Firstly, can you tell us a bit about your work? How do you help addicts?
I work in private practice and offer an integrative model of talking therapy. I mostly work with people who are interested in stopping taking cocaine. I rarely work with harm minimisation models, simply because my experience is that they don’t work when addressing cocaine addiction. My clients aim to work towards a lifestyle of abstinence. Initially, I help people understand that, once addicted to cocaine, returning to being an occasional user is unrealistic. Psycho-education is an essential aspect of initial addiction therapy. I encourage my patients to identify the wider consequences of their cocaine use. For example: physical illness, lost days at work, loss of job, being estranged from friends and family, being in debt.
Addiction is often referred to as a ‘progressive condition’, so once tolerance levels build up, an increased amount of the substance is required to achieve the same effect. It is not possible to say that if you use X grams of cocaine weekly over a six month period that you will become addicted. It is possible to be a 'functional cocaine addict' for a period of time before needing to seek help.
Cocaine is one of the most psychologically addictive drugs because of how it stimulates and increases levels of the feel good neurotransmitter dopamine in the brain
Through continued and increased use over a period of time. Cocaine is one of the most psychologically addictive drugs because of how it stimulates and increases levels of the feel good neurotransmitter dopamine in the brain. It interferes with the pleasure and reward pathways in the brain.
Because cocaine affects the reward pathways in the brain, increased use over time results in an inability to gain pleasure and reward from what would be considered “normal” pleasures. An example is sex. If cocaine is used repeatedly in sex, the ability to enjoy and experience sexual pleasure without cocaine becomes diminished. As well as affecting the reward pathways, cocaine also affects the brain pathways that respond to stress. In my experience, I often see a presentation of cocaine addiction co-occurring alongside a stress disorder. Cocaine use elevates stress hormones, but people then seek out more cocaine to alleviate their stress, creating the addictive cycle.
In most cases, people will experience an intense euphoria followed by intense flatness of mood and depression
Loss of appetite, malnourishment, increased heart rate and blood pressure, constricting blood vessels, increased rate of breathing, dilated pupils, headaches, disturbed sleep patterns, nausea and abdominal pain and hyper-stimulation. As well as bizarre, erratic, sometimes violent behaviour and risky sexual behaviour. Hallucinations, hyper-excitability, irritability, anger. In most cases, people will experience an intense euphoria followed by intense flatness of mood and depression. In extreme cases: tactile hallucination that creates the illusion of bugs burrowing under the skin, itching and scratching, as well as high levels of anxiety and irritability paranoia; depression matched with an intense craving for the drug, panic and psychosis, convulsions, seizures and in rare cases, sudden death from high doses.
They're rather varied. From permanent damage to blood vessels of the heart and brain, to high blood pressure leading to heart attacks, strokes, and death, to liver, kidney and lung damage, to destruction of tissues in the nose if sniffed. Infectious diseases and abscesses if injected. Respiratory failure when cocaine is smoked. Malnutrition and weight loss as a result of appetite suppression. Tooth decay. Sexual health issues including reproductive damage and infertility (affecting both men and women.) Disorientation, apathy, confusion and exhaustion. Irritability and high mood disturbances. Auditory hallucinations, increased frequency of dangerous and high risk taking behaviour – especially sexual behaviour and unpredictable and increased irrational behaviour leading to psychosis and/or delirium and clinical depression.
'I just want to have a good time, I’m not hurting anyone else, I’m only young once, I’ll stop when I settle down, when I get married, when I have children, when I’m 25, 28, 35….'. This is denial of one’s addiction.
Media glamorisation combined with low prices makes it more affordable to a wider demographic. It is no longer exclusive to celebrities and high salaried professionals. Cocaine has been glamorised over recent decades in films, songs, media; it’s seen as cool. And importantly it makes us feel good – so we ask ourselves, “How can it be harming me?” There is also a lack of public awareness campaigns that educate young people about the reality of its dangers.
What kind of behavioural tendencies should people watch out for in themselves and in others?
A key indicator of whether a person’s use of cocaine has progressed from being a social habit they are in control of, to dependency, is when they are unable to keep to their decision not to buy cocaine despite having made a decision to have a cocaine free night. This decision will typically happen once alcohol has been consumed. This is a clear indicator that there is a shift in power, i.e. the drug has control over you; you are no longer in charge of your own using patterns and the choice has been taken away. This is dependency/addiction. It is at this stage that we observe denial of the dependency: “I do have a choice, I just want to have a good time, I’m not hurting anyone else, I’m only young once, I’ll stop when I settle down, when I get married, when I have children, when I’m 25, 28, 35….”. This is denial of one’s addiction and is the most common narrative I hear in my rooms. If someone recognises this, I would invite them to seek help.
Young women are under increased pressure to be smart, funny, charming, sexy, beautiful, thin, clever, professional, high achieving... the list goes on. Cocaine makes young women feel these things and takes away those pressures, replacing them with momentary misguided feelings of success.
Cocaine evokes feelings of confidence and makes people feel “sexy”. Young women (20-35) are under increased pressure to be smart, funny, charming, sexy, beautiful, thin, clever, professional, high achieving... the list goes on. Cocaine makes young women feel these things and takes away those pressures, replacing them with momentary misguided feelings of success. Cocaine is also a disinhibiting drug so young women will feel confident to behave in ways that they might not if they were not under the influence of cocaine. For example, sexually.
How old is your typical client for cocaine addiction?
What are the common misconceptions you think people fall victim to when addressing their own drug habits?
Addiction is a condition that tells you that you haven’t got a condition. Denial. People reassure themselves by comparing their own use to someone they know who uses more than they do. Therefore they are OK. Telling themselves that everyone they know uses cocaine and thereby normalising it. Minimising their own use and the reality of the consequences of their use.
What's in modern street cocaine?
Cocaine has historically been cut with glucose and laxatives. Increasingly the cutting agents of choice are benzocaine, a dental anaesthetic that imitates the numbing effect of cocaine and levamisole, a cow and horse de-worming product. The BBC has a comprehensive list of the impurities found in cocaine.
Initial help can be found through your local GP. GP surgeries should have links to community drugs projects although many of these are often over subscribed. The Federation of Drug and Alcohol Professional (FDAP) Accrediting body website (www.FDAP.org.uk) details lists of therapists and support across the UK. My company is based in London (www.addictiontherapylondon.com) but I have nationwide and global links to therapists and rehab centres.