Cocaine (chemical name: benzoylmethylecgonine) is a central nervous system stimulant drug processed from plants that are indigenous to South America. Cocaine has a well-deserved reputation as a serious drug of abuse; however, cocaine is a substance that has been used for medicinal reasons for quite some time and still may be used by some physicians and dentists as a topical medication to numb nasal tissues during surgery as well as for several other very restricted uses.
The United States Drug Enforcement Administration (DEA) still lists cocaine as a Schedule II controlled substance. Its medical uses remain quite restricted, and the drug is tightly controlled by the DEA.
Crack vs. Powder Cocaine
In its natural form, when cocaine is extracted from the leaves of the coca plant, it is a hydrochloride salt. The substance is refined into a paste and then eventually processed into a white powdery substance. The powdery substance is most often snorted, mixed with a liquid and injected, or smoked.
Crack cocaine is essentially the same substance as powdered cocaine but in a different form. The process to make crack cocaine involves mixing the powder form of cocaine with some base, such as baking soda or another substance, boiling it in water, and then removing the baking soda, which removes the hydrochloride. This results in the active ingredient in cocaine being more amenable to being smoked.
The two substances are basically chemically identical except that crack cocaine has the hydrochloride salt removed; hydrochloride salt has no psychoactive effects. Thus, crack cocaine is a bit more concentrated.
The name crack comes from the crackling sound that the substance makes when individuals smoke it in a pipe or cigarette. Smoking the drug is a far more efficient means of getting the drug into one’s system, and the individual experiences the results in a much more intense fashion, but its effects are short-lived.
There are number of myths associated with crack cocaine; a few are outlined below:
- Crack cocaine is more dangerous or more addictive than powder cocaine.
- These two substances are actually almost chemically identical. It has been long observed in research that the differences between crack cocaine and powder cocaine are minor, and the difference in the manner in which both substances are normally taken is responsible for this myth. Similarly, mixing powder cocaine in water and injecting it results in a quicker onset of the psychoactive effects, more intense effects, and a shorter duration of these effects. Individuals who snort powder cocaine get essentially same psychoactive effects as individuals who smoke crack; however, smoking the drug, whether in powder form or as crack, results in the intensity of the psychoactive effects being perceived as more powerful and the effects wearing off more quickly. The difference is due to the way the drug is taken (smoked or injected versus snorted) and not due to the chemical composition of different forms of cocaine. Because individuals who smoke drugs like cocaine often experience the effects as being very strong and short-lived, they may be more likely to binge on the drug to maintain the psychoactive effects, but again, this is due more to the method of administration and not to chemical differences in the forms of cocaine.
- African American individuals are more likely to use crack.
- This is another myth that is a result of a social construction. As it turns out, crack is more likely to be used by individuals in lower social economic classes despite of their ethnic background. It is more readily available to these individuals and it is seemingly less expensive than powder cocaine (another myth).
- “Crack babies” are worse off than babies of mothers who abuse other drugs.
- A very powerful socially constructed myth is the “crack baby” myth. Since the 1980s, this myth has been propagated and basically asserts that women who were pregnant and smoked crack give birth to babies who are addicted to cocaine, have a number of social and cognitive deficits that are specific to crack cocaine, and do not thrive. The assertion that “crack babies” are qualitatively different from babies who are born to pregnant mothers who had abused heroin, powder cocaine, alcohol, etc., is not empirically validated.
While taking any drug of abuse is dangerous to the fetus, numerous research studies have suggested that the differences attributed to the so-called “crack baby” actually result from being raised in poverty and neglect as opposed to being directly related to crack cocaine use by the mother. It is important to understand that this myth is partially true; taking drugs while pregnant will harm the fetus, but the notion that there is a specific “crack baby” presentation is a socially constructed myth that has been used to justify a number of different sanctions and penalties on individuals in lower social economic classes who use the drug.
- Crack cocaine use leads to more aggression and violence than the use of powder cocaine.
- There is no empirical evidence to support this myth. Violence and aggression are related to other variables and not to using crack versus powder cocaine.
- The penalties for crack cocaine use and possession should be higher than for the use and possession of powder cocaine.
- While research has indicated that the penalties for the possession of crack or use of crack cocaine are indeed more stringent than the penalties for possession or use of powder cocaine, there is no empirical evidence to suggest that this should be the case. They are essentially the same drug in slightly different forms. Researchers have repeatedly concluded that there is no empirical basis for the harsher sentences imposed on individuals who use crack cocaine compared to those who use the powder form of cocaine.
