Cocaine addiction: what it is, how to manage it and treatment

By Cristiano Antonino On Apr 17, 2023

Cocaine addiction is one of the most common forms of substance dependence. Cocaine can be taken by chewing (leaves), by inhalation (cocaine powder), by vapour inhalation (Freebase or Crack) and intravenously

It acts by globally stimulating all structures of the brain, increasing the amount of neurotransmitters (especially dopamine) that act on the reward and pleasure systems.

The resulting and addictive effects of cocaine are (generally): euphoria, a feeling of well-being, security and confidence, increased mental and physical energy, lucidity, resistance to fatigue and needs (sleep, hunger, tiredness), increased sexual desire.

The effects of cocaine depend on the mode of intake (e.g. rapid effects are obtained if taken intravenously or by inhalation, slower if aspirated or chewed) but may vary greatly depending on the person, the particular time of intake and the stage of structuring of the addiction.

Prolonged and frequent use of cocaine creates a strong psychological and physical dependence, which may manifest itself in withdrawal crises and symptoms such as irritability, depressive syndromes, anxiety states, insomnia and paranoia.

Chronic use in cocaine addiction also exposes one to the risk of thrombosis, heart attack, hypertension, immune system deficits and erectile dysfunction

Cocaine withdrawal causes depression, drowsiness, restlessness, tremors, muscle pain and consequently the urge to use again.

For withdrawal there are no specific therapies: the drugs used act in an attempt to reduce ‘craving’.

Of these, the most commonly used are mood stabilisers, dopamine agonists and antidepressants.

In order to avoid relapses in cocaine addiction, it is indispensable to combine drug therapy with a psychotherapeutic course, e.g. cognitive-behavioural therapy is elective.

The aim of therapy, according to this approach, is to make the person aware of the emotions and thoughts connected with use: what function has cocaine had in one’s life?

Are there situations in which cocaine is used in a systematic way?

What connections does cocaine abuse have with one’s thoughts? With emotions?

What coping strategies can be implemented to cope with difficulties in a healthy way instead of feeding cocaine addiction?

Cognitive behavioural therapy (CBT) is a brief and useful focal approach to help cocaine-dependent individuals become abstinent.

This approach recognises cocaine abuse behaviour as a learnt and maintained behaviour over time: each individual has his or her own ‘cognitive set-up’ (made up of mental schemas, beliefs, opinions, ‘life’ rules, assumptions…) that determine the way one perceives oneself and the surrounding reality (Beck, 1976).

TCC treatment helps the person to understand which variables determine his or her cocaine abuse behaviour (functional analysis) in order to recognise risk factors and learn how to cope with the situations that determine them (coping strategies, problem solving, relaxation…).

Among the TCC protocols for cocaine dependence the most validated psychotherapeutic approach is that of Carroll et al. (1994), whose manual is available in Italian (Carrol, 2001).

Another validated approach for substance use disorders in comorbidity with Borderline Personality Disorder is that of Marsha Linehan (2001, 2002).

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