The Brain’s Anti-Reward System is Impacted by Cocaine Withdrawal
According to the National Institute on Drug Abuse, about 15% of people in the United States have tried cocaine. Cocaine is known for producing a range of severe withdrawal symptoms, including depression and anxiety. A new study analyzing the impact of cocaine withdrawal on the brain's anti-reward system could help clinicians understand addiction and create a better treatment plan for managing substance withdrawal.
What Is Cocaine?
Cocaine is a powerful and addictive stimulant that derives from coca leaves. The coca plant is indigenous to South America, where the substance has been used for thousands of years.1However, several studies found that cocaine is a highly addictive substance that can cause changes in the brain if used regularly.2
Today, cocaine is often used by people to increase energy, feelings of well-being, and focus. It blocks dopamine reuptake, causing messages to be transmitted in the brain faster and raising dopamine levels. Those who are after a more intense, faster, cheaper high may start abusing crack cocaine. Many users start with cocaine but the transition to crack cocaine use when their cocaine habit becomes too expensive to maintain.
Cocaine’s Drug Class and Schedule
Cocaine belongs to a class of drugs known as stimulants. They speed up messages that travel between the brain and the body, making a person feel more energetic, awake, and confident.3
Due to its risk for abuse, cocaine is a Schedule II drug. It has a high potential for abuse, but medical professionals can use it for legitimate medical uses, such as local anesthetic for eye, ear, and throat surgeries.
Why Is It Addictive?
Researchers now know that repeated cocaine use affects the neurological system in the brain, more specifically, the systems associated with memory, pleasure, and decision making. When a person becomes addicted to cocaine, they may have difficulties controlling their urges, making it challenging to quit using the drug.
The reward circuit in the brain adapts to the extra dopamine caused by the drug, becoming less sensitive to it. Consequently, people need higher doses to experience the same high and avoid the negative cocaine withdrawal symptoms.4
Can You Overdose on Cocaine?
Using excessive amounts of cocaine at once can result in a cocaine overdose and eventually death. Knowing how much cocaine it takes to overdose and the signs of coke overdose could save a life.
How Much Cocaine Does It Take to Overdose?
The amount of cocaine required for an overdose depends on several factors. One important factor is the amount of cocaine a person takes and whether other drugs are mixed with the cocaine. The leading cause for cocaine overdoses in recent years is the mixing of cocaine with fentanyl. Fentanyl is a powerful synthetic opioid similar to morphine but only fifty to one hundred times more potent
Dangers of an Overdose
Without medical intervention, cocaine overdoses may result in death. Cocaine deaths are often a result of cardiac arrest or seizures. In the US, drug overdose deaths involving cocaine increased from 3,822 in 1999 to 15,883 in 2019. The number of overdose deaths due to a combination of cocaine with synthetic opioids has been increasing steadily since 2014 and is the main driver behind the high number of cocaine overdose deaths.5
Cocaine Use Symptoms
Cocaine might produce feelings of euphoria, but it can also give people pretty unpleasant effects. The most common cocaine use symptoms include:
Anxiety
Many studies have found that cocaine use and anxiety co-occur. Stimulants are known for speeding up the neurotransmitters in the brain, which may lead to feelings of anxiety.
Moreover, anxiety can also appear while the user goes through cocaine withdrawal or between uses. When withdrawing from stimulants, the brain’s neurotransmitters can drop dramatically.
Paranoia
Cocaine psychosis is a possible side effect of regular cocaine use. It develops from heavy cocaine use and may lead to the person experiencing hallucinations and delusions. Cocaine-induced psychosis can last from a couple of hours to a few days or even weeks.6 The most common symptom of cocaine-induced psychosis is paranoia.
Panicky Feelings
In addition to anxiety and paranoia, cocaine users may also experience panic attacks and possibly panic disorder. In fact, studies show that cocaine users have a three-fold excess risk of a panic attack.7
Common Signs of Cocaine Overdose
The following are some of the most common signs someone may show if they are suffering from a cocaine overdose:
- Behavior : Some of the initial symptoms of a cocaine overdose are unusual changes in someone’s mood or behavior. The person who overdoses on cocaine may show symptoms such as paranoia, delirium, confusion, and violence.
