Cocaine Addiction - What Happens in the Brain? Why Is It So Hard to Just Stop?
Why can you take cocaine recreationally for a while and then become unable to control yourself? What happens that drives you from occasional fun-seeking to compulsive need? How can it be so hard to just not do something?
Here’s a brief explanation of how and why cocaine use can lead to heavier use and how heavier use can lead to addiction (without you realizing it at the time).
Read on to go beyond simplistic explanations of addiction and to gain a real understanding of the factors that lead you from recreational use to addiction and about the brain changes of addiction that make it so incredibly hard to overcome.
In this article:
- From use to abuse to addiction – how does it happen?
- Cocaine addiction – the brain changes that make it so hard to beat (changes to reward systems, memory systems, stress systems and even thinking and decision making).
- How long does cocaine addiction last? How to beat it.
- Risks of cocaine use.
- Signs of cocaine addiction (self test).
From Use to Abuse to Addiction
At the neural level, humans are hard-wired to avoid punishment and seek reward – we avoid pain and danger and seek out the pleasures of sex and food for biological reasons of survival.
Things that help us survive and thrive make us feel good by stimulating a release of dopamine, the brain’s feel-good chemical, in an area of the brain called the nucleus accumbens of the limbic system – also known as the brain’s reward center.
Cocaine creates powerfully rewarding feelings by causing a spike of dopamine activity in the nucleus accumbens (the high), which is followed by a temporary dopamine shortfall (the unpleasant crash), that is easily reversed (for a while) by the use of more cocaine.1
Since cocaine makes you feel great, it’s something you tend to want to do again.
To Heavier Use (Abuse)
Some people are able to stick with occasional recreational use forever. Many people find that because cocaine feels so good they gradually start taking it more often. As use goes up:
- Tolerance can start to rise – you start to need more to get the same effects you used to get with smaller quantities.
- You can start to feel worse after using. With tolerance your brain has started adapting to your cocaine use. Tolerance makes it harder to get high and it also worsens the after-effects. The worse you feel when not using the more likely you are to use more frequently.
You pass from heavy use to addiction silently, and few people can self-recognize this passing in real-time.
There are a number of primary components to persistent cocaine addiction.
- High tolerance and needing to use to feel normal
- A hijacked memory and reward system (long-term associative memories)
- Eroded behavioral control
Read on through the next section to learn how these 4 components of cocaine addiction worsen and perpetuate the situation.
The Anatomy of a Cocaine Addiction
1. Needing Cocaine to Feel OK
With regular heavy use, the brain compensates for the dramatic dopamine spikes of cocaine use by reducing the number of dopamine receptors in the nucleus accumbens (and by other means).
With this dopamine down-regulation, a person requires a lot of cocaine to get high and some cocaine just to feel normal. Without any cocaine use, dopamine and serotonin levels in the brain fall far below ‘baseline’ and this leads to feelings of depression, anxiety, dysphoria, tiredness and lethargy – and to very strong cravings and motivation to use more cocaine.
- So once you pass a certain point, normal everyday pleasures no longer bring you any pleasure and you need a certain amount of cocaine at all times just to feel OK.
This helps to explain why people will endure considerable adverse consequences to get cocaine:
- You wouldn’t walk 5 miles to get a glass of water and under normal circumstances, you’d find drinking a glass of water only nominally pleasurable. But were you dying of thirst, you’d gladly walk for that water and you can bet that drink of water would be pretty enjoyable.
- Well, unlike a glass of water, under normal circumstances, a person might walk 5 miles to receive a highly pleasurable reward like cocaine. And when need gets amplified, such as when a person experiences cocaine withdrawal symptoms, the motivation to get cocaine goes through the ceiling and a person will work through considerable obstacles and distractions to meet their needs.
But avoiding withdrawal doesn't explain everything:
Though needing cocaine to feel normal motivates continual use, it doesn’t really explain all of the behaviors of addiction. After all, people trying to quit cocaine remain at high risk for relapse even when abstinent for months or years and no longer experiencing any withdrawal effects.
