Cocaine's
Effect on the Body and the Brain--
"Why treatment is usually required."

Note to the reader: This section begins with a letter from a friend who is concerned about abusing cocaine and is looking for help. In writing my response, I am trying to assist the individual and, at the same time, provide information for a more general audience seeking information about addiction--Floyd Else, Webmaster.

Question:  Hi, I am seeking an online program for cocaine abuse. I need it to be discreet. I have never been in a rehab and I never intend to be, however I have a cocaine problem and desperately would like some help to help me figure out how I can overcome this addiction.   "George" ***

*** Not his real name.

I am a retired chemical dependency treatment counselor and retired licensed mental health counselor.  I begin with these words to assure you that I not a part owner in any in any treatment or recovery program.  I am answering from my experience with addicts and with my gut feelings.

I hear your need to be discreet, and hope that you can achieve this and still recover from your addiction. However, I do not think that an online cocaine treatment program will be of any use to you.  Face to face, live participation in a group setting is an experience you need to have.  You will benefit from sharing your addiction and recovery history with other addicts.  Most important, when you tell your own story and make your excuses, the experienced addicts in the group can "call you on your bull-shit" and help you face the reality of your situation for the first time.

I do support the idea of educating yourself online or by reading one or two of the more recent books on cocaine addiction.  Don't bother to read the old books from the 1970s or 1980s.  In the beginnings of cocaine's most recent invasion, authors often called cocaine the ideal "rich man's drug" --that cocaine was expensive, but didn't impair your functioning and was not addictive. No one believes that any more.

In the beginning.

The speed with which one becomes addicted has progressed as the techniques for using it have changed. Snorting cocaine was bad enough, but when they began to make it in a form that could be smoked, the drug goes directly to the brain in seconds. Mainlining or "shooting up" cocaine was even more addictive and carried the additional risk of HIV infection and AIDS from shared needles or works.

I have only worked with addicts for 19 or 20 years and so I don't feel that I know everything about recovery, but I have learned a lot.  First, I can not tell from your brief letter, whether you are in an early stage of addiction with a life that is still fairly intact and functional. You may still have a job and a relationship--perhaps a family.

If so, you have not yet learned just how bad the addiction will become or how much it will take from your life.  Because of this, you still want to avoid any action that would let others know about your problem.  This in turn, keeps you from using the resources that are closest to you, most easily available, and most likely to be effective.

When I think of your situation it make my heart ache and brings tears to my eyes. I have known so many really likeable people who were undergoing treatment for cocaine addiction.  Clean and sober they are just as intelligent, charming and likeable as anyone in the general population. And I have eagerly wished for their complete recovery.

Treatment can help.

I would highly recommend that you get in touch with an addictions counselor in your area and get a referral to addiction treatment.  Generally addiction counselors will try the least restrictive techniques first, so that would probably mean an outpatient treatment program.  If you fail at that level then inpatient treatment would be required. But you need to act quickly while your life is reasonably intact and you are still able to pay for or finance treatment!

Whatever the treatment technique, studies have shown that the longer the total treatment time the more effective the treatment will be.   Withdrawal from cocaine is commonly associated with deep depression which usually hits about 28 days after last use (and every 28 days or so thereafter to a lessening degree).  Any cocaine addict knows that the easiest way to escape depression is to use cocaine.  The addict completes a 28 day inpatient treatment program, becomes deeply depressed and relapses.  You really need the continued structure and support of an outpatient treatment at this point to avoid relapse--and perhaps a prescribed antidepressant medication.

Failures in recovery.

However, like many addictions, cocaine is a very tricky substance to kick. In the beginning it is stimulating, energizing and altogether pleasant. How could anything this good be bad for you?  People frequently use cocaine in concert with sexual activity and you get the double high of sex and cocaine.  Afterwards the thought of sex without cocaine seems rather boring.

Often men discover that cocaine is a great way to get sex. Tell the female cocaine addict that you have some cocaine to share and they are ready to go to bed to get their cocaine high. After pursuing this path for some time, the recovering addict often finds he not only does not enjoy sex without cocaine, but he doesn't know how to get sex without cocaine.

Often the men that I worked with in addiction treatment who were entirely willing to give up cocaine use, would still try to figure out how they could get the benefits of cocaine without using it themselves. They worked out these clever but unsuccessful plans where they will still buy and sell cocaine, but not use it themselves. This way they will still have the money and the sex without the pain and problems that using cocaine has brought to their lives. I have known a number of men who have tried this unsuccessfully. They buy and sell the drug and use it to get material possessions, sex and to exercise power over others. However, invariably there comes a time when they use again, and rapidly resume their decent into addiction.

