by: Harry J. Felch
Most people who use cocaine are fortunate and escape death, but thousands per year do not. As for the rest, some just don't find her alluring and never develop a relationship. For others, there develops a relationship that will become the script for a horror film. They will be stripped of their self-respect. They will eventually sell their soul for a few more fleeting seconds of "feeling normal" before they are cast back into the claws of addiction. They will lose their spouses, their kids, their cars, their homes and eventually their jobs. They eventually either seek treatment for their addiction, get arrested or die.
Why is this drug so powerful, so all consuming, so deadly? The answers lie within the brain. This drug is one of many that has the capacity to alter brain functioning and take an individual's freedom of choice away. It happens to be quicker and more efficient than others.
Before you can understand how its vice grip is established, you need to know, in elementary terms, how the brain works.
The brain is composed of a network of trillions of neurons. The neurons are composed of three basic parts: the cell body; the axon, which carries impulses away from the cell body; and the dendrites, which receive impulses from other neurons.
Now, the brain is not hot-wired; it has no physical contact among its trillions of interconnecting neurons. Each nerve cell is physically separated from others by a small space called a synapse. When a cell body fires, the impulse travels down the long fiber of the axon to the synapse separating the axon of one neuron from the dendrites of another. The impulse is then carried across the synapse to the receiving neuron by small molecules that are released into the synapse. These molecules, called neurotransmitters, move across the synapse and become attached to receptor sights which are embedded in the membrane of the dendrites.
There are thousands of neurotransmitters in our brain. Each neurotransmitter is different in chemical structure and will attach or "fit" only in post-synaptic terminals that have tailor-made receptors to fit neurotransmitters of a specific structure. When the neurotransmitters "fit into the locks" of the accepting receptors, the new cell bodies are able to fire, and the process goes on and on and on....
Addiction can be defined as self-induced changes in neurotransmission that result in behavior problems. It becomes evident when one becomes progressively unable to control the beginning or end of a need-fulfilling activity.
Compulsive problem behavior is solely the responsibility of the brain, which may be described as the most complex entity in the universe. From a purely biochemical standpoint, all of our emotions, perceptions and bodily functions are controlled by neurotransmission. Alter your neurotransmission and you can change your personality, sensations and bodily functions. Alter them for too long or too many times, however, and the brain begins to fight back and attempts to neutralize the effect of the drug ingested, attempting to maintain a sense of "normalcy." Remove the drug from the body for a lengthy period of time and the body is placed out of balance and withdrawal symptoms appear. To avoid withdrawal symptoms, an individual ingests more of the drug to return to normalcy. This is the cycle of addiction.
COMPONENTS OF ADDICTION
Abraham Walker has developed a two-state model for the origin and progression of addiction--acquisition and maintenance. In the acquisition phase, the beginning user begins and continues a potentially compulsive pleasurable sensation brought about through drug use. The human body usually adapts to this stimulation by reducing the potency of the drug's effect through increasing its production of enzymes, which reduce the amount of neurotransmitters.
In the maintenance stage of addiction, a person is no longer motivated by any sense of pleasure from the need-gratifying behavior. Instead, the receptor activity now serves only to relieve the sense of despair and physical discomfort resulting from the absence of the mood-altering action. the individual is now only trying to "break even" or regain a sense of normalcy by continuing to use the drug. This is the stage of compulsion and preoccupation.
Addiction's greatest allies, of course, are the enablers and codependents--those individuals who either assist the user in maintaining the denial and avoiding the consequences of their use or who are themselves caught up in the same behaviors except for the drug use.
Cocaine becomes the No. 1 priority in the addict's life. He or she is preoccupied with its use and is physically craving another "fix." The preoccupation and compulsion is so strong that individuals become willing to do whatever it takes to continue possession of the drug. They will risk their marriage, their health, their home, their job and even their freedom to continue using. It's common for professionals to lose $60,000 to $200,000 through cocaine use, as well as have their license to practice their profession revoked. Their families and friends generally leave long before.
That is how strong this addiction (compulsion) can be.
Addiction mirrors itself to the world through denial. We've all heard the term, we all understand how individuals are unwilling or unable to acknowledge or accept the impact their drug use has had and their powerlessness to "control" it.
Denial has two components. The first is the out-and-out lying and deception--lying that the drug abuser may actually come to believe him or herself. It can take many forms: rationalizing, blaming, excusing, minimizing, etc.
The second and often ignored type of denial takes the form of unawareness. Because the drug abuser is inclined to hang around with other abusers, attends parties where drug use is prevalent and avoids socializing with nonusers, he or she comes to have a distorted perception of the population, seeing most everyone as a drug abuser.
Also, because users often alienate themselves from family and friends, they really don't see the pain and anguish others are suffering because of their drug use. They come to believe the impact on their spouse, kids or family is a lot less than it is in reality.
One of the questions I ask a new patient entering our drug abuse program is "How has your drug use affected your family?" The overwhelming majority will respond with something like "not much" or "it upset them but it mainly just affected myself." And they believe it because in their reality it's true. They're like a horse with blinders; they truly do not see the devastation.
THE MYTH OF CONTROL
There is no such thing as "control" of drug intake. By definition, if you need to control something, it must be out-of-control. For the social drinker or recreational drug user, for example, the concept of control does not even exist; there is nothing out-of-control. The social drinker does not have the compulsion to drink 6 to 12 glasses of beer, no more so than the average eater has the compulsion to eat four, five or six Big Macs at one time! There is satisfaction at a low level and for them to increase that level would be dysphoric. Therefore there is no need to control anything. People who use willpower to rein in their compulsion are already out-of-control, and pretty soon, the willpower is no longer effective. Individuals who begin to think they need to or can control drug use are probably already addicted.
