This is the 2007 version. Click here for the 2017 chapter 14 table of contents.

Cocaine and Methamphetamine Addiction

Next to alcohol addiction, cocaine and methamphetamine addiction are the most serious and widespread drug addictions in America. Both cocaine addiction and methamphetamine addiction have been called epidemics. The reason for their popularity is simple: they act directly upon the dopaminergic "pleasure center" areas of the brain. Like direct stimulation of the pleasure centers, cocaine and methamphetamine are most enjoyable to people who are depressed or in pain. Sigmund Freud raved about cocaine, and he was profoundly depressed for a year before he first encountered it.

Why are cocaine and meth so popular? What adaptation occurs in regular users?

Cocaine and methamphetamine's ability to produce intense spikes of pleasure make them dangerous. They can simply take over people's lives. As with heroin, users adapt to the foreign substance constantly in their bodies. Their natural production of dopaminergic transmitters is depressed as the drug takes over this function. As is the case with heroin addicts, soon the drug is needed to feel normal. Heroin addicts who do not get the drug feel a lack of opiates in their bodies, so they feel pain. Cocaine addicts who do not get the drug feel a lack of excitement and pleasure in their lives, so they feel bored and depressed. Without their drug, life seems gray and unexciting.

What is the "insidious" effect of cocaine on the brain? What behavior results?

To make matters worse, high levels of these stimulants lead to changes in brain tissue (overexpression of the transcription factor CREB in the nucleus accumbens) that has an insidious effect. It "decreases the rewarding effects...and makes low doses of the drug aversive" (Carlezon, Thome, Olson, Lane-Ladd, Brodkin, Hiroi, Duman, Neve & Nestler, 1998). In other words, after a person uses high levels of cocaine or meth, low levels are not satisfying; they are actually unpleasant. This drives users to use higher and higher dosages. It may explain why many cocaine and meth abusers often follow a binging pattern.

One student wrote about her experience with serious cocaine addiction :

What was the student's experience with cocaine in the late 1970s?

My husband and I were in the music industry in the late 70's, as we owned a large entertainment-booking agency in Atlanta. We worked with rock groups nationwide. I was introduced to cocaine as we socialized with the entertainers. I had sampled many drugs, but I disliked them all. I never smoked cigarettes, had no problem with alcohol and after trying numerous drugs recreationally (out of insanity or boredom) I felt quite sure I was not the "type" who would ever get hooked in a drug scene.

Cocaine was different. I liked it very much—too much—and looked forward to different groups that always had it available and even routed them through Atlanta at my convenience to get the drug again. For approximately six months, it was purely recreational. I did not feel hooked, but there was definitely something different about my chemical makeup when I was using cocaine.

Then a terrible crisis occurred in my life. My husband committed suicide. After his death, I had a great deal of money and was not at all willing to accept the reality of his suicide. Cocaine made that easier for a while. Within six months, I was extremely addicted. I was using between four and six grams of cocaine each day intravenously. I learned to use the needle from my entertainer friends. I went through $250,000 in fifteen months on cocaine. I could not stop. After all, when I did stop, I was going to have to accept reality.

After a while, the reality was that I, too, was committing suicide. My behavior pattern was this: I would shoot coke for four days without eating or sleeping, then I would pass out and sleep between two or three days, wake up, eat like I had been starving (I had been) and start over again with the cocaine. It became a ritual and a nightmare.

Unfortunately, when I was almost dead physically and ready for help, there was little knowledge about cocaine addiction. As a matter of fact, people kept telling me it was not addictive. But I could not stop doing it. I can certainly agree with the statement that "intravenously administered cocaine is the most reinforcing drug." I am quite sure that animals will press that bar "several thousand times for an injection of cocaine." I, too, would have gladly pressed the bar. I did a lot of things to get it far worse than pressing a bar.

I had a lot of guilt, shame, and remorse to add to the other reality I needed to when I stopped using it. But I did stop. I came to a hospital here two years ago and did everything they asked me to do. They asked me to stay in [this small town] for maybe five years. It was strongly suggested that I not go back to Atlanta or ever try to work in the music business again. I am so glad to be alive and able to get back in school and see if my brain still works (and it does—somehow I made the Dean's List last quarter). I feel as if I have been granted a new lease on life. [Author's files]

Did the "new lease on life" last, or was it just a temporary reprieve from addiction? In this case I have an answer. The student who wrote the above essay was somewhat older than the typical college student, because she had come back to college after her treatment for cocaine addiction. About 15 years later, her son took introductory psychology from me! I would not have known, except he identified himself and told me that his mother said Hello and that she was the one who wrote the essay about cocaine addiction. The good news is that she stayed clean and was a "good Mom" according to her son.

What never ceases to be a threat with ex-cocaine addicts?

Staying clean is not always easy. Just as with other addictions such as alcoholism, recidivism (backsliding) never ceases to be a threat for ex-cocaine addicts. Steve Howe, a pitcher for the Dodgers, sabotaged a promising major league baseball career because of his inability to give up cocaine. After being elected Rookie of the Year, he was suspended, then given a second chance. In the end, he was given six consecutive "last chances" to clean up his act, but he could not seem to leave the drug alone. John Drew of the Utah Jazz in the National Basketball Association had the same problem. As one doctor put it, "Chemical dependency is a chronic relapsing disorder."


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