Of course in the latter stages of addiction, sex ceases to be a factor.  The addict wants the drug and is unwilling to share it with anyone else.

You should avoid alcohol use in recovery because alcohol use lowers your inhibitions and is a frequent factor in the relapse process. You get intoxicated and think, "This is not the high I want. I want some...(cocaine, heroin, methamphetamine)...to get the high I want and need."

The recovering addict says, "I know that in my recovery I am supposed to avoid those who use drugs and hang out with people who are clean and sober; but I don't know anyone who doesn't drink or drug." 

Part of the increasing dysfunction of drug addiction involves moving away from social situations and people who do not use drugs and toward frequent participation in situations that involve drugs and other addicts.  In recovery, when you try to hang out with clean and sober people, you may find that you feel awkward and anxious (a little drink or drug would sure help you relax.) This is the difficult time to get through--learning to live again without drinking or drugging.

Even when men have lost their business, wives and children; even when they have lost shelter, health and self-respect, they keep trying to figure out how to get the positive part of drug use without the negative part. The same is true whether the drug is cocaine, heroin or methamphetamines.

Recovery requires new thinking and coping skills.

Recovery from addiction requires you to learn new thinking habits.  Self-talk or internal dialogue can tempt you to use: "Just once wouldn't hurt anything," is probably the most frequent relapse thought.  Right after that comes, "No one will ever know!"  Of course you can not resume regular use until you use that first time, and once you relapse, everyone knows.

To succeed in recovery, one needs to learn new coping techniques to achieve physical and emotional needs that have been habitually met by drug use. How can you meet women without having drugs in your possession? How can you have friends or a social life without drugs? Learning clean and sober social skills is a real challenge.

I have always encouraged my clients to make use of anonymous 12-step programs such as Alcoholics Anonymous, Cocaine Anonymous and Narcotics Anonymous.  For some, it is very easy to participate in 12 step programs and to develop new friend and to participate in clean and sober activities.

For others in early recovery, participation in 12-step programs can be much more difficult. They may be less trusting and unwilling to share with other. Perhaps they had fewer social skills to begin with.  But the 12 Step programs offer much more than meetings.  In some areas 12 step groups sponsor camp outs, volleyball tournaments, hikes, softball games, social dances and many other activities.  These provide opportunities to regain social confidence in a safe environment.

Gradually the person in recovery can develop a widening circle of friends through work, church or other activities.  Many find that heavy involvement in 12 step activities gradually begins to drop off after a year or two as the person progresses in their recovery and their support network enlarges.  However, many others build such deep friendships within the recovering population that continued participation in group activities is rich and rewarding.

Best wishes,

Floyd Else, MA, LMHC, NCC, MAC
Webmaster.

Dear George:

If by "I should just quit altogether," you are referring to stopping your cocaine use, then I would agree.  If you mean, "I should just quit trying," then I would say, "get off the pity pot."

Lots of people have had their lives temporarily destroyed by cocaine and they have gotten off the crap and gotten their lives together.  You can do it too, but you need to be tough. To quit cocaine for good you need to recognize that while once cocaine was a source of pleasure, it now is your master and your enemy.  You must be willing to do anything that you need to do to get free of it.  You are not in that space yet, though I hope you make it.  You began your inquiry with the flat statement, "I have never been in a rehab and I never intend to be."  Recognize that for what it is--you are saying that you are not willing to consider a treatment program to get free of the drug. 

By all means, if you fee that dopamine and noradrenalin would help you get off cocaine, see a doctor who is knowledgeable about addictions and see what he would prescribe for you.  To me it makes no difference HOW you achieve success, only that you ARE successful and quit using cocaine.  

However, the more techniques you use at the same time, the more likely they will reinforce each other and contribute to your eventual success.  In addition to your medication, attend and participate in Narcotics Anonymous Meetings or Cocaine Anonymous Meetings.  Find support from others in recovery.  If using medication doesn't do the job for you, then I urge you to continue the anonymous group meetings and try conventional chemical dependency treatment.  

I can not understand how contacting a friend who was a counselor could have caused you to end up in jail.  Some big part of the story is missing.  Tell me about it.

