As most of my early addictions training (and indeed most of my professional addictions work) has revolved around alcohol, which of course is by far the most widely used drug, I recall how cocaine began to show up as an issue for my patients sometime around 1980. At that time, believe it or not, cocaine was not regarded as addictive, even though we know that, a century earlier, Sigmund Freud had confronted its addictive qualities. (What he first thought was a wonderful antidepressant for his patients became an consuming, addictive burden.) In fact, during the early 1980s, snorted cocaine was fashionable and associated with the rich and famous.
It didn’t take long, however, before treatment facilities began to fill up with cocaine addicts to the point that their numbers edged out those coming to the hospital wrestling with their inability to stop drinking. (Much the same phenomenon has occurred in more recent years with opioid addicts becoming the majority population in many detoxes and rehabs.) By this time, it became clear that cocaine was actually quite addictive, partly because of its quick, rewarding effect, followed by a steep drop-off, leading users to want to use it again. Individuals’ early experiences with cocaine were highly reinforcing – they often felt much more confident (bordering on grandiose), energized, and productive. Later on, when it became much harder to refrain from using, those rewarding effects diminished and continued use was driven by the addiction itself, sometimes resulting in consequences like paranoid psychosis, shredded nasal passages, and heart attacks. I was working in an inpatient setting at the time, and many of those who sought help reported that they were motivated by the death of a co-user. Others were inspired by what happened to some of the rich and famous, such as the death of basketball star Len Bias, or the severe injuries to comic genius Richard Pryor when he was “free-basing.” (That method, like the use of “crack,” were ways to get even higher even faster by inhaling rather than snorting.)
After a few years, if my recollection is correct, alcohol was back as the number one addiction represented in hospital settings – until the prolonged opioid crisis (delivered to us largely courtesy of pharmaceutical and medical interests who denied the dangers), which continues to this day, though thankfully the rates of prescriptions and hospitalizations seem now to be declining.
In my own Boston-area practice, I frankly have not
encountered cocaine addiction for at least 20 years, but apparently it’s been
making a comeback. What brought it to my
attention, I’m embarrassed to say, was not keeping up with CDC or NIDA stats,
but learning that cocaine addiction (as well as alcoholism) was the subject of
the Intervention and 2020/21 rehab year of wonderful comedian John
Mulaney.
Indeed, it appears that cocaine
is back. According to the National
Center for Drug Abuse Statistics, cocaine/crack was used by 6.3 million
Americans in 2018, and, according to NIDA, cocaine was involved in over 19,000
deaths in 2020 (couldn’t find matching stats in the same year). There is one crucial difference between the
cocaine of the past and the cocaine appearing now – like much of the heroin, it
is often mixed with fentanyl, which of course makes it much more deadly.
If you or someone close to you has been seduced by the
reinforcing properties of cocaine, be alarmed, be careful, and consider meeting
with an addiction specialist.