Thus, the evidence indicates that the differences attributed to the use of crack cocaine are largely fueled by the differences in the common means of administration of the drug as opposed to any chemical differences between crack cocaine and powder cocaine. Other myths are associated with misconceptions regarding crack cocaine being different from powder cocaine. The criteria to diagnose cocaine abuse are the same whether the individual uses crack cocaine, powder cocaine, or injects cocaine.
Cocaine Abuse and Treatment
The diagnostic category that the American Psychiatric Association (APA) uses to categorize individuals who abuse cocaine and suffer ill effects is a stimulant use disorder. In general, a substance use disorder refers to both issues with abusing a drug and developing an addiction to the drug. These issues occur on a continuum, and the term substance use disorder is now applied by APA to recognize that substance abuse and addiction are related issues that are not easily separated. Whether one uses crack cocaine or powdered cocaine, the development of a substance use disorder occurs when the individual suffers negative and distressing effects from using the drug, has issues with controlling their use of the drug, and continues using the drug in spite of these negative ramifications. There are no formal medical tests that can diagnose a substance use disorder, and the formal diagnosis can only be made by a licensed mental health clinician.
Clinicians closely evaluate the person’s behavior and the effects of their behavior, and then determine whether or not the individual is suffering from a formal substance use disorder. Generally, those who are suffering from a stimulant use disorder exhibit similar symptoms.
Symptoms of a stimulant use disorder include:
- The person frequently uses the drug in greater amounts or for greater periods of time than they originally intended to use it.
- The person continues to use the drug even though they want to stop using it or attempt to cut down on their use.
- The person continues to use the drug in spite of their drug use resulting in negative issues in life, such as troubles in their relationships with others, problems at work or in school, etc.
- The person continues to spend a lot of time trying to get the drug, using the drug, and/or recovering from use.
- Even though the person recognizes that their use of cocaine is causing them physical or emotional harm, they continue to use the drug.
- The person gives up a number of important activities in favor of their drug use or as a result of their drug use.
In addition, individuals will often experience:
- A compulsive need to use the drug that is fueled by cravings
- An inability to fulfill major obligations in life
- Significant tolerance that drives individual to use more of the drug than they once used, leading to a dangerous cycle of using more and more of the drug to get the effects that occurred at lower doses
- Withdrawal symptoms when the individual stops using cocaine (e.g., severe depression, apathy, cravings, etc.)
The development of physical dependence to any drug is neither sufficient nor is it necessary to be diagnosed with a substance use disorder. Chronic users of cocaine will most likely develop some level of physical dependence on the drug that reinforces their substance use disorder.
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Treatment and Recovery
Treatment for an individual who has abused crack or powder cocaine and developed a stimulant use disorder will follow a standard overall plan that will be adjusted to fit the needs of the person. The first step is to perform a comprehensive physical, emotional, and cognitive evaluation of the person in order to determine all the issues that need to be addressed in the recovery plan. Many individuals who abuse cocaine also abuse other drugs, such as alcohol, cannabis products, narcotic drugs, etc., and it is important to understand the complete picture before placing individual treatment. This leads to a much more effective overall treatment.
Individuals should be placed in a physician-assisted withdrawal management program to help them negotiate withdrawal issues once they stop using cocaine and other drugs. For most individuals, this is best accomplished on an inpatient basis; however, this may not always be possible.
Nonetheless, an inpatient withdrawal management program can help treatment providers immediately address any issues that come up, isolate the person from influences that would trigger relapse in the early stages of recovery, and better help the person commit to a recovery program from their substance use disorder. This program will assist the person in withdrawal from their use of cocaine by administering other medications that can control withdrawal symptoms.
Even though being placed in a formal withdrawal management program will help reduce the risk of relapse in the early stages of recovery, withdrawal management programs alone are not sufficient to sustained recovery. The ultimate intervention for the treatment of any substance use disorder is getting the individual involved in substance use disorder therapy. Therapy can be delivered on an individual basis, in a group, or in a combination of both.
Therapy is a formal intervention that uses psychological principles to help an individual change their behavior. Most individuals in substance use disorder therapy benefit from forms of Cognitive Behavioral Therapy that help them to readjust their thinking, change their behaviors, and develop skills to deal with potential relapse in the future.
A strong support base is a crucial factor in recovery. Individuals need the support of friends and family to assist them in overcoming their issues with substance abuse. One of the best ways to build a peer support system is to become involved in support groups, such as 12-step groups (e.g., Alcoholics Anonymous or Cocaine Anonymous). These groups provide long-term support and also provide a structured program that is compatible with recovery.
Individuals who abuse powder or crack cocaine often need numerous other interventions that include treatment for any co-occurring disorders, financial and housing support, occupational training or vocational rehabilitation, medical interventions, and more.
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