- Skin : Another common symptom of cocaine overdose is if the individual begins showing blue-colored skin or increased paleness.
- Breathing : A person overdosing on cocaine may also experience abnormally rapid or labored breathing.
- Seizures : The most severe symptom of cocaine overdose is having seizures. Seizures signify that the person’s body is starting to shut down, and if they are experiencing seizures, they require immediate medical assistance.
- Physiological : The most common physiological symptoms seen in patients overdosing on cocaine are dilated pupils, constricted blood vessels, rapid heartbeat, increased blood pressure, tremors or shaking, chest pain, and hyperthermia.
Why Is Cocaine Overdose on the Rise?
Statistics on Cocaine Use
College campuses have some of the highest percentages of drug use in the US. Several common reasons contribute to the widespread use of cocaine among college students.
Open attitudes toward drug abuse, increased anxiety before exams, participating in fraternity and sororities, newfound personal freedom, and frequent partying are some of the most common reasons college students may abuse cocaine.
According to the 2019 National Survey on Drug Use and Health : 8
- 2% of people aged twelve or older used cocaine in the past year
- 0.4% of adolescents used cocaine in the past year
- 5.3% of young adults (eighteen to twenty-five years) used cocaine in the past year
- 1.7% of adults used cocaine in the past year
Fentanyl-Laced Cocaine
According to the Centers for Disease Control and Prevention, synthetic opioid fatalities rose by 55% during the period between September 2019-2020.9 The reason for the dramatic increase in the number of overdose deaths is fentanyl-laced cocaine. Reports show that 70% of cocaine overdose deaths in 2020 also involved fentanyl.10
In 2016, only 1% of the cocaine samples tested by the Drug Enforcement Administration contained synthetic opioids, including fentanyl. In 2020, that number rose to 3.3%. Fentanyl-related overdoses can lead to sudden death due to respiratory arrest, cardiac arrest, severe respiratory depression, cardiovascular collapse, or severe anaphylactic reaction.11
The combination of the two drugs can be lethal if action is not taken immediately. Overdoses of such kind should be treated with a naloxone injection.
What Is the Brain Reward System?
The brain reward system is a neural network in the brain that has a central role in creating feelings of pleasure. The most important part of the brain reward system is dopamine, which is a neurotransmitter released by neurons when they are activated. Dopamine produces feel-good feelings and creates a “rewarding” sensation. It also affects areas of the brain that control movement, emotion, motivation, and cognition.
Dopamine is released when people engage in activities like eating ice cream, playing video games, and falling in love.
Drug Addiction and the Brain
Drugs activate the brain reward system in a similar manner. However, unlike a natural surge of dopamine from enjoying a hobby or a bar of chocolate, drugs produce a much higher and longer-lasting artificial pleasure sensation.
The strong high motivates people to use the drug over and over again, even when it is negatively affecting their personal life and well-being. Drugs have the power to reprogram the brain to become adapted to the extra dopamine, becoming less sensitive to it. Consequently, people need higher doses to experience the same high.
Anti-Reward System
The anti-reward system is a hypothesis on the existence of brain systems that act to limit reward. These anti-reward pathways are hypothesized to be a neural network in the brain that inhibits excessive reward-seeking behavior.12
This system is thought to help avoid negative consequences and prevents addictive, compulsive, or impulsive behaviors such as drinking alcohol to excess, using drugs, smoking cigarettes, binge eating, and having unsafe sex.
Impact on Cocaine Withdrawal
A recent study published in the journal Frontiers in Synaptic Neuroscience found that during cocaine withdrawal, neurons in the brain area associated with depression connect to neurons embedded in the anti-reward system. The connection may be key in driving adverse behavior during withdrawal.13
The findings also show that neurons in the anti-reward system project anti-reward information to the brain’s ventral tegmental area (VTA) – a region of the brain that produces dopamine – and into other parts of the brain responsible for processes such as decision making and motivation.