- So easing withdrawal symptoms and using to feel normal is just one component of cocaine addiction. To understand why cocaine addiction is so tough to beat for good, we also need to understand how cocaine use affects our memories and how it erodes our motivation and behavioral control systems.
2. A Hijacked Memory and Reward System
So needing cocaine to feel OK (when coupled with strong cravings) would make cocaine a tough drug to quit, but unfortunately there’s a lot more to cocaine addiction than that alone. Once addicted, you also need to overcome lasting changes to the brain’s cognition, memory and motivation systems.
Dopamine makes you feel good, but it also plays an important role in memory encoding. Why is this?
Well, from a biological-survival perspective, pleasurable activities, like eating palatable foods, tend to be activities associated with survival – and remembering how to recreate these experiences without needing to think much makes a lot of evolutionary sense.
Because of this, when something causes a dopamine spike, the brain takes extra pains to remember more about the experience – what led up to it, how were you feeling, who was there when it happened, what was the environment like where it happened and so on. These memories become cues used to predict future availability and this happens completely unconsciously. The brain also assigns a high motivation value to the reward, so the next time you’re faced with an opportunity to replicate the reward experience the brain knows to assign a high level of resources toward attaining it.2
Problematically, if you decide to stop using cocaine, all of these cocaine-related memories can make staying abstinent very difficult, and since you’re biologically primed to look-out for anything that spikes dopamine (high salience memories) your brain’s on constant alert for anything that might point to cocaine availability (your deep brain never gets the message that you want to stop using!)
- The brain is designed to seek out pleasure, so any time you see, hear, smell, feel or taste anything that reminds of drug use or suggests potential drug availability – even beyond your conscious awareness - your brain will perk up with a cocaine craving ("Hey, let's get some cocaine!") - and these long term associative memories can persist for many years or even for a lifetime.
And when you’re already feeling really down in the dumps, very frequent cocaine cravings that come as if out of nowhere (though actually cued by environmental reminders) can be very hard to resist.
But that's not all - stress also plays a significant role...
3. The Stress-Cocaine Link
It’s not only drug cues that prompt cravings, stressful situations, even those wholly unrelated to drug use or drug seeking, can also leave you desperately wanting to get high. Unfortunately, since people struggling out of addiction generally face the stressful task of life-rebuilding, stress-related relapses keep many people locked in a perpetual cycle of use, relapse and addiction.
People recovering from addiction show higher stress sensitivity than the general population, though it’s not known if this occurs as a result of addiction, or if people with higher stress sensitivity are more prone to become addicted in the first place.3
Stress and fear increase dopamine activity in the brain (though in ways that lead to bad feelings, not good) and this provokes drug cravings4 - and both animal-model and human behavioral studies show that stress leads to cocaine relapse, but why is this5? 6
Well, researchers don’t yet completely understand the brain-mechanisms involved in the stress-cravings link, but they’re getting closer to possible medications that could mitigate its relapse-provoking potential (by blocking kappa opiate receptors in the ventral tegmental area of the brain). For now though, it’s best to know that stress in recovery leads to drug cravings and that by learning techniques to minimize and cope with stress you increase your odds of maintaining abstinence.
4. Eroded Behavioral Control
OK, but even though you might feel low and have environmental cues and stress increasing your drug cravings, couldn't a determined person just resist and not use?
At face-value, this inability to control behavior is hard to understand, but it gets more comprehensible when you consider that addiction also disrupts the functioning of brain areas involved in higher-order decision making and impulse regulation, such as:
- The anterior cyngulate gyrus – an area that regulates attention and controls impulsivity.
- The orbital prefrontal cortex – an area that regulates the attention we pay to stimuli in the environment.
- The dorsal lateral prefrontal cortex – an area that regulates thinking and decision making.4
Some of the functional consequences of these brain changes include:
- Increased impulsivity and a disrupted ability to delay gratification.
