2.6iii Types of substances: Stimulants

A Family Guide to Concurrent Disorders: Part I - What are concurrent disorders?

Stimulants include:

• cocaine and “crack” (a potent form of cocaine)
• amphetamines such as methamphetamine
• ecstasy
• caffeine in coffee, tea, cola drinks, “power” drinks and “stay-awake” pills
• over-the-counter medications such as allergy medicines (e.g., Sudafed).

Stimulants increase activity in the central nervous system, including the brain. For example, they speed up mental processes and make people feel more alert and energetic. But while a drug such as caffeine may make you more alert, it still leaves you impaired, and when it wears off, sometimes quickly, it leaves you very tired and less alert.

Cocaine

People who use cocaine can become dependent after using it for short periods of time. An early sign of cocaine dependence is when a person finds it harder and harder to resist using cocaine whenever it is available.

Crack is a commonly used form of cocaine. Unlike other types of cocaine, it is easily turned into a vapour and inhaled. As a result, its effects are immediate.

Because cocaine breaks down in the body quickly, people frequently find they need to use cocaine often to maintain a high. People who are dependent can spend huge amounts of money on the drug in a short period. To get the large amounts of money needed, they may become involved in theft, prostitution or drug dealing. A person who is cocaine-dependent may often need to stop using for a few days to find more money to buy the drug.

Tolerance to cocaine occurs after repeated use. Withdrawal symptoms, particularly a poor mood, may occur but they often do not last long.

How does cocaine make you feel?

How cocaine makes you feel depends on:

• your age
• how much you use
• how often you use
• how long you use
• how you take it (e.g., by injection, orally or snorting)
• your mood
• how you expect it to make you feel
• whether you've taken any alcohol or other drugs (illegal, prescription, over-the-counter or herbal)
• whether you have certain pre-existing medical or psychiatric conditions.

Cocaine increases heartbeat, breathing, blood pressure and body temperature. It makes people feel energetic, talkative, alert and euphoric. They feel more aware of their senses, such as sound, touch and sight. Hunger and the need for sleep are reduced. Although cocaine is a stimulant, some people find it calming, and feel increased self-control, confidence and ease with others. Other people may feel nervous and agitated, and can't relax.

Taking high doses of cocaine for a long time can lead to:

• panic attacks
• psychotic symptoms, such as paranoia (feeling overly suspicious, jealous or persecuted), hallucinations (seeing, hearing or smelling things that aren't really there) and delusions (having false beliefs)
• erratic, bizarre and sometimes violent behaviour.

With regular use, people may become tolerant to the euphoric effects of cocaine. This means that they need to take more and more of the drug to get the same desired effect, or that they get less effect from the same amount of the drug. At the same time, people who use the drug regularly may also become more sensitive to its negative effects, such as anxiety, psychosis (hallucinations, loss of contact with reality) and seizures.

Is cocaine dangerous?

Yes. While many people use cocaine on occasion without harm, the drug can be very dangerous. Whether it's used once or often:

• Cocaine causes the blood vessels to thicken and constrict, reducing the flow of oxygen to the heart. At the same time, cocaine causes the heart muscle to work harder, leading to heart attack or stroke, even in healthy people.
• Cocaine raises blood pressure, which can explode weakened blood vessels in the brain.
• A person can overdose on even a small amount of cocaine. Overdose can cause seizures and heart failure. It can also cause breathing to become weak or stop altogether. There is no antidote to cocaine overdose.
• Snorting cocaine can cause sinus infections and loss of smell. It can damage tissues in the nose and cause holes in the bony separation between the nostrils inside the nose (nasal septum).
• Smoking cocaine can damage the lungs and cause “crack lung.” Symptoms include severe chest pains, breathing problems and high body temperatures. Crack lung can be fatal.
• Injecting cocaine can cause infections from used needles or impurities in the drug. Sharing needles can also lead to a person getting, or spreading, hepatitis or HIV.
• Chronic use can cause severe psychiatric symptoms, including psychosis, anxiety, depression and paranoia.
• Cocaine use is linked with risk-taking and violent behaviours. It is also linked to poor concentration and judgment, increasing risk of injury and sexually transmitted diseases.
• Chronic use can cause weight loss, malnutrition, poor health, sexual problems, infertility and loss of social and financial supports.
• Cocaine use in pregnancy may increase the risk of miscarriage and premature delivery. It also increases the chance that the baby will be born underweight. Because women who use cocaine during pregnancy often also use alcohol, nicotine and other drugs, we do not fully know the extent of the effects of cocaine use on the baby.
• Cocaine use while breastfeeding transmits cocaine to the nursing child. This exposes the baby to all the effects and risks of cocaine use.

Is cocaine addictive?

It can be. Not everyone who uses cocaine becomes dependent, but if they do, it can be one of the hardest drug habits to break.

People who become dependent on cocaine lose control over their use of the drug. They feel a strong need for cocaine, even when they know it causes them medical, psychological and social problems. Getting and taking cocaine can become the most important thing in their lives.

Smoking crack, with its rapid, intense and short-lived effects, is most addictive. However, any method of taking cocaine can lead to dependence. The amount of drug used, and how often people use the drug, has an effect on whether they become dependent.

Cocaine causes people to “crash” when they stop using it. When they crash, their mood swings rapidly from feeling high to distress. This brings powerful cravings for more of the drug. Bingeing to stay high leads quickly to dependence.

Symptoms of cocaine withdrawal can include exhaustion, extended and restless sleep or sleeplessness, hunger, irritability, depression, suicidal thoughts and intense cravings for more of the drug. The memory of cocaine euphoria is powerful, and carries a strong risk of relapse to drug use.

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