Researchers already knew that cocaine withdrawal makes changes to brain circuits linked to depression and reward. The study showed that there is also a reorganization of brain circuits that drive negative behavior. The next step for researchers is to dissect the functionality of these anti-reward circuits to see how they influence behavior.
Cocaine Overdose Treatment
In the Hospital
Benzodiazepines
Treatment in a hospital starts by giving the patient a sedative to lower their blood pressure and heart rate. The most commonly used medications for this are benzodiazepines. These medications can lower the risk of heart attack or stroke.
Non-Dihydropyridine Calcium Channels Blockers
Non-dihydropyridine calcium channels blockers act by reducing elevated blood pressure. The most common medication is diltiazem. Dihydropyridine calcium channel blockers should not be administered to patients as they can increase the heart rate and cause reflex tachycardia.
Nitroglycerin and Nitroprusside
Nitroglycerin and nitroprusside are often used in hospital settings to reduce high blood pressure. These medications also pose a risk of causing reflex tachycardia.
Antipsychotics
Antipsychotics are often administered together with benzodiazepines to help with psychological symptoms, such as delirium and hallucinations. A commonly used combination is the antipsychotic haloperidol, the benzodiazepine lorazepam, and the antihistamine diphenhydramine that helps with sedation.
Treatment for Cocaine Addiction
The following are the most effective approaches to cocaine withdrawal treatment:
Detox
Medical detox can be an important first step for those with a substance use disorder, dramatically improving one’s chances of long-term recovery. It is a medically supervised cocaine withdrawal treatment under the care of a licensed medical professional. It can reduce some of the risky symptoms common with withdrawals, such as seizures and dangerous electrolyte imbalances.
Inpatient/Outpatient Care
An inpatient treatment program usually lasts thirty days or longer, while an outpatient treatment program typically lasts five to ten weeks. Inpatient treatment programs provide the individual with twenty-four-hour care and supervision in a controlled environment, which can be more effective for individuals who are addicted to alcohol or drugs, have mental health issues, or may be suicidal.
Outpatient treatment programs allow individuals to live at home and maintain their normal daily routines during their recovery process. Outpatient treatments are usually less expensive than inpatient treatments because they require fewer resources. However, this does not suggest that outpatient treatment is less effective than inpatient.
Therapy
In addition to inpatient or outpatient treatment and detox, patients may also benefit from attending individual or group therapy to help them deal with their addiction. Therapy can help patients learn healthy coping mechanisms and obtain long-term sobriety.
The most effective types of therapy for addiction treatment include:
- Cognitive-behavioral therapy
- Motivational interviewing
- Stress management skills training
Resources
- https://pubs.asahq.org/anesthesiology/article/98/6/1503/39397/History-of-the-Development-and-Evolution-of-Local
- https://www.drugabuse.gov/publications/research-reports/cocaine/what-are-some-ways-cocaine-changes-brain
- https://adf.org.au/drug-facts/stimulants/
- https://www.drugabuse.gov/publications/drugfacts/cocaine
- https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181074/
- https://dukespace.lib.duke.edu/dspace/bitstream/handle/10161/20035/Obrien%202005%20Cocaine%20use%20and%20the%20occurrence%20of%20panic%20attacks%20in%20the%20community%20a%20case-crossover%20approach..pdf?sequence=2&isAllowed=y
- https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf
- https://www.npr.org/sections/health-shots/2021/04/22/989833102/overdose-deaths-surged-in-pandemic-as-more-drugs-were-laced-with-fentanyl
- https://www.washingtonpost.com/nation/2018/12/12/cocaine-deaths-increase-amid-ongoing-national-opioid-crisis/
- https://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/dear_colleague_letters/2013-colleague-letter-fentanyl-analogues.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549070/
- https://www.eurekalert.org/news-releases/896070
