Why is Cocaine so Addictive?

Cocaine is one of the most addictive and most commonly used drugs. More than 20 million people worldwide use it despite its various life-threatening side effects and its high risk of overdose death. But what exactly makes this stimulant so addictive?

Manufactured from the leaves of the coca plant native to South America, cocaine has many names and many faces. You may have heard it referred to as “coke”, “snow”, “rock”, “crack”, “pearl”, or “blow”. You can snort it through the nose, rub it into your gums, or dissolve it in water and inject the solution into your bloodstream. Alternatively, you can heat cocaine rock crystal and smoke it. That is to say: you can do it. But you really shouldn’t. Why? Because there is no “safe” way to use cocaine. While it has been approved in some countries for limited medical use as a local anaesthetic, its pharmaceutical application by a medical professional still carries risks.

As a so-called “stimulant drug” – an “upper” – cocaine temporarily improves physical or mental functioning, increasing the user’s alertness and energy. To experience that “high” again and again or to enhance performance in general, many people quickly develop a cocaine addiction.

How can this drug take charge so quickly, you wonder? Let’s have a closer look at how cocaine creates this addictive need for more and more.

Messin’ with the Dopamine

When you experience something pleasurable, the neurotransmitter dopamine is at work in your brain and involved in what we call a “reward process” along the primary dopamine pathways of the brain. Cocaine binds to dopamine transporters, thus preventing them from doing their job, which is clearing dopamine from the synapses (the place where neurons connect and communicate). This way, dopamine builds up in the synapses of the areas responsible for processing reward, motivation, and emotional regulation. This excess of dopamine causes euphoria as well as other typical key effects of a cocaine high, such as boosts of alertness or confidence.

Furthermore, dopamine also stimulates the hippocampus and amygdala, which help us remember the reward cues, i.e., the circumstances surrounding the high. These memories become triggers for later use. With continued use of cocaine, those triggers gain importance until they make the prefrontal cortex, which normally is involved in decision-making, redundant, thus giving way to compulsive cocaine use.[i]

Brief, quick and intense

A cocaine high is strong and short-lived. In general, you would start to feel it after 5 to 30 minutes of using, snorting, injecting or smoking it. The effects usually last between 20 and 30 minutes.[ii] However, the intensity of the high is matched by the intensity of the so-called “comedown” that follows it which can leave you feeling depressed or, in extreme cases, even suicidal. Seeing as the “positive” effects – euphoria, motivation, confidence, alertness – are so strong and short-lived, a user likely wants to experience them again as soon as possible.

Building up a tolerance

The bad news is that the brain adapts very quickly to cocaine-induced high levels of dopamine. It only takes a few times of using the stimulant to become desensitised to it. This means that you will gradually need more and more cocaine to experience the same effects. Moreover, recent research suggests that once you develop a cocaine addiction, it may be permanently imprinted in your limbic system. While research shows that abstinence from cocaine helps to reverse the impact on the dopamine transporter, a single exposure to cocaine even after longer breaks from cocaine use can lead to pre-abstinence levels of tolerance[iii] The findings indicate a ‘priming effect’ caused by cocaine administration, from which the brain does not fully recover.

Together they are stronger

Although cocaine is a powerful drug on its own, mixing it with other drugs, such as alcohol, is both common and dangerous. Especially the simultaneous use of cocaine (a stimulant, or: “upper”) and alcohol (a depressant, or: “downer”) is considered one of the most lethal combinations. Together, they create a new chemical in the liver: a toxic compound called cocaethylene. Cocaethylene is more potent than cocaine itself, and while it can cause a more intense and longer-lasting high, it is also significantly more toxic. Once the liver begins producing it, the cocaethylene remains in the body up to three times longer than cocaine, leaving more time for its toxic effects to unfold. It increases heart rate and blood pressure even more than cocaine does on its own, thus impairing the heart’s ability to contract. In other words, it puts enormous stress on the whole cardiovascular system,  and leads to a significant risk of heart attack and stroke.[iv]

Seek professional help

Seeking professional help is a major step on the road to recovery. Please contact us any time you feel you need support and guidance regarding cocaine addiction. Together, we will assess your situation and consult you on effective treatment options for a lasting recovery.