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Official websites use. Share sensitive information only on official, secure websites. Cocaine is an addictive stimulant drug. It is made from the leaves of the coca plant Erythroxylon coca , which is native to South America. Cocaine is a Schedule II drug, which means that it has high potential for misuse but can be administered by a doctor for medical uses, such as local anesthesia for some eye, ear, and throat surgeries. There are two chemical forms of cocaine: the water-soluble hydrochloride salt and the water-insoluble cocaine base or freebase. Hydrochloride salt is a powder that is injected or snorted. The base form of cocaine is created by processing the drug with ammonia or sodium bicarbonate baking soda and water, then heating it to remove the hydrochloride to produce a smokable substance. This form of cocaine is sometimes called crack, which refers to the crackling sound of the rock as it's heated. Crack can also be used by sprinkling it on marijuana or tobacco and smoking it. Cocaine is typically used orally, intranasally, intravenously, or by inhalation. When snorted intranasal use , cocaine powder is inhaled through the nostrils, where it is absorbed into the bloodstream through the nasal tissues. People may also rub the drug onto their gums oral use. Dissolving cocaine in water and injecting it intravenous use releases the drug directly into the bloodstream and heightens the intensity of its effects. When people smoke cocaine inhalation , they inhale its vapor or smoke into the lungs, where absorption into the bloodstream is almost as rapid as by injection. Cocaine use ranges from occasional to repeated or compulsive use, with a variety of patterns between these extremes. Any route of administration can potentially lead to absorption of toxic amounts of cocaine, causing heart attacks, strokes, or seizures—all of which can result in sudden death. Find cocaine images from the U. In the normal communication process, dopamine is released by a neuron into the synapse the small gap between two neurons , where it binds to specialized proteins called dopamine receptors on the neighboring neuron. By this process, dopamine acts as a chemical messenger, carrying a signal from neuron to neuron. Another specialized protein called a transporter removes dopamine from the synapse to be recycled for further use. Drugs can interfere with this normal communication process. For example, cocaine acts by binding to the dopamine transporter, blocking the removal of dopamine from the synapse. Dopamine then accumulates in the synapse to produce an amplified signal to the receiving neurons. This is what causes the euphoria commonly experienced immediately after taking the drug. Use of cocaine can induce long-term changes in the brain. Animal studies show that cocaine exposure can cause significant neuroadaptations in neurons that release the excitatory neurotransmitter glutamate. The glutamate system may be an opportune target for anti-addiction medication development, with the goal of reversing the cocaine-induced neuroadaptations that contribute to the drive to use the drug. Stress can contribute to cocaine recurrence, and cocaine use disorders frequently co-occur with stress-related disorders. The ventral tegmental area seems to act as a critical integration site in the brain that relays information about both stress and drug cues to other areas of the brain, including ones that drive cocaine seeking. Chronic cocaine exposure affects many other areas of the brain too. For example, animal research indicates that cocaine diminishes functioning in the orbitofrontal cortex OFC , which appears to underlie the poor decision-making, inability to adapt to negative consequences of drug use, and lack of self-insight shown by people addicted to cocaine. This result suggests that strengthening OFC activity may be a good therapeutic approach to improve insight and awareness of the consequences of drug use among people who use cocaine. Small amounts of cocaine usually make people feel euphoric, energetic, talkative, mentally alert, and hypersensitive to sight, sound, and touch. The drug can also temporarily decrease the need for food and sleep. The faster the drug is absorbed, the more intense the resulting high, but also the shorter its duration. Snorting cocaine produces a relatively slow onset of the high, but it may last from 15 to 30 minutes. In contrast, the high from smoking is more immediate but may last only 5 to 10 minutes. Short-term physiological effects of cocaine use include constricted blood vessels; dilated pupils; and increased body temperature, heart rate, and blood pressure. Some people who use cocaine report feelings of restlessness, irritability, anxiety, panic, and paranoia. Severe medical complications can occur with cocaine use. Some of the most frequent are cardiovascular effects, including disturbances in heart rhythm and heart attacks; neurological effects, including headaches, seizures, strokes, and coma; and gastrointestinal complications, including abdominal pain and nausea. Cocaine-related deaths are often a result of cardiac arrest or seizures. Many people who use cocaine also use alcohol, and this combination can be particularly dangerous. The two substances react to produce cocaethylene, which may increase the toxic effects of cocaine and alcohol on the heart. People combine these drugs because the stimulating effects of cocaine are offset by the sedating effects of heroin; however, this can lead to taking a high dose of heroin without initially realizing it. Because cocaine's effects wear off sooner, this can lead to a heroin overdose. With repeated exposure to cocaine, the brain starts to adapt