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Addiction and Substance Abuse

Permanent cocaine effects?

09/26/2005

Question:

For about 8 months I was a regular cocaine user(about twice a week). I quit cold turkey five months ago and haven`t touched it since. My question is are there any permanent effects of cocaine use(physical or psychological). I have started having some anxiety problems since quitting.. they started about 6 weeks after stopping. Is it possible the anxiety will go away on its own, or should I see a doctor about it??

Answer:

Cocaine, a derivative from the coca plant, belongs to a family of drugs called stimulants. They are called stimulants because they affect the brain and body by causing increases in heart rate, blood pressure, breathing, reflexes, restlessness, decreased need for sleep and food as well as increased vigilance and aggressive mood. This increase in energy comes at the cost of a number of negative behavioral changes, namely impaired judgment, increased startle reflex, and abnormal movements like tremors and repetitive behaviors. Additionally, the user may experience hallucinations (usually auditory), and become paranoid (they may act like a person having schizophrenia).


After snorting, injecting or smoking cocaine, it rapidly affects the brain and body. Maximum plasma concentrations are reached within one hour, and concentrations in the brain can be obtained in 15- 20 minutes. Equally it is very quickly broken down by enzymes in the liver, brain, plasma and lungs into two  compounds benzoyl ecgonine and ecgonine methylester, with half-lives of up to six hours. Both of these substances are inactive and do not affect the body. Use of cocaine can be detected within four hours by analyzing the urine (urine drug screen for the cocaine breakdown products), and the drug screen can be positive for up to 72 hours (it remains positive longer in chronic users). Treatment for acute cocaine use is rarely necessary since it is such a short-acting drug.


Having said all this, it would seem natural to think that cocaine has only short term effects on a person. This is not at all true. The long term (and short term) effects are related to a number of factors:

While the exact number and type of long term effects may vary from person to person, cocaine use over long periods of time can cause changes in the brain which can take months to resolve after the last use. Most studies mention problems with cognitive functions such as attention, verbal memory, and  decision-making. Sleep patterns can be affected, and problems with behavior regulation have been reported. There usually are not any prolonged psychotic problems unless the person has underlying psychiatric issues.


To directly answer your question, you have had a number of exposures to the drug. How cocaine will effect you depends a lot on those factors already mentioned as well as a few new ideas. Did you develop tolerance to the drug? That is, as time went on did you use more of the drug per each episode, or did you switch from snorting to injecting or smoking to try to get the same effect as you did initially?  Cocaine use is usually characterized by binges  and controlled use (where you can abstain for variable periods of time), and may easily change to compulsive use (where you can not control use). What I hope is that you have truly quit before any serious problems have occurred.

The development of tolerance is a risk factor for developing dependence on the drug. I mention this  because some of the anxiety may or may not be related to increased cravings for the drug. The start of anxiety symptoms six weeks after stopping the cocaine usually is not related to a post-binge set of symptoms which usually include restlessness and irritability. 

Another concept that is important here is the idea of sensitization. Basically this means that low intensity, intermittent use of the drug can cause an enhanced response the next time it is used. This seems to play a role in relapse and cravings. Estimates by the National Institute on Drug Abuse (NIDA),  indicate that  10 to 15 percent of those who initially try stimulants become addicted. Cravings can last months and gradually decrease over time. Some people can experience "using dreams," which are very vivid and can cause unease and anxiety. 


There are also mood problems such as depression which can pop up after stopping use which can cause a person to relapse. If the depression lasts longer than one or two weeks after withdrawal, you may have been "self-medicating" an underlying depression (or anxiety disorder), which then should be treated with a specific antidepressant. In this case, getting an evaluation by a trained healthcare provider could benefit you and perhaps prevent a relapse from occurring.

Great question - we wish you the best! 

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Response by:

Christina M Delos Reyes, MD Christina M Delos Reyes, MD
Assistant Professor of Psychiatry
School of Medicine
Case Western Reserve University

Nyk   Pidhorodeckyj, MD, MSC Nyk Pidhorodeckyj, MD, MSC
Formerly, Addiction Psychiatry Fellow
School of Medicine
Case Western Reserve University