- Dysregulated motivation systems – so your brain places excessive emphasis on getting cocaine rewards at the expense of motivation to get non-drug rewards (the disruption of this circuit explains why cocaine users will sometimes buy drugs rather than buy food and eat or pay for shelter.)
- General loss of function in the prefrontal cortex leads to diminished learning, concentration and decision making skills.7
Cocaine Addiction – The Perfect Storm
So when you consider how all these components of addiction fit together, it’s no wonder that people have such a hard time not using.
- You have to use just to feel normal and use a lot to feel good (though with increasing use it can be difficult to even achieve ‘good’)
- Your evolutionary brain becomes hyper-attuned to emotional states and environmental situations associated with prior drug use or availability and such stimuli elicit strong drug cravings that seem to come out of nowhere (from beyond conscious awareness).
- While trying to stop you face elevated internal and environmental stress – and stress also provokes drug cravings.
- And on top of all of this – when everything around you seems to provoke strong cravings – your thinking abilities decline and you become less able to resist impulses, focus on long term goals and make sound decisions.
It’s a perfect storm for relapse – and it’s why many if not most cocaine addicted people benefit from ongoing addiction treatment to learn compensatory tools and stress-reduction strategies that help to increase the odds of longer success..
Who Is at Risk of Addiction?
People have different susceptibilities. Cocaine is a very addictive drug, but not everyone who uses cocaine, even regularly, gets addicted.
Factors that can increase a person’s likelihood of getting addicted include:8
- A history of addiction in the family, particularly among close relatives.
- High current stress levels.
- Being an impulsive or thrill-seeking type of person.9
- Having a co-occurring mental illness.
- Using to self medicate anxiety, depression or loneliness.10
- Early initiation of drug or alcohol use (using drugs or alcohol during adolescence primes the brain to develop addiction, even much later in life).
The more risk factors you identify with, the more at-risk you are. Of course no one, no matter how many risk factors they posses, will get addicted should they choose to abstain completely.
Does Cocaine Addiction Last a Lifetime?
Addiction is a persistent disease that can last a lifetime, but with treatment you can retake control for long periods – or even for a lifetime.
We know that brain changes such as associative memories and reward cues can last for many years and this explains why addiction is considered a chronic disease where relapse is the rule rather than the exception - and where repeated bouts of treatment are a normal sensible response across the lifespan.
Fortunately, we also know that with treatment people learn tools to resist cue-related cravings, manage stress and compensate for diminished drug-related behavioral control, and that the more often you’re able to resist drug cravings, the less power they exert over your behaviors.
So it’s a long fight – a marathon, not a sprint – but it is doable and with treatment and determination you can expect a much better quality of life.
Once addicted, however, you’ll never be able to use cocaine recreationally again. No matter how many years of abstinence you have under your belt, even small amounts of cocaine can rekindle full-blown addiction in those with previous addiction histories.
Risks of Cocaine Use
Recreational Cocaine Use and Heart Attack Risks
Cocaine use can lead to fatal overdose, additionally, even recreational users are at increased risk of cardiac events.
Cocaine use harms your heart, maybe more than you realize, and you don’t have to be cocaine-addicted to be at a substantially increased risk of heart attack.
In one study, researchers compared the cardiac functioning of otherwise fit cocaine using adults with an average age of 37 with a control group of similarly aged subjects who had never used cocaine. Subjects in the cocaine group had used the drug at least once a month for 12 months.
- Cocaine using adults were found to be at much higher risk of heart attack, with an average of 8mm Hg higher systolic blood pressure, a 30 – 35% increase in stiffening of the aorta and an 18% increase in left ventricle wall thickness.10
Other Heavy Use Risks
With increased use, risks and health consequences rise substantially. Heavy chronic cocaine users may face one or more of the following problems:
- Problems related to mode of use – such as sinus infections, loss of smell or very painful nasal septum holes (all related to snorting), serious lung problems and chest pain (from smoking crack) and skin infections and abscesses from injecting cocaine.