If you are using cocaine, it's easy to determine whether you're likely to be addicted. You don't need a long questionnaire or a counseling session. Just ask yourself three simple questions.
Over the past few weeks or months, has there been an increase in your use and tolerance?
Do you experience cravings, compulsions or preoccupations?
Despite negative consequence resulting from your use, do you continue to use?
If you answer positive to at least two of these questions, you have a problem and are likely to need assistance in quitting. If you answered "yes" but found yourself thinking "I can control it," hit yourself in the head with a hammer and knock some sense into it. If you could "control" it, you wouldn't have the problem in the first place!
Remember, addiction is the product of a long-term alteration in the brain's neurotransmission. An addict's brain no longer functions in the same manner as before the drug use and psychological attempts (willpower) to overcome this change are not very effective. If you had poison ivy on your leg and I told you not to scratch, sooner or later you'd scratch, regardless of how much willpower you tried to conjure up.
The neurotransmission patterns that have been altered will likely return to normal over time when one quits and the cravings and compulsion slowly leave, but the brain will always "remember" the effects of the cocaine and any return to its use, even years down the road, may trigger changes in the brain and catapult one back into the hell they came from before they know it. This doesn't apply to just cocaine. The use of any mood-altering drug, including alcohol, marijuana, etc., will likely cause the same reaction. Why? Well, because all mood-altering drugs alter neurotransmission in much the same way. So much, in fact, that if one quits cocaine, it's unlikely that he or she can use any mood-altering drug without encountering abuse or addiction to that drug.
So, in the treatment industry, when we talk about quitting or stopping the use of all mood-altering drugs, we believe that to quit cocaine but to continue to drink, for example, is to remain in denial, and is stupid. Thousands of cocaine addicts have found themselves back in hell as a result of continuing to use alcohol, pot or other drugs.
HOW TO QUIT
The first step for the addict is to admit that he or she is powerless over cocaine use and their life is unmanageable or "uncontrollable." Until they do that, addicts are unlikely to stop or stay off the drug.
The second step is to find help. for most addicts, CA (Cocaine Anonymous) is the place to begin. It is patterned after Alcoholics Anonymous and utilizes the same principles. Millions of people have maintained sobriety through AA or other 12-step programs. AA was around long before treatment centers. The organization is in the phone book.
For those who have been unsuccessful at quitting through AA or CA, have relapsed several times or have a very limited support network, an out-patient chemical-dependency program is the logical step and is generally as effective or more effective than inpatient programs for most addicts. It allows one to continue working and functioning within the family and on the job while on treatment.
For those who are in need of extensive detoxification because of poly-drug use, alcohol, tranquilizers, etc., have failed outpatient treatment several times, or who have concomitant medical problems, inpatient programs are logical. Most inpatient programs, however, strive to get patients stabilized in as few days as possible and then enroll them in an outpatient program.
In most programs, inpatient or out, the families are strongly encouraged to attend. We believe that drug addiction is a family disease and the family, not just the addicted individual, needs to recover.
There really is no medical detoxification for sole cocaine use. The individual may crash and then suffer the jitters and cravings, but they are not at risk for withdrawal such as heroin addicts or alcoholics. A physician may prescribe a drug to help reduce cravings, but not all individuals report extreme cravings.
If the cocaine addict is also using alcohol and downers, there may be a dual addiction from which an individual requires detoxification. If this is the case, an individual is encouraged to see a physician before discontinuing use or quitting cold-turkey. A lot of detoxification can be done on an outpatient basis while the individual is actively involved in the program.
Why do some individuals love cocaine while others disdain cocaine but drink gallons of alcohol, and others try to mellow out on heroin?
From a psychological perspective, the use of a particular drug generally depends on how well it "fits" with one's usual style of coping. The drug one chooses is actually a pharmacologic defense mechanism; it bolsters already established patterns for managing psychological threat. People really don't become addicted to a particular drug; they become addicted to the sensations of pleasure derived from them. Individuals rely on three distinct types of experience to achieve a sense of well-being: relaxation, excitement and fantasy.
Individuals who interact with the environment with feelings of rage and hostility may seek out drugs such as Valium or heroin. Or they may become excessively reliant on TV, excessive consumption of food or withdrawal from the world. These individuals are seeking to tranquilize themselves. Cocaine would likely agitate them.
In sharp contrast to the depressant user, cocaine addicts are likely thrill seekers who maintain a posture of active confrontation toward what they perceive is a hostile, even threatening, world. They may harbor feelings of inferiority and attempt to overcome these feelings through activities that require physical prowess or intellectual ability. They are likely extroverts who have an inflated sense of self-worth which hides the underlying insecurities. Cocaine addicts are often individuals who repeatedly engage in risky behavior. A sky diver's or mountain climber's adrenaline rush is psychologically similar to the rush or "jolt" one receives from a line of cocaine. Many cocaine addicts consistently mix danger with drugs.
THE SEARCH FOR NIRVANA
Nirvana is a state of mind. Those individuals who seek to discovery it with cocaine will soon have it slip away. And for those who don't quit cocaine, one of three things is guaranteed to happen.
They will end up in prison.
They will end up in a mental hospital.
They will die.
The real tragedy is the number of individuals whose lives they destroy along the way.
Reprinted by permission of the American Bar Association. This article originally appeared in the January/February 1991 issue of Law Practice Management.