In 2017, the Department of Health and Human Services (HHS) declared the opioid crisis a national health emergency. This triggered nationwide, coordinated efforts to stem decades-long increases in opioid misuse, overdose, overdose fatalities, and other opioid-related deaths. The response involved the public and private sectors. Federal, state, municipal, and local authorities participated, from the White House all the way to neighborhood groups. Progress was made. Before the coronavirus pandemic arrived in the U.S., total opioid overdose rates began to decline. Although deaths from illicit, synthetic opioids increased from 2017 to 2018, the template for an effective response to this increase is in place.
It’s still a bad situation, but we’re going in the right direction with the opioid crisis.
During the period when opioid use and overdose deaths rose at alarming rates – 2012 to 2018 – the use of another dangerous and addictive drug also increased, also at alarming rates: cocaine. The opioid overdose and addiction numbers dwarf the cocaine numbers, but that doesn’t change the fact that in the U.S., right now, cocaine use, cocaine-related overdose, cocaine-related deaths, and cocaine addiction rates are more than double those in reported in the 1980s, when cocaine use was prevalent across a wide range of demographic subgroups.
This article presents the latest statistics on cocaine use, discusses cocaine addiction and withdrawal, and ends with information on the treatment of and recovery from cocaine use disorder, a.k.a. cocaine addiction.
Cocaine Use, Cocaine Use Disorder, and Cocaine Overdose in the U.S.
The Department of Health and Human Services (HHS), in collaboration with the Substance Abuse and Health Services Administration (SAMHSA) and the University of Michigan, conducts an annual research effort called the National Survey on Drug Use and Health (NSDUH).
The purpose of the NSDUH is to collect and analyze “…information for youths aged 12 to 17 and adults aged 18 or older on drug, alcohol, and tobacco use, as well as substance use disorder (SUD), risk and availability of substance use, treatment, health topics, and alcohol consumption.”
Policy makers, health officials, and medical professionals use the results of the survey – which includes data from over seventy-thousand people – to make evidence-based, data-driven decisions on matters regarding substance use, mental health, and treatment.
The following two sets of statistics were reported in the 2018 NSDUH.
Cocaine Use: Age 12 and older, Age 18-25, Age 26 +
- An estimated 5.5 million people age 12 or older reported using cocaine in the 12 months prior to taking the survey
- That’s about 2.0% of people age 12 or older in the U.S.
- An estimated 2.0 million young adults age 18-25 reported using cocaine in the 12 months prior to taking the survey
- That’s about 5.8% of young adults age 18-25 in the U.S.
- An estimated 3.5 million adults reported using cocaine in the 12 months prior to taking the survey
- That’s about 1.6% of adults aged 26 or older in the U.S.
Now we offer data on cocaine use disorder, a.k.a. cocaine addiction.
Cocaine Use Disorder: Age 12 and older, Age 18-25, Age 26 +
- About 977,000 people aged 12 or older in 2018 had a cocaine use disorder in the 12 months prior to taking the survey
- That’s 0.4 percent of people age 12 or older in the U.S.
- About 212,000 young adults age 18 to 25 in 2018 had a cocaine use disorder in the 12 months prior to taking the survey.
- That’s 0.6 percent of young adults age 18-25 in the U.S.
- About 760,000 adults aged 26 or older had a cocaine use disorder in the 12 months prior to taking the survey
- That’s about 0.4 percent of adults in this age group
To round out the data section of this article, we offer the numbers on cocaine overdose in the U.S. published by the Centers for Disease Control (CDC).
Cocaine Overdose: Trends from 1999-2018
- Age adjusted rates for cocaine overdose deaths rose from 1.4 per 100,000 in 1999 to 2.5 per 100,000 in 2006.
- For 1999, that’s 4,000 overdose deaths
- For 2006, that’s about 7,500 overdose deaths
- Age adjusted rates for cocaine overdose deaths decreased from 2.5 per 100,000 in 2006 to 1.5 per 100,000 in 2011.
- For 2006, that’s about 4,000 overdose deaths
- For 2011, that’s about 4,500 overdose deaths, representing an overall increase, but a decrease as a percentage of the total population
- Age adjusted rates for cocaine overdose deaths rose from 1.4 per 100,000 in 2012 to 4.5 per 100,000 in 2018.
- For 2012, that’s about 4,400 overdose deaths
- For 2018, that’s about 14,500 overdose deaths
That last set of numbers – the increase in cocaine overdose deaths from 2012-2018 – represents a total increase of around 200 percent, or over 25 percent per year. That’s why it’s important for us to keep an eye on the trends in drug use for all drugs of misuse – not only opioids. That’s an alarming increase, because cocaine use disorder – like opioid use disorder – can cause long-term damage to cocaine users, their families, and society at large.
Now that we’ve presented the latest data on cocaine use, cocaine use disorder (cocaine addiction), and cocaine overdose, we’ll talk about how cocaine works on the brain and body, then offer tips to spot problem cocaine use.
