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COCAINE.
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Examined as a major drug of abuse.... More...
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Paper Abstract: Examined as a major drug of abuse. Overview and definitions of cocaine addiction. Severe physical and mental problems. Long-term psychological effects. Distinction between cocaine dependence and addiction. Assessment of the etiological issues and concerns. Neurochemical sources. Describes alternative treatments and interventions. Assesses their effectiveness. Concludes a multi-disciplinary treatment approach is needed.
Paper Introduction: Cocaine: An Evaluation of Effective Treatment Interventions
Introduction
According to the National Institute on Drug Abuse (NIDA), in 1997 about 1.5 million Americans were current cocaine users, defined as using cocaine in the month prior to the NIDA national study of drug use. Because of underreporting, the Office of National Drug Control Policy estimated that the actual figure was closer to 3.6 million. Although these numbers represent a significant decrease from the 5.7 million reported regular users in 1985, they indicate that cocaine remains an important drug of abuse (New treatments for cocaine addiction, 2001).
This report will examine cocaine as one common type of substance abuse in the United States. It will present an overview of cocaine addiction, and then move to an assessment of the
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However,it must be noted that any treatment to address the problem must beaccompanied by some type of psychotherapy to ensure that the comorbidpsychological and emotional aspects of cocaine dependence or use areameliorated, Lacking such interventions, it is possible that the cocaineaddict will simply increase his or her intake of other substances,including alcohol and other illicit or controlled drugs. On balance, while no consistentlysuccessful treatment or intervention for cocaine addiction has yet beenidentified (and the participation of the addict is crucial to treatmentoutcome), it would appear that cognitive-behavioral therapies and supportgroup immersion are most likely to have a positive outcome. Repeated snorting of cocaine can cause damage and holes on the inside of the nose and runny, inflamed nasal passages. Crack is the term for cocaine that hasbeen made into small rocks or pellets that can be smoked in a pipe. Cocaine - History of use, manufacture of preparation and related kinetics. The vaccine, called TA-CD, holds promise of being aneffective pharmaceutical intervention that can assist both the dependent oraddicted user of cocaine in overcoming cravings and ending use. In any event, the addict must willingly want to embrace theintervention and must also remove him- or herself from the environment inwhich substance use is facilitated. It is highly addictive and cancause severe mental and physical problems, including death from overdose. M. However, overtime, awareness of the potential side-effects and harmful consequences ofcocaine dependence and addiction has led to classification of thissubstance as "illicit." Cocaine is a white powder that comes from drying the leaves of thecoca plant; slang names for cocaine include coke, snow, blow, toot, nosecandy, and flake (Stevens, 2 2). Other brain circuits and neurotransmitters may be involved in theconditioned learning that creates the risk of relapse in response to cuesand associations (Cocaine abuse and addiction, 1999). Becauseof underreporting, the Office of National Drug Control Policy estimatedthat the actual figure was closer to 3.6 million. Conventional treatment or therapies for cocaine addictions includecognitive-behavioral therapies, self-help groups, and psychotherapy - havehad limited success. Although these numbersrepresent a significant decrease from the 5.7 million reported regularusers in 1985, they indicate that cocaine remains an important drug ofabuse (New treatments for cocaine addiction, 2 1). Use of an instrument known as the CAGE screening questionnaire -afour-item instrument that asks the patient is he or she has ever tried tocut down on substance use, been annoyed by questions regarding substanceuse, felt guilty about such behavior, and needed an "eye-opener" to beginthe day - can be helpful in determining the extent of the problem.Conclusions This brief report has considered the causes, etiology, andmanifestations of cocaine addiction. Secondly, once a medical history has been completed, apsychotherapist or other psychological clinician may be needed to determineif the myriad psycho-emotional signs and symptoms of cocaine dependence oruse are present. First, a caregivermay elect to examine the patient to determine if any or all of the signsand symptoms that are physiological manifestations of cocaine dependenceand abuse are present. Cocaine dependence isindicative of a strong emotional psychological and sometimes physical needto consume the drug (Cocaine dependence, 2 1). (2 2). . S. Physicalsymptoms of cocaine use can include blurred vision, chest pain, nausea,fever, muscle spasms, convulsions and death from convulsions, coma, heartfailure, or brain failure that causes breathing to stop (Stevens, 2 2). (2 1). The most