Cocaine Use Disorder

Cocaine Use Disorder:

Generally, It can  administer orally, intranasally, either by smoking ( especially free basing) or parenterally, depending on the preparation available. Moreover, Cocaine HCl is the commonest form use, follow by the free base alkaloid.

After that, Both intravenous use also free base inhalation produce a ‘rush’ of pleasurable sensations. Additionally, Cocaine is a central stimulant which inhibits the reuptake of dopamine, along with the reuptake of norepinephrine and serotonin.

In animals, cocaine is the most powerful reinforcer of the drug-taking behaviour. A typical pattern of cocaine use is cocaine ‘runs’ (in other words, binges), followed by the cocaine ‘crashes’ (in other words, interruption of use).

Besides this, Cocaine is sometimes use in combination with opiates like heroin (in other words, ‘speed ball’) or at times amphetamines. Lastly, Previously uncommon, cocaine misuse appears to be recently a growing problem in the metros of India.

Indian epidemiology then other

Causes of Cocaine Use Disorder

• Some change in brain structure
• Imbalance in brain chemicals
• Genetic factors
• Environmental problems
• Negative effects of brain’s pleasure center

Risk factors of Cocaine Use Disorder

Things that may raise the risk of this problem are:

• Having anxiety, depression, loneliness, and past or current alcohol use disorder
• Misuse of medicines
• Family history of drug use or acting without thinking. (2)

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Pathophysiology of Cocaine Use Disorder

Cocaine, by blocking presynaptic serotonin binding sites in the brain and inhibiting the reuptake of serotonin, causes serotonin to accumulate.

This results in intense stimulation and seizure development. (2)

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Sign & Symptoms of Cocaine Use Disorder

Mind:

• Euphoria
• Mood swings
• Anxiety
• Depression
• Impulsivity
• Cocaine taken over longer period of time

Eye:

• Pupillary dilatation

Nose:

• Loss of the sense of smell
• Nosebleeds
• Chronically runny nose

Mouth:

• Difficulty swallowing

Stomach:

• Nausea
• Vomiting

Heart:

• Hypertension
• Tachycardia

General:

• Sweating
• Hyperactivity
• Social withdrawal (1)

generally, Acute cocaine intoxication is characterised by pupillary dilatation, tachycardia, hypertension, sweating, also either nausea or vomiting.
A hypomanic picture with increased psychomotor activity, grandiosity, elation of mood, hypervigilance also increased speech output may be present. Later, judgement is impaired and there is impairment of either social or occupational functioning.

Cocaine use produces a very mild physical, but a very strong psychological, dependence. A triphasic withdrawal syndrome usually follows an abrupt discontinuation of chronic cocaine use.

Phases in Cocaine Withdrawal Syndrome:

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Differential diagnosis of Cocaine Use Disorder

• Amphetamine-Related Psychiatric Disorders
• Attention Deficit Hyperactivity Disorder (ADHD)
• Bipolar Disorder
• Delirium
• Delusional Disorder
• Depression
• Hallucinogen Use
• Panic Disorder
• Phencyclidine (PCP)-Related Psychiatric Disorders
• Schizoaffective Disorder
• Schizophrenia
• Schizophreniform Disorder
• Sleep-Wake Disorders (4)

Complications are what happen after you have a disease. They are the negative consequences of the disease process.The complications of chronic cocaine use i.e.;

• Acute anxiety reaction,
• Uncontrolled compulsive behaviour,
• Psychotic episodes (with persecutory delusions, also tactile and other hallucinations),
• Delirium and delusional disorder.

High doses of cocaine can often lead to i.e.;

• Seizures,
• Respiratory depression,
• Cardiac arrhythmias,
• Coronary artery occlusion,
• Myocardial infarction,
• Lung damage,
• Gastrointestinal necrosis,
• Foetal anoxia,
• Perforation of nasal septum.

Investigation of Cocaine Use Disorder

• CBC
• CT chest
• Bronchoalveolar lavage
• Transthoracic echocardiogram
• Urine toxicology ± gas chromatography/mass spectrometry testing for levamisole
• ECG
• Chest x-ray
• CT head (3)

Generally, Before starting treatment, it is essential to diagnose (or rule out) co-existent psychiatric and/or physical disorder, also assess the motivation for treatment. Additionally, Cocaine use disorder is commonly associate with mood disorder, particularly major depression and cyclothymia.

Treatment of Cocaine Overdose:

The treatment of overdose consists of oxygenation, muscle relaxants, also IV thiopentone and/or IV diazepam (especially, for seizures and severe anxiety). IV propranolol, a specific antagonist of cocaine induced sympathomimetic effects, can helpful, administered by a specialist. Moreover, Haloperidol (or pimozide) can be used for the treatment of psychosis, as well as for blocking the cardio stimulatory effects of cocaine. Lastly, These must be administered very carefully by an expert specialist.

Treatment of Chronic Cocaine Use:

The management of underlying (or co-existent) psychopathology is probably the most important step in the management of chronic cocaine use. The pharmacological treatment includes the use of bromocriptine (e.g. a dopaminergic agonist) and amantadine (an antiparkinsonian) in reducing cocaine craving. Other useful drugs are desipramine, imipramine also trazodone (both for reducing craving and for antidepressant effect). Besides this, The goal of the treatment is total abstinence from cocaine use. Finally, The psychosocial management techniques, such as supportive psychotherapy and contingent behaviour therapy, are useful in the post-withdrawal treatment and in the prevention of relapse.