I care.                                 FE

 

Dear George:

Thank you for sharing.  I wasn’t there, but based on my previous experience with addicts, I may be able to give you another perspective of those confusing events.  First, remember that at the time this happened you were in an altered state caused by alcohol and cocaine use.

You saw a woman that you had liked in the past. She was glad to see you again.  You were lonely, going through withdrawals and depressed.  When you went back to your old house you found a gun and a bottle of Scotch and started drinking.

You called up the woman and wanted to meet. She seemed reluctant.  She was a married woman and a crisis counselor.  She wanted you to call the crisis line but you would not.  She agreed to see you but said it would be, “on the record” meaning it would be an official meeting in her capacity as a crisis counselor.

One of the primary duties of a crisis counselor is to determine when a caller is a threat to themselves or others.  If you are assessed to be a threat to yourself or others, it is her duty to notify authorities who can take you into custody for observation and keep you safe.

When she found herself in a car with a drunk who had a gun she was probably scared to death.  When her husband drove up (perhaps in a mistaken attempt to rescue her), she may have told you to drive away, thinking to save her husband from getting shot.  (I know that, If I were faced by a drunken, depressed client with a gun in his hand, and he asked me if what he said would be confidential, I would say “yes, hell yes!”)  But events in a crime are not confidential.

Now we know you are a nice guy, but to the police who took you down that day and seized your gun, you probably were considered to be an armed, drunk, possibly suicidal addict, who was holding a woman hostage in his car.  None of the police wanted to get shot trying to free the hostage.   It’s not surprising that they would be quite forceful and rough in the process of apprehending you.  From what you say, it sounds like the world would have seen you as guilty of kidnapping and assault with a deadly weapon. (An assault is when you cause a person to fear for their life or safety.)

It sounds like everyone wanted you to be safe. To that end, they put you on probation for 10 years. I will bet that the conditions included that you stay sober and drug free. However, not realizing the extent of your addiction, they did not insist on alcohol and drug treatment. Had they realized the extent of your addiction, it is more likely that you would have received the treatment, recovery education, and support that you need.    [Learn about Drug Courts.]

Neither inpatient chemical dependency treatment (where you agree to stay at the treatment center) nor outpatient chemical dependency treatment where you go to treatment for a few hours each day or week, requires that you be locked up.

One of my recommendations to you was that you get outpatient treatment. The outpatient treatment programs that I am familiar with are usually in three stages. Once you have gone through an assessment to determine whether treatment is appropriate, you would start State I: the intensive phase. This is usually three or four hours a day, five days a week for about four weeks.  You are there during the day and each evening you return to your own home.

The Substance Abuse and Mental Health Services Administration maintains the Substance Abuse Treatment Facility Locator.

Outpatient Stage II is a weekly 90 minute treatment group for five months.

Stage III is the final eighteen months (a year & a half) of 90 minute treatment groups once each month. You are required to stay clean and sober throughout treatment and you are subject to unannounced drug screening and breathalyzer tests.  Usually clients are also required to attend 12 step groups independently outside of the official treatment groups and to report attendance to the treatment program counselor.

The main purpose is to provide structure for your life in recovery. The 12 step groups (such as Cocaine Anonymous and Narcotics Anonymous) put you in the fellowship of others who are recovering and who understand your weaknesses, temptations and cravings and can help you find the strength to overcome them. Others in those groups offer you the friendship you can find nowhere else.

In treatment and in the 12 Step groups you would learn that having lots of money is one of many relapse triggers for a recovering addict.  This trigger that is now threatening your recovery.  Addicts need to learn to think in new ways about money and to handle it in recovery.

You are doing what is normal for an addict. Your addiction has driven away the clean and sober people in your life. Meanwhile you are feeling lonely and sorry for yourself and still trying to find a way to continue to use alcohol and cocaine in a way that lets you escape the consequences. You say that you are addicted but at the same time, you deny that you need the treatment that has helped so many in the past.  Becoming suicidal because of your life situation, you are unable to take the help you need because you fear that it will cost you the poison that is killing you.

Get help. You are worth it. And there are a lot of people out there who will do everything they can to help you. But you need to want the help and you need to ask for it.  Recognize that addiction is common and no longer carries the shame and public disgrace that it once did.  Hundreds of well known public figures have been through treatment that has been widely reported in the press, without ending their careers.

Best wishes,       FE

[More letters about cocaine users.]

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" A Cognitive-Behavioral Approach: Treating Cocaine Addiction," a report by the National Institute on Drug Abuse.

Cocaine is in a class of drugs called stimulants: more information.
                

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