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Cocaine is a central nervous system stimulant drug processed from plants that are indigenous to South America. Its chemical name benzoylmethylecgonine, 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.
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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.
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.
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:
In addition, individuals will often experience:
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.
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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