Prevention of Cocaine Use Disorder

• Avoid Temptation and Peer Pressure.
• Seek help for mental illness.
• Examine the risk factors :- Look at your family history of mental illness and addiction, several studies have shown that this disease tends to run in the family, but can be prevented. The more you are aware of your biological, environmental and physical risk factors the more likely you are to overcome them.
• Keep a well-balanced life:- People often turn to drugs and alcohol when something in their life is missing or not working. Practicing stress management skills can help you overcome these life stressors and will help you live a balanced and healthy life. (5)

Homoeopathic treatment

Homeopathic Treatment of Cocaine Use Disorder

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Cocaine Use Disorder

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines:

AVENA SATIVA

Avena sativa is one of the best remedies for drug addiction. It is effective for the bad effects of morphine or heroin addiction. It is a good remedy for those addicted to cocaine, marijuana, nerviness, tranquilizers or sedatives. Insomnia due to drug s or alcohol. Sleeplessness with nervous exhaustion and weakness.

NUX VOMICA

Nux vomica is effective for the bad effects of alcohol, tobacco, opium, coffee, wine etc. The patient is nervous and highly irritable. Headache and intoxicated feeling. Dyspepsia, nausea and vomiting, constipation are other leading symptoms.

MORPHINUM

Morphinum is used for the bad effects of over use of drugs. Mentally the patient is depressed and behaves in a dream-like state. Vertigo and dizziness on least movement of head. Face is dusky red or pallid lividity of face, lips, tongue, mouth, or throat. Violent throbbing in heart and carotids. Alternation of tachycardia and bradycardia.

COFFEA

Severe insomnia due to drug addiction. Hyperactivity of mind and body. Increases the sensibility of nerves, making them over excitable and over sensitive. Special senses become over acute, emotions especially joy and pleasurable surprise, produces dangerous symptoms. Now joyous, now gloomy. Coffea removes the bad effects of sleeping pills.

CANNABIS INDICA

Exaltation of spirits. Constant fear of becoming insane. Horror of darkness. Absent minded, forgetful. Emotions and sensations are exaggerated.

BELLADONNA

Fear of darkness and vision of ghosts as a result of drug addiction. Desire to escape or hide himself. Acuteness of all senses. Changeable moods. Hallucinations, sees monsters, hideous faces. Spit on faces of other persons. Easily angered.

HYOSYAMUS NIGER

Headache from narcotic addiction. Hallucinations most marked. Talks with imaginary persons to dead ones. Imagines things are animals. Inclined to laugh at everything. Does foolish things, behaves like mad. Laughs, sings, talks, babbles and quarrels.

SULPHUR

Sulphur antidotes the bad effects of Cannabis addiction. Sulphur patient express sadness and melancholy. They imagine himself a great man. Strong impulsive tendency to suicide by drowning or leaping from a window.

LACHESIS

Headache from narcotics addiction. The patient is highly talkative. Sensation of tension in various parts. Cannot bear anything tight anywhere. Sensation of constriction in throat, abdomen and head.

PULSATILLA NIGRICANS

Diarrhea from heroin addiction. Changeable stools, no two stools alike.

PASSIFLORA INCARNATA

Sleeplessness due to drug addiction. Effective for morphine addiction. Give mother tincture doses.

OPIUM

Drowsiness and coma from drug addiction. The patient falls into a heavy deep sleep. Thinks he is not at home. Sees frightful visions of mice, scorpions. Perversion of all senses. Euphoric state, overexcitement and sleeplessness.

VIPERA

A remedy for drug addictions by injections. (6)

Diet & Regimen of Cocaine Use Disorder

• Eat fiber rich diet.
• Take enough sleep.
• Do regular physical exercise.
• Stay away from cigarette & alcohol.
• Avoid high sugar meals.

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Reference

1. A Short Textbook of Psychiatry by Niraj Ahuja / Ch 4.
2. https://www.google.com/search?q=cocaine+use+disorder+pathophysiology
3. https://bestpractice.bmj.com/topics/en-us/199
4. https://emedicine.medscape.com/article/290195-differential
5. https://www.pvamu.edu/sa/drug-and-alcohol-abuse-prevention-program-daapp/tips-for-preventing-substance-abuse/
6. https://www.linkedin.com/pulse/homeopathy-substance-use-disorder-drug-addiction-dr-ks-gopi/

Frequently Asked Questions

What is Cocaine Use Disorder?

Cocaine is an alkaloid derive from the coca bush, Erythroxylum coca, found in Bolivia also  Peru.

What are the symptoms of Cocaine Intoxication?

• Pupillary dilatation
• Tachycardia
• Hypertension
• Sweating
• Either, Nausea or vomiting
• Increased psychomotor activity
• Grandiosity
• Elation of mood
• Hypervigilance
• Increased speech

What is the treatment of Cocaine use disorder?

• Oxygenation
• Muscle relaxants
• IV thiopentone
• IV diazepam
• IV propranolol
• Haloperidol
• Bromocriptine
• Amantadine
• Imipramine
• Trazodone

Give the symptoms of cocaine withdrawal Syndrome?

• Agitation
• Depression
• Anorexia
• Craving
• Fatigue
• Depression
• Sleepiness
• Exhaustion
• Hypersomnia with intermittent  awakening
• Hyperphagia
• Normal sleep, also improved mood