difficult aspect of assessment and diagnosis isovercoming the patient's denial (Carson-DeWitt, 1999). A thoroughmedical workup can be extremely helpful in determining if cocaine isinvolved in producing any of the signs and symptoms listed above. The medial forebrain bundle and otherbrain regions contain many kinds of receptors for dopamine with differentfunctions, and it is not clear which ones are responsible for cocaineaddiction. ReferencesCarson-DeWitt, R. It has examined several treatmentalternatives and assessment procedures. L. A promising class of pharmaceuticals that act on dopamine receptorsor other related neurotransmitter receptors in the brain may be useful intreating this problem (New treatments for cocaine addiction, 2 1). People who inject cocaine are at increased risk of acquiring hepatitis and HIV, the virus that causes AIDS. Cocaine addicts are atsignificant risk for relapse, often linked to participation in socialgroups in which cocaine use is ongoing. Resolving the problem will therefore be extremelydifficult and will involve a combination of intervention strategies ratherthan a single strategy.Assessment Issues Identifying cocaine dependence and addiction requires both a medicaland a psychological assessment process (Seger, 2 ). Substance abuse and dependence. The Journal of The American medical Association, 287 (1), 146 - 147. In addition, cocaine is associated with a host of negative physicaleffects that are also viewed by clinicians as possible indicators ofcocaine addiction. Cocaine: An Evaluation of Effective Treatment InterventionsIntroduction According to the National Institute on Drug Abuse (NIDA), in 1997about 1.5 million Americans were current cocaine users, defined as usingcocaine in the month prior to the NIDA national study of drug use. Finally, the Federal Drug Administration has recently released ananti-cocaine vaccine being developed by a major pharmaceutical house andpermitted clinical trials of the drug to begin (FDA releases anti-cocaine..., 2 1). One such drug, Ritalin, is already inwidespread use as a treatment for attention deficit/hyperactivity disorder,which is common in cocaine addicts. Next, in order for any psychological or otherintervention to be successful, the addict must want to give up cocaine andbe willing to place him or herself in a drug free environment; this maynecessitate temporary institutionalization (Cocaine dependence, 2 1).Alternative, self-help groups such as Cocaine Anonymous or other supportgroups may be useful in assisting the addict in remaining drug free.Regular exercise, a nutritious diet, sufficient rest, and relaxationtraining are also helpful. The immediate effects of taking cocaine include increased heart rateand increases in blood pressure and body temperature. Elevated heart rate and blood pressure and so forthare common indicators that cocaine may be being abused or used. Stevens (2 2) noted that there are currently no pharmaceuticalpreparations that are known to be effective in treating cocaine addiction.Researchers are currently testing such drugs. Clinical Reference Systems, Annual, 436+.De la Hey, M. This may lead a patient to denysubstance use or cause the person to greatly underestimate the degree ofthe problem and its effects on his or her life. Overall, a study by Brown University researchers found that treatmentof cocaine addiction must be multi-disciplinary and of long duration to beeffective (Duration of initial..., 2 2). Cocaine can be consumed via inhalation,injection, mouth, or by smoking. The neurochemical sources of cocaine's attraction arestill not completely understood. Like cocaine, they prevent the reabsorptionof dopamine by transmitting neurons. . . Harvard Mental Health Letter, 17 (11), 1 - 2.Seger, D. However, cognitive-behavioral therapy isthe most commonly used treatment and involves learning new coping skills toavoid using cocaine and development of skills related to stress managementand problem-solving (Stevens, 2 2). As cocaine dependence and then addiction increases, the individualdevelops a craving for larger and larger amounts of the drug to achieve adesirable level of euphoria or sense of well-being. . Acupuncture treatment ineffective for cocaine addiction. This report will examine cocaine as one common type of substanceabuse in the United States. (2 2). Denial is apsychological trait wherein a person is unable to allow him- or herself toacknowledge the reality of a situation. Cocaine addiction. The report will then describealternative treatments and intervention and assess their effectiveness.The conclusion of the report will identify those treatments most likely toend cocaine addiction.Cocaine Addiction: Overview and Definitions Cocaine addiction falls under the category of substance abuse, apattern of use that displays many adverse results from continual use of asubstance (Carson-DeWitt, 1999). It will present an overview of cocaineaddiction, and then move to an assessment of the etiological issues andconcerns associated with the addiction. This learning islikely to be governed by the prefrontal cortex and amygdale, which light upon brain scans when an addict is presented with a cocaine-related cue.Researchers are currently trying to identify the complex interactions amongbrain regions and neurotransmitter