace the activities that involved your drug use.
  • Spend more time with family and friends you lost touch with while you were using. Consider not seeing friends who are still drug users.
  • Exercise and eat healthy foods. Taking care of your body helps it heal from the harmful effects of cocaine use. You will feel better, too.
  • Avoid triggers. These can be people you used cocaine with. Triggers can also be places, things, or emotions that can make you want to use cocaine again.
  1. Roque Bravo R, Faria AC, Brito-da-Costa AM, Carmo H, Mladěnka P, Dias da Silva D, Remião F, On Behalf Of The Oemonom Researchers. Cocaine: An Updated Overview on Chemistry, Detection, Biokinetics, and Pharmacotoxicological Aspects including Abuse Pattern. Toxins (Basel). 2022 Apr 13;14(4):278. doi: 10.3390/toxins14040278[↩][↩]
  2. Richards JR, Laurin EG. Cocaine. [Updated 2023 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430769[↩][↩]
  3. NIDA. 2024, September 27. Cocaine . Retrieved from https://nida.nih.gov/research-topics/cocaine[↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩]
  4. Pomara C, Cassano T, D’Errico S, Bello S, Romano AD, Riezzo I, Serviddio G. Data available on the extent of cocaine use and dependence: biochemistry, pharmacologic effects and global burden of disease of cocaine abusers. Curr Med Chem. 2012;19(33):5647-57. doi: 10.2174/092986712803988811[↩]
  5. Kalapatapu RK, Bedi G, Haney M, Evans SM, Rubin E, Foltin RW. The subjective effects of cocaine: relationship to years of cocaine use and current age. Am J Drug Alcohol Abuse. 2012 Nov;38(6):530-4. doi: 10.3109/00952990.2012.704461[↩][↩]
  6. Calatayud J, González A. History of the development and evolution of local anesthesia since the coca leaf. Anesthesiology. 2003 Jun;98(6):1503-8. doi: 10.1097/00000542-200306000-00031[↩]
  7. Reigstad A, Reigstad O. Lokalbedøvelsens historie – fra kokablader til effektiv analgesi [The history of local anaesthesia – from coca leaves to effective analgesia]. Tidsskr Nor Laegeforen. 2021 Dec 13;141(18). Norwegian. doi: 10.4045/tidsskr.21.0381[↩]
  8. Drake L.R., Scott P.J.H. DARK Classics in Chemical Neuroscience: Cocaine. ACS Chem. Neurosci. 2018;9:2358–2372. doi: 10.1021/acschemneuro.8b00117[↩]
  9. Drug Scheduling. https://www.dea.gov/drug-information/drug-scheduling[↩]
  10. Mladěnka P, Applová L, Patočka J, Costa VM, Remiao F, Pourová J, Mladěnka A, Karlíčková J, Jahodář L, Vopršalová M, Varner KJ, Štěrba M; TOX-OER and CARDIOTOX Hradec Králové Researchers and Collaborators. Comprehensive review of cardiovascular toxicity of drugs and related agents. Med Res Rev. 2018 Jul;38(4):1332-1403. doi: 10.1002/med.21476[↩]
  11. Goldstein RA, DesLauriers C, Burda AM. Cocaine: history, social implications, and toxicity–a review. Dis Mon. 2009 Jan;55(1):6-38. doi: 10.1016/j.disamonth.2008.10.002[↩][↩][↩][↩][↩][↩][↩]
  12. Riezzo I, Fiore C, De Carlo D, Pascale N, Neri M, Turillazzi E, Fineschi V. Side effects of cocaine abuse: multiorgan toxicity and pathological consequences. Curr Med Chem. 2012;19(33):5624-46. doi: 10.2174/092986712803988893[↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩][↩]
  13. Zimmerman JL. Cocaine intoxication. Crit Care Clin. 2012 Oct;28(4):517-26. doi: 10.1016/j.ccc.2012.07.003[↩]
  14. Richards JR, Le JK. Cocaine Toxicity. [Updated 2023 Jun 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430976[↩][↩][↩][↩][↩][↩][↩][↩]
  15. Berridge KC, Dayan P. Liking. Curr Biol. 2021 Dec 20;31(24):R1555-R1557. doi: 10.1016/j.cub.2021.09.069[↩][↩]
  16. Nguyen D, Naffziger EE, Berridge KC. Positive Affect: Nature and brain bases of liking and wanting. Curr Opin Behav Sci. 2021 Jun;39:72-78. doi: 10.1016/j.cobeha.2021.02.013[↩][↩]
