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Cocaine in The City

Powder cocaine has a stereotyped reputation as the ‘recreational’ drug of choice for rich high-flyers in pressured jobs, but recreation can quickly become a destructive dependency. What are the reasons for this, and how can problematic use be alleviated with treatment?

How this ‘recreation’ activity can quickly turn sour

Cocaine is one of the most expensive plants in the world. Three out of four ‘wraps’ bought in the UK are from Columbia: cultivated and smuggled over for a high and rising demographic of users. According to a recent UN report, one in 50 people in the UK have used cocaine — a higher figure than anywhere else in the world. Of them, 100 will die every year as a direct result, and the related problems it can cause in their lives (relationship problems, lost jobs, financial strain etc) are almost limitless.

Sociologically, cocaine is an interesting phenomenon. Subdivided into ‘powder’ and ‘crack’ forms, the latter is cheaper, associated with lower-class use, and will net you more prison time if you’re caught with it. Powdered cocaine users are stereotypically rich high-flyers who use the drug recreationally at parties.

The status implication of being financially able to snort £50 at a time without a second thought draws in new users embedded in settings which, explicitly or not, treat cocaine as socially acceptable (banking, film, media, advertising etc). Powdered cocaine is seen by many as a recreational drug: something you can take in the evening and still get up for work the next day. It doesn’t involve injection like heroin, or the rapid loss of one’s looks like methamphetamine. In fact, for the body-conscious, cocaine can be especially attractive as it is a known appetite-suppressant.

Thinking about tomorrow’s use before you’ve got through today

When you’re surrounded by people who use it and seem to be doing well, the temptation to join them can be overwhelming. The trouble is, despite the friendly stereotypes, cocaine is highly addictive. ‘Weekend snorting’ can quickly descend into a constant preoccupation, and its price makes it a difficult habit to maintain. As one participant in a large Home Office study into cocaine use said, “It’s like when it’s in your head you can’t move it. You’re even thinking about tomorrow’s use before you’ve got through today.”

Cocaine is a serotonin-noradrenaline-dopamine reuptake inhibitor, which increases the levels of chemical messengers (neurotransmitters) in the brain. In the same way selective serotonin reuptake inhibitor (SSRI) antidepressants can lift your mood and make you less anxious, the added effects of noradrenaline and dopamine make the experience of cocaine both stimulating and pleasurable.

Rats on cocaine

When rats in laboratory settings are allowed to self-administer cocaine, many will grow to do so continuously, ignoring all other activities such as eating and sleeping. In humans, the progression from casual use to problematic use can be rapid, with cravings that become more frequent and intense with every high. In 2001, a team of neuroscience researchers in the USA used brain scans of a group of crack cocaine-dependent men to locate activity in specific areas of the brain that might underlie this phenomenon.

1 in 50 people in the UK have used cocaine, the majority of which is smuggled from Columbia

They found the amygdala (an area in the limbic system or ‘pleasure centre’ of the brain) showed increased activation to internal cocaine-craving as well as in response to external cues such as handling paraphernalia or watching videos of others doing the drug. This seems to be why it can seem almost impossible to quit cocaine without removing yourself from the social scene that regularly uses it. Seeing other people use cocaine can stir up a neural response just as powerful as a strong craving.

The financial strains on the post-recession cocaine crowd seem to be triggering a diversified outlet for these cravings. The cost of cocaine in its purer forms has doubled since the recession from £25,000 to £52,000 per kilo. Though the ‘street price’ has halved on average in the past 5 years to £30 per gram (according to a large survey by dance music magazine Mixmag), quality-savvy connoisseurs know that this is because the drug is being more heavily ‘cut’ with other (often more toxic) ingredients to push the price down.

Rise in the use of substitutes

Cost considerations, combined with a desire to evade corporate drug tests (which cover cocaine but rarely ‘new’ drugs) have led to a rise in the use of substitutes such as ‘miaow miaow’ (mephedrone) and GHB (gamma-hydroxybutyric acid) . Both are class B drugs and so a bit less risky in terms of punitive consequence if caught, but they are certainly not without their own problems. GHB, for example, is known as the ‘date rape’ drug, due to its effects of euphoria, reduced inhibitions and drowsiness. It makes your tongue blister and crack, and with repeated use can build in the bloodstream leading to blackouts and coma.

What all these drugs, including cocaine, have in common is that they are stimulants. Cocaine in particular increases dopamine levels in the brain which with heavy use can lead to cocaine psychosis. Psychosis is a loss of contact with reality manifested as delusions and hallucinations, which occurs naturally in conditions such as schizophrenia. In a large psychological study in Bangalore in 2011, over half of the cocaine users investigated reported psychotic symptoms at some point. These effects become more severe the more of the drug you use, and can include intense paranoia and the feeling of insects crawling underneath the skin.

Self-medication to mask underlying issues

So what can be done to help people release themselves from a problematic relationship with and dependency on cocaine? Often the drug itself is the problem, but dependent behaviours can evolve as a means of self-medication allowing a person to mask underlying issues such as low self-esteem, anxiety and depression.

Eva Rausing (wife to the heir of the Tetra Pak fortune), whose body was found in her home in 2012, two months after her death, is thought to have died from cocaine overdose. Her family say they believe she turned to stimulant drug use in her late teens to overcome acute social anxiety (‘cocaine confidence’ is a common side-effect of the drug).

For these reasons, therapy from a drug and alcohol specialist psychological therapist (as opposed to purely addiction-focussed help groups such as Narcotics Anonymous) may have an advantage, allowing the person’s needs to be met as a whole, not just as viewed under the lens of addiction. Also, one-to-one therapy is often preferred by those who are uncomfortable sharing their problems with a large group of strangers. Though the solidarity of experience with others who are struggling can be a comfort, group work is not the only means of finding this.

Many counsellors who choose to specialize in helping people with drug problems, do so because they have experience of doing so themselves. This explanation is supported by psychological research, much of which finds psychological therapies to be helpful. For example, in a recent review of treatments for cocaine dependence conducted by a group at the University of Virginia, therapies such as CBT Cognitive Behavioural Therapy seemed to show the best results as measured by patient retention and relapse prevention.

City Addictions, March 24, 2017

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