How Cocaine Works
Cocaine is an addictive stimulant derived from the leaves of the South American coca plant. The use of cocaine results in short-term euphoria, a burst of energy, and extreme talkativeness. Cocaine also causes a dangerous increase in both heart rate and blood pressure.
Cocaine is most often used in powdered form. Users inhale cocaine powder through the nose, where it’s absorbed into the bloodstream through nasal tissue. Cocaine can also be dissolved in water, smoked, or injected directly into the bloodstream. A cocaine high from inhaling or drinking lasts about 15-30 minutes, while the high from smoking cocaine lasts from 10-15 minutes.
When the cocaine high – which users report is intensely euphoric – begins to fade, the user often begins to crave more of the drug immediately.
How Cocaine Addiction Develops
Cocaine use disorder develops when users take the drug repeatedly, over short periods of time, in order to achieve and maintain its euphoric effects. However, this binge pattern – due in large part to the short duration of the cocaine high – can quickly lead a state of disordered use. Significant changes in the brain occur – and occur quickly.
These changes cause cocaine users to seek more of the drug at increasingly higher doses.
Inside the brain, cocaine increases the level of the neurotransmitter dopamine, a chemical that regulates pleasure and movement in the body. Typically, dopamine is recycled back into brain cells relatively quickly. Cocaine, however, prevents dopamine recycling (called reuptake) and causes excessive, unnatural, and atypical amounts to accumulate between neurons. The dopamine then disrupts normal communication within the brain, causing the euphoria associated with the cocaine high. In addition, cocaine impairs cognitive function and rational decision-making, which can lead to impulsive, risky behavior.
Cocaine Use Disorder: Signs and Symptoms
While the signs and symptoms of cocaine use vary from individual to individual, they manifest in three general categories: physical, behavioral, and psychological.
Physical symptoms of cocaine use include, but are not limited to:
- Dilated pupils
- Impaired sense of smell
- Runny nose
- Gastric ulcers
- General gastrointestinal difficulties
- Impaired sexual function
Behavioral symptoms of cocaine addiction include, but are not limited to:
- Excess energy
- Rapid, excited speech
- Financial problems
- Impaired interpersonal relationships
- Difficulty managing work, family, and school responsibilities
- Lying about cocaine use
- Lying about financial problems
- Legal issues
Psychological symptoms of cocaine addiction include, but are not limited to:
The signs and symptoms listed above may appear obvious in some cases, but in other cases, they may not appear at all. It’s possible for an individual to develop a cocaine addiction and keep it hidden from almost everyone in their lives. When that happens, the cocaine use disorder may not become visible until the user tries to stop using cocaine – which results in withdrawal.
The signs and symptoms of cocaine withdrawal include, but are not limited to:
- Intense cravings for cocaine
- Anhedonia: reduced ability to feel pleasure
- Increased appetite
- Decreased energy
- Vivid, unpleasant dreams
The prolonged disordered use of cocaine can, in some instances, lead to a condition known as post-acute withdrawal syndrome (PAWS). PAWS refers to a group of symptoms that continue to bother an individual after initial withdrawal symptoms pass. PAWS can persist for weeks, months and, in rare cases, for years.
Characteristics of PAWS include:
- Mood swings (including an outward defensiveness)
- Inconsistent energy levels
- Low enthusiasm
- Impaired cognitive function
The difficulties of withdrawal, the intensity of cravings, and the long-term effects of PAWS make recovery from cocaine addiction challenging. Decades of research show the best way to achieve sustained sobriety after cocaine addiction is through clinical treatment delivered by mental health professionals.
Evidence-Based Treatment for Cocaine Addiction
The most effective treatment for cocaine use disorder follows an integrated treatment model. Integrated treatment addresses the entire person, which means it accounts for and supports all areas of life, including biological, psychological, and social factors that may be at play. If a co-occurring mental, behavioral, or mood disorder is present, then it’s essential to treat that as well. An integrated treatment plan must be customized to the needs of each individual.
Evidence-based treatment plans for cocaine use disorder include, but are not limited to:
- Individual counseling
- Group Counseling
- Family Counseling
- Medication (if needed)
- Community/peer support
- 12 Step groups such as Narcotics Anonymous (NA)
- Lifestyle Modifications
- Experiential activities
- Expressive therapies (art, music, journaling)
- Relapse Prevention
- Aftercare plans
- Ongoing community support
When seeking treatment for cocaine addiction, find a treatment program that includes all the elements above. Each piece is important, and each contributes to long-term, sustained sobriety. Well-respected treatment programs – residential, partial hospitalization, intensive outpatient, or outpatient – will include the elements above. While effective treatment programs share many common components, each treatment center has its own identity approach to treatment. The best way to find the right program is to gather all the available information, then call or visit to get a feel for the clinical staff, support staff, and general atmosphere of the treatment center. Committing to an addiction rehab program is a life-changing decision. Receiving the highest quality professional support in an environment that synchronizes with the specific needs of the person in treatment increases their chances of achieving sustained, lifelong sobriety.