  17. Baik JH. Dopamine signaling in reward-related behaviors. Front Neural Circuits. 2013 Oct 11;7:152. doi: 10.3389/fncir.2013.00152[↩][↩]
  18. Salgado S, Kaplitt MG. The Nucleus Accumbens: A Comprehensive Review. Stereotact Funct Neurosurg. 2015;93(2):75-93. doi: 10.1159/000368279[↩][↩]
  19. Koob GF. Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development. Pharmacol Rev. 2021 Jan;73(1):163-201. doi: 10.1124/pharmrev.120.000083[↩]
  20. Koob GF, Volkow ND. Neurobiology of addiction: a neurocircuitry analysis. Lancet Psychiatry. 2016 Aug;3(8):760-773. doi: 10.1016/S2215-0366(16)00104-8[↩]
  21. Schmidt HD, Pierce RC. Cocaine-induced neuroadaptations in glutamate transmission: potential therapeutic targets for craving and addiction. Ann N Y Acad Sci. 2010 Feb;1187:35-75. doi: 10.1111/j.1749-6632.2009.05144.x[↩][↩]
  22. Wolf ME. The Bermuda Triangle of cocaine-induced neuroadaptations. Trends Neurosci. 2010 Sep;33(9):391-8. doi: 10.1016/j.tins.2010.06.003[↩][↩][↩]
  23. Mantsch JR, Vranjkovic O, Twining RC, Gasser PJ, McReynolds JR, Blacktop JM. Neurobiological mechanisms that contribute to stress-related cocaine use. Neuropharmacology. 2014 Jan;76 Pt B(0 0):383-94. doi: 10.1016/j.neuropharm.2013.07.021[↩]
  24. Lucantonio F, Stalnaker TA, Shaham Y, Niv Y, Schoenbaum G. The impact of orbitofrontal dysfunction on cocaine addiction. Nat Neurosci. 2012 Jan 22;15(3):358-66. doi: 10.1038/nn.3014[↩]
  25. Lucantonio F, Takahashi YK, Hoffman AF, Chang CY, Bali-Chaudhary S, Shaham Y, Lupica CR, Schoenbaum G. Orbitofrontal activation restores insight lost after cocaine use. Nat Neurosci. 2014 Aug;17(8):1092-9. doi: 10.1038/nn.3763. Epub 2014 Jul 20. Erratum in: Nat Neurosci. 2014 Sep;17(9):1287.[↩]
  26. Mahboub N, Rizk R, Karavetian M, de Vries N. Nutritional status and eating habits of people who use drugs and/or are undergoing treatment for recovery: a narrative review. Nutr Rev. 2021 May 12;79(6):627-635. doi: 10.1093/nutrit/nuaa095[↩]
  27. Bjorness TE, Greene RW. Interaction between cocaine use and sleep behavior: A comprehensive review of cocaine’s disrupting influence on sleep behavior and sleep disruptions influence on reward seeking. Pharmacol Biochem Behav. 2021 Jul;206:173194. doi: 10.1016/j.pbb.2021.173194[↩]
  28. Spronk DB, van Wel JH, Ramaekers JG, Verkes RJ. Characterizing the cognitive effects of cocaine: a comprehensive review. Neurosci Biobehav Rev. 2013 Sep;37(8):1838-59. doi: 10.1016/j.neubiorev.2013.07.003[↩][↩]
  29. Advokat C, Comaty J, Julien R. Julien’s Primer of Drug Action. 13th ed. New York, NY: Worth Publishers; 2014.[↩][↩]
  30. Pennings EJ, Leccese AP, Wolff FA. Effects of concurrent use of alcohol and cocaine. Addiction. 2002 Jul;97(7):773-83. doi: 10.1046/j.1360-0443.2002.00158.x[↩]
  31. Laizure S.C., Mandrell T., Gades N.M., Parker R.B. Cocaethylene metabolism and interaction with cocaine and ethanol: Role of carboxylesterases. Drug. Metab. Dispos. 2003;31:16–20. doi: 10.1124/dmd.31.1.16[↩]
  32. Nolan ML, Shamasunder S, Colon-Berezin C, Kunins HV, Paone D. Increased Presence of Fentanyl in Cocaine-Involved Fatal Overdoses: Implications for Prevention. J Urban Health. 2019 Feb;96(1):49-54. doi: 10.1007/s11524-018-00343-z[↩]
  33. Liu X, Singer ME. Intentional use of both opioids and cocaine in the United States. Prev Med Rep. 2023 May 5;33:102227. doi: 10.1016/j.pmedr.2023.102227[↩]
  34. Büttner A. Neuropathological alterations in cocaine abuse. Curr Med Chem. 2012;19(33):5597-600. doi: 10.2174/092986712803988947[↩][↩][↩][↩]
  35. Volkow ND, Wang GJ, Fowler JS, Tomasi D, Telang F, Baler R. Addiction: decreased reward sensitivity and increased expectation sensitivity conspire to overwhelm the brain’s control circuit. Bioessays. 2010 Sep;32(9):748-55. doi: 10.1002/bies.201000042[↩]