so that the reward pathway becomes less sensitive to natural reinforcers. These combined effects make the people more likely to focus on seeking the drug instead of relationships, food, or other natural rewards. With regular use, tolerance may develop so that higher doses, more frequent use of cocaine, or both are needed to produce the same level of pleasure and relief from withdrawal experienced initially. Some people take cocaine in binges, in which cocaine is used repeatedly and at increasingly higher doses. This can lead to increased irritability, restlessness, panic attacks, paranoia, and even psychosis, in which the individual loses touch with reality and experiences auditory hallucinations. Specific routes of cocaine administration can produce their own adverse effects. Regularly snorting cocaine can lead to loss of sense of smell, nosebleeds, problems with swallowing, hoarseness, and an overall irritation of the nasal septum leading to a chronically inflamed, runny nose. They also may experience allergic reactions, either to the drug itself or to additives in cocaine, which in severe cases can result in death. Cocaine damages many other organs in the body. It reduces blood flow in the gastrointestinal tract, which can lead to tears and ulcerations. Cocaine has significant and well-recognized toxic effects on the heart and cardiovascular system. In addition to the increased risk for stroke and seizures, other neurological problems can occur with long-term cocaine use. Cocaine use during pregnancy is associated with migraines and seizures, premature membrane rupture, and separation of the placental lining from the uterus prior to delivery. Babies exposed to cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are shorter in length than babies who are not exposed to cocaine during pregnancy. Scientists find that exposure to cocaine during fetal development may lead to subtle, yet significant, later problems in some children. Currently, there are no medications approved by the U. Food and Drug Administration to treat cocaine use disorder. But, many behavioral treatments have proven to be effective in both residential and outpatient settings. Indeed, behavioral therapies are often the only available and effective treatments for many drug problems, including stimulant use disorders. One form of behavioral therapy that shows positive results in people with cocaine use disorders is contingency management CM , also called motivational incentives. Programs use a voucher or prize-based system that offers patients who abstain from cocaine and other drugs with rewards. CM may be particularly useful for helping patients achieve initial abstinence from cocaine and stay in treatment. Research indicates that CM benefits diverse populations of cocaine users. For example, studies show that cocaine-dependent pregnant women and women with young children who participated in a CM program as an adjunct to other substance use disorder treatment were able to stay abstinent longer than those who received an equivalent amount of vouchers with no behavioral requirements. Cognitive-behavioral therapy CBT is another effective approach for treating cocaine addiction. This approach helps patients develop critical skills that support long-term abstinence—including the ability to recognize the situations in which they are most likely to use cocaine, avoid these situations, and cope more effectively with a range of problems associated with drug use. This therapy can also be used in conjunction with other treatments, thereby maximizing the benefits of both. Movies present examples and information that support the development of coping skills; quizzes, games, and homework assignments reinforce the lessons and provide opportunities to practice skills. Therapeutic communities TCs —drug-free residences in which people in recovery from substance use disorders help each other to understand and change their behaviors—can be an effective treatment for people who use drugs, including cocaine. TCs can also provide support in other important areas—improving legal, employment, and mental health outcomes. Regardless of the specific type of substance use disorder treatment, it is important that patients receive services that match all of their treatment needs. For example, an unemployed patient would benefit from vocational rehabilitation or career counseling along with addiction treatment. Patients with marital problems may need couples counseling. Once inpatient treatment ends, ongoing support—also called aftercare—can help people avoid recurrence. Research indicates that people who are committed to abstinence, engage in self-help behaviors, and believe that they have the ability to refrain from using cocaine self-efficacy are more likely to abstain. Research Topics. More Research Topics. Quick Links. About NIDA. Highlights Image. Expand All What is cocaine? How does cocaine work in the brain? What are the short-term effects of cocaine use? What are the long-term effects of cocaine use? How does cocaine use affect pregnancy? How is cocaine use disorder treated? News Release. January 10, NIH-supported findings suggest the need to expand definitions of addiction treatment success beyond abstinence. June 14, National data show need for more research into the factors underlying differences in sex-based vulnerability to drug use. History of the development and evolution of local anesthesia since the coca leaf. Cocaine: history, social implications, and toxicity--a review. Dis Mon. Interstitial lung damage due to cocaine abuse: pathogenesis, pharmacogenomics and therapy. Curr Med Chem. HHS Publication No. Side effects of cocaine abuse: multiorgan toxicity and pathological consequences. Baik J-H. Dopamine