By Chris Woolston, M.S.
Whether it's smoked, snorted, or injected, cocaine is a powerfully addictive drug. The first rush is so intense that many users come back for more. As the brain grows accustomed to the drug, it takes more and more hits to reach anything close to those early highs. People who think they can use cocaine once in a while or "recreationally" may find that eventually their entire lives center around the drug: where to find it, where to use it, how to afford it.
Recovery from cocaine addiction takes total commitment. The best treatment programs help users take a new approach to their lives, including their family, friends, work, and free time. With the right help, even the heaviest users can find an alternative to addiction.
Years after stopping cocaine use, people may still experience cravings for it. Since the craving for crack cocaine is so overwhelming, many users prefer to "detox" in a safe, medically supervised residential setting.
"Detox" -- short for "detoxification" -- is often the first step to kicking a drug addiction. People addicted to cocaine typically suffer withdrawal symptoms such as anxiety, depression, agitation, and cravings. In many cases, according to the National Institute of Drug Abuse, these withdrawal symptoms can be treated with medication. The agency notes that "treating withdrawal is not the same as treating addiction," and recommends that all "detox" programs be followed by counseling and medication, if available.
Intensive counseling -- often including an approach known as cognitive behavioral therapy, or CBT -- is the cornerstone of successful treatment. CBT helps equip addicts with the skills needed to recognize and avoid the high-risk situations that encourage coke use, and to develop better ways of dealing with those situations if they do arise. Clients also need to find their own motivations for quitting the drug. Through therapy, they can see how their lives will eventually be easier and more fulfilling if they can give up cocaine.
The thinking behind CBT is this: If you use cocaine but come to see it in a different light, you can make the wholesale lifestyle changes that are needed to break the habit. First, you need to avoid the people and situations that trigger urges to use the drug. For some people, that means finding new friends and new hangouts. You may also need to find a new job, preferably something that keeps you occupied and satisfied. If youre in recovery but don't find anything rewarding in your life, youre more likely to turn back to cocaine.
Counselors in most treatment programs will encourage their clients to see their addiction as a behavior, not a disease. Clients who believe they have a disease may also believe that they're unable to get better. Twelve-step programs such as Narcotics Anonymous, by contrast, teach clients that they have no control over their addiction and need to give their lives over to a higher power. Even though the two approaches differ widely, some recovering addicts seem to benefit by going through both types of treatment at the same time. The Matrix Model, a successful treatment program for addiction to cocaine or methamphetamine, is one such approach, combining cognitive behavioral therapy with regular 12-step meetings, group therapy, and family involvement.
Ideally, treatment should be tailored to a user's needs and problems. Some recovering addicts may need help becoming more assertive with their friends and family. Others may need to learn new ways to relax or manage stress. (By the time they reach treatment, many cocaine abusers don't have any other way to cope with life's difficulties.) Some may need help finding a place to live before they can even think about cleaning up their lives. Because recovery is so personal, one-on-one counseling sessions are especially effective, although group sessions can also be helpful under the guidance of a good counselor.
Typical programs last three to six months. Clients have one or two therapy sessions each week during that time, perhaps along with follow-up phone calls and quick one-on-one meetings with counselors. If clients can avoid cocaine for at least three weeks during this treatment period, they may be more likely to stay drug-free during the 12 months after treatment ends, according to the National Institute on Drug Abuse (NIDA). Some users will need more sessions or more intensive therapy, perhaps including inpatient treatment in a hospital. As reported by NIDA, outpatient CBT therapy is generally not enough for people who are also hooked on other drugs or who suffer from psychosis or bipolar disorder that cannot be stabilized with medication.
Some programs offer meal vouchers or other rewards to patients who reach certain goals, such as having a negative drug test two weeks in a row. A free dinner may seem trivial, but it can actually help inspire clients to stay clean. Withdrawal from cocaine doesn't feel very rewarding while you're going through it, so any sort of positive reinforcement can help.
People in outpatient treatment often miss many of their appointments or don't follow up on suggestions from their counselors. But this shouldn't cause them to give up on themselves. It's just one more sign that they need help getting their life together.
The future of treatment
Although there are no drugs yet available to break cocaine dependency, NIDA is looking at some that may show promise. Disulfiram, used to treat alcoholism, has produced the most consistent results. In some small experimental trials, researchers are evaluating topiramate, a seizure disorder drug, and modafinil, a drug used to treat narcolepsy, as possible treatments for cocaine addiction, according to NIDA. Researchers are also experimenting with baclofen, a muscle relaxant, which has shown some promise for a smaller group of cocaine addicts who are heavy users. Another promising treatment is a vaccine that prevents cocaine from entering the brain, thus reducing the risk of relapse. After a person has stopped using cocaine, antidepressant drugs may be useful to alleviate the mood changes that come from withdrawal, according to NIDA.
Unfortunately, treatment for all kinds of drug abuse is woefully lacking: The 2008 National Survey on Drug Use and Health found that 20 million people who needed drug treatment did not get it. Until the government puts more emphasis on drug treatment and less on incarcerating drug users, according to the Drug Policy Alliance, an organization calling for a national drug policy based on health, science, and compassion, many cocaine abusers and others may have a hard time getting the treatment they urgently need.
Cocaine: Abuse and Addiction. National Institute on Drug Abuse. National Institutes of Health Publication Number 10-4166. Revised September 2010. www.drugabuse.gov
Drug Enforcement Administration. Cocaine. 2006. http://www.usdoj.gov/dea/concern/cocaine.html
Nestler EJ. The neurobiology of cocaine addiction. Science and Practice Perspectives December 2005.
Petry NM. Contingency management in addiction treatment. Psychiatric Times. February 2002, Vo. XIX, Issue 2
National Institute on Drug Abuse. Topiramate shows promise in cocaine addiction. http://www.drugabuse.gov/NIDA_notes/NNvol19N6/Topiramate.html
National Institute on Drug Abuse. Modafinil improves behavioral therapy results in cocaine addiction. http://www.drugabuse.gov/NIDA_notes/NNvol20N3/Modafinil.html
Office of Applied Studies. Substance Abuse and Mental Health Services Administration. Results from the 2008 national survey on drug use and health: National findings. September 4, 2009. http://www.oas.samhsa.gov/nsduh/2k8nsduh/2k8Results.cfm#7.3