- An increased risk of other infectious diseases, like HIV and Hepatitis C.
- Problems stemming from cocaine’s influence on appetite, such as extreme weight loss and malnutrition.
- Sexual problems and infertility.
- Antisocial behaviors that erode social relationships and necessary social supports.
- Increased risk-taking behaviors increase risk of violence, STDs and legal problems.
- Cocaine binges can lead to disrupted thinking and emotional processing, an inability to concentrate, anxiety, depression, paranoia, delusions and psychosis.11
- Seizures – about 3% of cocaine users will experience seizures at some point.12
- Levamisole complications – cocaine is frequently laced with the veterinary drug levamisole. Levamisole in cocaine can lead to painful skin and blood infections.
Although drinking alcohol makes cocaine last longer and though cocaine lets you drink more, combining the two isn’t such a good idea.
When you drink alcohol while using cocaine the two drugs combine in the liver to create a metabolite called cocaethylene. Cocaethylene stays in the body for much longer than cocaine or alcohol taken alone and so does far more damage to the liver, heart, brain and other organs than either substance taken alone. In fact, people are 18 times more likely to die suddenly after using alcohol and cocaine together than after using cocaine alone.13
Signs of Cocaine Addiction
How do you differentiate between cocaine use -> cocaine abuse -> cocaine addiction?
When you pass from use into addiction it’s like someone flicks-on an invisible switch in your brain. You don’t notice it at the time, but once it’s turned on you can’t ever go back to what you were before.
- Although you can sometimes look back after the fact and recognize when you passed from use to addiction, it’s very difficult to see that invisible line as you cross it.
So if you use cocaine, even if you think you’ve still got it all under control, you’d be wise to check yourself from time to time to make sure you aren’t already displaying some of the warning signs of current addiction.
Cocaine Addiction Self-Test
According to Cocaine Anonymous, if you are a current user and you answer yes to any of the following questions, you may have a cocaine problem that needs attention:14
- Has your cocaine use ever caused you problems at work?
- Has your cocaine use ever led to conflict with your partner or with other family members?
- Have you ever stolen money or drugs from friends or other family members?
- Do you ever find yourself spending time with people you wouldn’t normally associate with so you can use cocaine?
- Are you using cocaine alone?
- Do you ever wish you’d never tried cocaine?
- Do you ever have scary rapid irregular heartbeats or chest pains when using?
- Do you ever get nosebleeds or other sinus problems?
- Do you feel like you can’t stop using cocaine or your work will suffer or you’ll lose energy, motivation or confidence?
- Do you ever feel like other people are watching or talking about you?
- Do you always use-up your supply in one continuous binge?
- Do you use cocaine at work, in your car, in public bathrooms or in other public places?
- Have any friends or family members expressed concern about your cocaine habit?
- Do you lie to friends or family members about how much you use?
- Have you tried quitting or cutting down and been unable to do it?
- Are you obsessed with getting cocaine when you don’t have it?
- Are you having financial problems because of your cocaine use?
- Harvard Help Guides: Addiction Hijacks the Brain
- NIDA: Drugs, Brains and Behavior
- Harvard Health: The Addicted Brain
- Psychiatry News: Drug Addiction Erodes Free Will over Time
- Stress-Induced Cocaine Craving and Hypothalamic-Pituitary-Adrenal Responses Are Predictive of Cocaine Relapse Outcomes
- Study Stops Stress-Based Drug Relapse in Rats
- Neurocircuitry of Addiction
- SAMHSA: What Is Substance Abuse Treatment?
- Psychology Today: Are You at Risk of Addiction?
- Mayo Clinic: Drug Addiction Risk Factors
- Medical News Today: Recreational Cocaine Use and Heart Attack Risk
- CAMH: Cocaine and Crack
- Neurological Effects of Cocaine
- Cocaine Anonymous: Self Test
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