systems that underlie cocaine addiction;they are also looking for hereditary roots of individual, differences insusceptibility, which may rest in genes that govern the manufacturer ofreceptors for dopamine and other transmitters.Alternative Treatment Interventions There is no known reliable, lasting, inexpensive cure for cocaineabuse or addiction; the process of treatment is often complicated,requiring services of several kinds, especially because addicts often havemany other social and psychological problems (Cocaine abuse and addiction,1999). Harvard Mental Health Letter, 16 (6), 1 - 3.Cocaine dependence. Cocaine addictsgradually lose interest in sexual pleasure (which is often heightened whenthe drug is used infrequently), require constant intake of the drug toavoid psychological discomfort, and may experience fatigue, suicidalideation, a decreased level of activity, and episodes of overdose (Cocainedependence, 2 1).Etiological Issues and Cocaine According to the Harvard Mental Health Letter (Cocaine abuse andaddiction, 1999). Cocaine is linked to psychological problems such as psychosis, paranoia, depression, anxiety disorders, and delusions (Stevens, 2 2). Research suggests that about one-half of all cocaineaddicts who participate in such interventions continue to use cocaine andonly about 25 percent of people who have undergone long-term treatment arestill drug-free five years later (New Treatment for cocaine addiction,2 1). It is important to differentiate betweencocaine dependence and cocaine addiction, though the two terms are oftenused (albeit incorrectly) interchangeably. Seger (2 ) notedthat cocaine has been a recreational drug and a drug of abuse for literallythousands of years and was once legal in the United States. (1999). The Journal of Addiction and Mental Health, 5 (3), 7 - 8.Duration of initial cocaine treatment predictive of long- Term outcomes. Stevens(2 2) noted that cocaine is a stimulant that makes the user feel "high" oreuphoric, energetic, and mentally alert. These include: . New treatments in the form of vaccinesor drugs may be promising for cocaine addiction, but these treatments havenot as yet been tested in clinical trials and are not readily available. (1999). Community-based treatment inindividual and group settings seems to be somewhat effective, but successis mediated by the presence or absence of personal support groups, familyassistance, and amelioration of accompanying depression or anxiety, andparticipation in cognitive-behavioral therapy. Journal of Toxicology: Clinical Toxicology, 38 (2), 18 - 181.Stevens, L. However, the prospects for these drugsare still in doubt; the effect of cocaine is difficult to neutralize andscientists are now looking for ways to prevent cocaine from reaching thebrain in the first place. Dependence can result from cocaine use, causing depression when the user is not high on the drug. The long-term psychological effects of cocaine addition include: . Herbal interventions are also not generallyeffective in reducing the cocaine cravings experienced by addicts. For the clinician, breaking through a patient's denial is key tobeginning any type of potentially effective intervention (Carson-DeWitt,1999). Vaccine Weekly, August 15, 1.New treatments for cocaine addiction. Amongthese drugs are selective dopamine reuptake inhibitors, which partiallymimic the effect of cocaine. Some caregivers have suggested that alternative medicine may beuseful in treating cocaine addiction. The Brown University Digest of Addiction Theory and Application, 21 (7), S2 - S3.FDA resumes anti-cocaine vaccine from clinical hold and trials resume. (2 2). Gale Encyclopedia of Medicine, Edition 1, 2756+.Cocaine abuse and addiction - Part I. Large amounts (morethan 1 milligrams) can cause violent or erratic behavior. Cocaine addiction,according to Stevens (2 2), is characterized not only by dependence, butby the needs to consumer larger and larger quantities of the substance inorder to derive the desired effects. When an individual is identified by a physician or other caregiver asaddicted to or dependent on cocaine, the first step in treatment is athorough physical assessment to deal with the physiological complicationsthat may have occurred. Cocaine use of all types has been linked to heart attacks, chest pain, respiratory failure, strokes, and abdominal pain and tensions (Stevens, 2 2). De la Hey (2 2) examined theefficacy of acupuncture in this context and found that such treatment haslittle desirable benefits. After repeated uses, the cocaine high may be replaced by feelings of restlessness, anxiety, irritability, mood swings, paranoia, sleeplessness, and weight loss. Substance abuse is a problem that cuts across all socioeconomic,gender and racial/ethnic lines in the United States. Because of the mood swingsthat often accompany cocaine withdrawal, antidepressants are sometimesprescribed and can be helpful. Cocaine is associated causally with emotional problems, problems in school and at work, and isolation from family and friends. . Nor is dopamine the only neurotransmitter involved in thisaddiction; recent research suggests that serotonin may be involved in thatits reabsorption is blocked by cocaine. (2 ). (2 1).
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