  36. Armentia A, Martín-Armentia B, Martín-Armentia S, Ruiz-Muñoz P, Quesada JM, Postigo I, Conde R, González-Sagrado M, Pineda F, Castillo M, Palacios R, Tejedor J. Cocaine Allergy in Drug-Dependent Patients and Allergic People. J Allergy Clin Immunol Pract. 2018 Jan-Feb;6(1):201-207. doi: 10.1016/j.jaip.2017.06.013[↩]
  37. Fonseca AC, Ferro JM. Drug abuse and stroke. Curr Neurol Neurosci Rep. 2013 Feb;13(2):325. doi: 10.1007/s11910-012-0325-0[↩][↩]
  38. Maraj S, Figueredo VM, Lynn Morris D. Cocaine and the heart. Clin Cardiol. 2010 May;33(5):264-9. doi: 10.1002/clc.20746[↩][↩][↩]
  39. Black E. Cocaine: What you need to know. National Drug and Alcohol Research Centre; 2014.[↩]
  40. Bhuvaneswar CG, Chang G, Epstein LA, Stern TA. Cocaine and opioid use during pregnancy: prevalence and management. Prim Care Companion J Clin Psychiatry. 2008;10(1):59-65. doi: 10.4088/pcc.v10n0110[↩]
  41. Cain MA, Bornick P, Whiteman V. The maternal, fetal, and neonatal effects of cocaine exposure in pregnancy. Clin Obstet Gynecol. 2013 Mar;56(1):124-32. doi: 10.1097/GRF.0b013e31827ae167[↩][↩]
  42. Behnke M, Smith VC; Committee on Substance Abuse; Committee on Fetus and Newborn. Prenatal substance abuse: short- and long-term effects on the exposed fetus. Pediatrics. 2013 Mar;131(3):e1009-24. doi: 10.1542/peds.2012-3931[↩]
  43. Gouin K, Murphy K, Shah PS; Knowledge Synthesis group on Determinants of Low Birth Weight and Preterm Births. Effects of cocaine use during pregnancy on low birthweight and preterm birth: systematic review and metaanalyses. Am J Obstet Gynecol. 2011 Apr;204(4):340.e1-12. doi: 10.1016/j.ajog.2010.11.013[↩]
  44. Lambert BL, Bauer CR. Developmental and behavioral consequences of prenatal cocaine exposure: a review. J Perinatol. 2012 Nov;32(11):819-28. doi: 10.1038/jp.2012.90[↩]
  45. Lester BM, Lagasse LL. Children of addicted women. J Addict Dis. 2010 Apr;29(2):259-76. doi: 10.1080/10550881003684921[↩][↩]
  46. Ackerman JP, Riggins T, Black MM. A review of the effects of prenatal cocaine exposure among school-aged children. Pediatrics. 2010 Mar;125(3):554-65. doi: 10.1542/peds.2009-0637. Epub 2010 Feb 8. Erratum in: Pediatrics. 2011 Sep;128(3):593.[↩]
  47. Buckingham-Howes S, Berger SS, Scaletti LA, Black MM. Systematic review of prenatal cocaine exposure and adolescent development. Pediatrics. 2013 Jun;131(6):e1917-36. doi: 10.1542/peds.2012-0945[↩]
  48. Li K, Zhu D, Guo L, Li Z, Lynch ME, Coles C, Hu X, Liu T. Connectomics signatures of prenatal cocaine exposure affected adolescent brains. Hum Brain Mapp. 2013 Oct;34(10):2494-510. doi: 10.1002/hbm.22082[↩]
  49. Richards JR, Garber D, Laurin EG, Albertson TE, Derlet RW, Amsterdam EA, Olson KR, Ramoska EA, Lange RA. Treatment of cocaine cardiovascular toxicity: a systematic review. Clin Toxicol (Phila). 2016 Jun;54(5):345-64. doi: 10.3109/15563650.2016.1142090[↩][↩]
  50. Anderson JL, Adams CD, Antman EM, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Jun 11;61(23):e179-347. doi: 10.1016/j.jacc.2013.01.014. Erratum in: J Am Coll Cardiol. 2013 Sep 10;62(11):1040-1.[↩]
  51. Zun LS. Evidence-Based Review of Pharmacotherapy for Acute Agitation. Part 1: Onset of Efficacy. J Emerg Med. 2018 Mar;54(3):364-374. doi: 10.1016/j.jemermed.2017.10.011[↩]
  52. Penberthy JK, Ait-Daoud N, Vaughan M, Fanning T. Review of treatment for cocaine dependence. Curr Drug Abuse Rev. 2010 Mar;3(1):49-62. doi: 10.2174/1874473711003010049[↩][↩][↩][↩]
  53. Kampman K.M. The treatment of cocaine use disorder. Sci. Adv. 2019;5:eaax1532. doi: 10.1126/sciadv.aax1532[↩]