signaling in reward-related behaviors. Front Neural Circuits. Cocaine-induced neuroadaptations in glutamate transmission: potential therapeutic targets for craving and addiction. Ann N Y Acad Sci. Wolf ME. The Bermuda Triangle of cocaine-induced neuroadaptations. Trends Neurosci. Neurobiological mechanisms that contribute to stress-related cocaine use. The impact of orbitofrontal dysfunction on cocaine addiction. Nat Neurosci. Orbitofrontal activation restores insight lost after cocaine use. Characterizing the cognitive effects of cocaine: a comprehensive review. Neurosci Biobehav Rev. Drug abuse and stroke. Curr Neurol Neurosci Rep. Effects of concurrent use of alcohol and cocaine. Addict Abingdon Engl. Neuropathological alterations in cocaine abuse. Higher sensitivity to the conditioned rewarding effects of cocaine and MDMA in High-Novelty-Seekers mice exposed to a cocaine binge during adolescence. Psychopharmacology Berl. Cocaine and the heart. Clin Cardiol. Sinha R. The clinical neurobiology of drug craving. Curr Opin Neurobiol. Khalsa JH, Elkashef A. Interventions for HIV and hepatitis C virus infections in recreational drug users. Clin Infect Dis. Curr HIV Res. Substance abuse, HIV-1 and hepatitis. Wendell AD. Overview and epidemiology of substance abuse in pregnancy. Clin Obstet Gynecol. The maternal, fetal, and neonatal effects of cocaine exposure in pregnancy. Treatment of cocaine abuse during pregnancy: translating research to clinical practice. Curr Psychiatry Rep. Contingency management with community reinforcement approach or twelve-step facilitation drug counseling for cocaine dependent pregnant women or women with young children. Drug Alcohol Depend. Prenatal substance abuse: short- and long-term effects on the exposed fetus. Effects of cocaine use during pregnancy on low birthweight and preterm birth: systematic review and metaanalyses. Am J Obstet Gynecol. Developmental and behavioral consequences of prenatal cocaine exposure: a review. Children of addicted women. J Addict Dis. A review of the effects of prenatal cocaine exposure among school-aged children. Systematic review of prenatal cocaine exposure and adolescent development. Connectomics signatures of prenatal cocaine exposure affected adolescent brains. Hum Brain Mapp. SMA Emerging drugs for the treatment of cocaine use disorder: a review of neurobiological targets and pharmacotherapy. Expert Opin Emerg Drugs. Pharmacological treatments for cocaine dependence: is there something new? Curr Pharm Des. Kampman KM. The 5-HT2C receptor agonist lorcaserin reduces cocaine self-administration, reinstatement of cocaine-seeking and cocaine induced locomotor activity. Pharmacogenet Genomics. Biol Psychiatry. Can you vaccinate against substance abuse? Expert Opin Biol Ther. Cocaine vaccine for the treatment of cocaine dependence in methadone-maintained patients: a randomized, double-blind, placebo-controlled efficacy trial. Arch Gen Psychiatry. Modulating cocaine vaccine potency through hapten fluorination. J Am Chem Soc. Prospects, promise and problems on the road to effective vaccines and related therapies for substance abuse. Expert Rev Vaccines. Psychiatr Genet. Accelerating cocaine metabolism as an approach to the treatment of cocaine abuse and toxicity. Future Med Chem. Review of treatment for cocaine dependence. Curr Drug Abuse Rev. A randomized trial adapting contingency management targets based on initial abstinence status of cocaine-dependent patients. J Consult Clin Psychol. Efficacy of contingency management for cocaine dependence treatment: a review of the evidence. Contingency management treatments decrease psychiatric symptoms. Am J Psychiatry. Enduring effects of a computer-assisted training program for cognitive behavioral therapy: a 6-month follow-up of CBT4CBT. Computer-assisted delivery of cognitive-behavioral therapy: efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone. Therapeutic communities for addictions: a review of their effectiveness from a recovery-oriented perspective. Sci World J. Leon GD. Is the therapeutic community an evidence based treatment? What the evidence says. Factors in sustained recovery from cocaine dependence. J Subst Abuse Treat. A comparison of four telephone-based counseling styles for recovering stimulant users. Psychol Addict Behav. Voucher incentives increase treatment participation in telephone-based continuing care for cocaine dependence. The genetics of addiction-a translational perspective. Transl Psychiatry. Genome wide association for addiction: replicated results and comparisons of two analytic approaches. PloS One. Opiate addiction and cocaine addiction: underlying molecular neurobiology and genetics. J Clin Invest. Nestler EJ. Epigenetic mechanisms of drug addiction. Epigenetics and psychostimulant addiction. Cold Spring Harb Perspect Med. Mechanisms of transgenerational inheritance of addictive-like behaviors. Nipping cue reactivity in the bud: baclofen prevents limbic activation elicited by subliminal drug cues. Mesocorticolimbic circuits are impaired in chronic cocaine users as demonstrated by resting-state functional connectivity. Cortico-amygdala coupling as a marker of early relapse risk in cocaine-addicted individuals. Front Psychiatry. An intrinsic connectivity network approach to insula-derived dysfunctions among cocaine users. Am J Drug Alcohol Abuse. Reduced interhemispheric resting state functional connectivity in cocaine addiction. Dissociated grey matter changes with prolonged addiction and extended abstinence in cocaine users. Intact inhibitory control processes in abstinent drug abusers I : a functional neuroimaging study in former cocaine addicts. March
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