  54. Nuijten M., Blanken P., van de Wetering B., Nuijten B., van den Brink W., Henrdriks V. Sustained-release dexamfetamine in the treatment of chronic cocaine-dependent patients on heroin-assisted treatment: A randomised, double-blind, placebo-controlled trial. Lancet. 2016;387:2226–2234. doi: 10.1016/S0140-6736(16)00205-1[↩]
  55. Kampman K.M., Pettinati H.M., Lynch K.G., Spratt K., Wierzbicki M.R., O’Brien C.P. A double-blind, placebo-controlled trial of topiramate for the treatment of comorbid cocaine and alcohol dependence. Drug. Alcohol. Depend. 2013;133:94–99. doi: 10.1016/j.drugalcdep.2013.05.026[↩]
  56. Reith M.E., Blough B.E., Hong W.C., Jones K.T., Schmitt K.C., Baumann M.H., Partilla J.S., Rothman R.B., Katz J.L. Behavioral, biological, and chemical perspectives on atypical agents targeting the dopamine transporter. Drug. Alcohol. Depend. 2015;147:1–19. doi: 10.1016/j.drugalcdep.2014.12.005[↩]
  57. Petry NM, Barry D, Alessi SM, Rounsaville BJ, Carroll KM. A randomized trial adapting contingency management targets based on initial abstinence status of cocaine-dependent patients. J Consult Clin Psychol. 2012 Apr;80(2):276-85. doi: 10.1037/a0026883[↩][↩]
  58. Schierenberg A, van Amsterdam J, van den Brink W, Goudriaan AE. Efficacy of contingency management for cocaine dependence treatment: a review of the evidence. Curr Drug Abuse Rev. 2012 Dec;5(4):320-31. doi: 10.2174/1874473711205040006[↩]
  59. Schottenfeld RS, Moore B, Pantalon MV. Contingency management with community reinforcement approach or twelve-step facilitation drug counseling for cocaine dependent pregnant women or women with young children. Drug Alcohol Depend. 2011 Oct 1;118(1):48-55. doi: 10.1016/j.drugalcdep.2011.02.019[↩]
  60. Petry NM, Alessi SM, Rash CJ. Contingency management treatments decrease psychiatric symptoms. J Consult Clin Psychol. 2013 Oct;81(5):926-31. doi: 10.1037/a0032499[↩]
  61. Carroll KM, Ball SA, Martino S, Nich C, Babuscio TA, Nuro KF, Gordon MA, Portnoy GA, Rounsaville BJ. Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT. Am J Psychiatry. 2008 Jul;165(7):881-8. doi: 10.1176/appi.ajp.2008.07111835[↩][↩]
  62. Carroll KM, Ball SA, Martino S, Nich C, Babuscio TA, Rounsaville BJ. Enduring effects of a computer-assisted training program for cognitive behavioral therapy: a 6-month follow-up of CBT4CBT. Drug Alcohol Depend. 2009 Feb 1;100(1-2):178-81. doi: 10.1016/j.drugalcdep.2008.09.015[↩][↩][↩]
  63. Carroll KM, Kiluk BD, Nich C, Gordon MA, Portnoy GA, Marino DR, Ball SA. Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. Am J Psychiatry. 2014 Apr;171(4):436-44. doi: 10.1176/appi.ajp.2013.13070987[↩][↩]
  64. Vanderplasschen W, Colpaert K, Autrique M, Rapp RC, Pearce S, Broekaert E, Vandevelde S. Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective. ScientificWorldJournal. 2013;2013:427817. doi: 10.1155/2013/427817[↩][↩]
  65. Leon GD. Is the therapeutic community an evidence based treatment? What the evidence says. Ther Communities Int Journal Ther Support Organ. 2010;31(2):104-128.[↩]
  66. McKay JR, Van Horn D, Rennert L, Drapkin M, Ivey M, Koppenhaver J. Factors in sustained recovery from cocaine dependence. J Subst Abuse Treat. 2013 Aug;45(2):163-72. doi: 10.1016/j.jsat.2013.02.007[↩]
  67. Donovan DM, Daley DC, Brigham GS, Hodgkins CC, Perl HI, Garrett SB, Doyle SR, Floyd AS, Knox PC, Botero C, Kelly TM, Killeen TK, Hayes C, Kau’i Baumhofer N, Seamans C, Zammarelli L. Stimulant abuser groups to engage in 12-step: a multisite trial in the National Institute on Drug Abuse Clinical Trials Network. J Subst Abuse Treat. 2013 Jan;44(1):103-14. doi: 10.1016/j.jsat.2012.04.004. Epub 2012 May 31. Erratum in: J Subst Abuse Treat. 2015 Feb;49:71. Kau’ibaumhofer, Nicole [corrected to Kau’i Baumhofer, Nicole].[↩]

you might also like

Health Jade