The neurology of cocaine cravings

Last Updated:

December 4th, 2023

What is Neurology and why is it Important?

Neurology is the scientific study of the central nervous system. It specifically interrogates the role of the brain. It focuses on the ways that the brain’s anatomical structures and chemical processes can impact the ways we think, feel and behave.

Understanding the neurology of drug cravings can help us to understand how addiction works. This subsequently informs the ways that we treat addiction. If we understand how the brain plays a role in cocaine addiction, we can begin to think about how we can use this information to inform our approach to cocaine treatment in rehab settings. It can help us to understand what biological factors are involved in the development of addiction.

Not only does this help us to take a research driven approach to treatment, but it can also help people to come to terms with the fact that addiction is a complex phenomenon and hopefully shift the onus from addiction as a kind of personal failure to a biological circumstance that needs to be studied and properly understood as a ‘complex process’.

The Mechanisms Behind Cocaine Cravings: Neurobiology Explains

Cocaine is a very complex drug. Research into how cocaine functions has indicated that the substance impacts the brain in several ways:

Cocaine stimulates the brain through the central nervous system, increasing the activity of specific neurotransmitters

Cocaine impacts the function of the prefrontal cortex

Cocaine impacts brain plasticity

All of these effects are associated with the functioning of the limbic system. The limbic system is an intricate ‘ set of interconnected regions that regulate pleasure and motivation.’ An addiction to cocaine can therefore develop due to its complicated interactions with this system.

The Central Nervous System (CNS)

Cocaine is a stimulant drug. It is categorised as such as it works to stimulate the brain to work faster. We all function through a complex network of messages that are sent between the brain and specific locations in the body. A stimulant increases the speed with which these messages are transmitted.

These messages that are sent are carried by neurotransmitters. Neurotransmitters are unique chemicals in the brain that each have a different function. As they move across the brain, neurotransmitters travel towards specific receptor cells. When they find these, neurotransmitters can ‘dock’ or attach to them, which then triggers a specific response by the receptor cell. Each neurotransmitter is unique and will ‘fit’ into each receptor like a lock into a key.

Neurotransmitters are ‘endogenous chemicals’ (this means that they are created inside us).

However, the use of drugs (such as stimulants, including cocaine) can increase the activity in them.

Understanding Dopamine and Cocaine Cravings

How does dopamine work?

One of the main neurotransmitters in the neurobiology of cocaine cravings is dopamine. Dopamine is known as ‘the reward chemical,’ as it stimulates the brain to make us feel positive. It’s associated with higher feelings of pleasure, achievement and success.

Dopamine can be positive, as it’s been shown to play a key role in motivation, suggesting that the neurotransmitter is an essential part of helping us feel driven and to stay productive.

Researchers have hypothesised that the negative symptoms experienced by individuals with depression, for example, anhedonia (a difficulty or loss in the ability to feel pleasure) and blunted affect (reduced emotional response), can be linked to low levels of dopamine in the brain.

Dopamine and Cocaine

Taking cocaine increases dopamine activity in the brain. When it attaches itself to a dopamine receptor cell (a dopamine transporter,) it binds itself to the cell. This means that new dopamine receptor cells are unable to ‘dock’ into transporter cells as the cocaine has already locked into it. This leads to a build up of dopamine in the brain, which then causes a buildup of the neurotransmitter in the brain.

This increase can make you feel more alert and awake, increase your energy and make you feel positive and productive, even increasing confidence for a short period of time. That means if you take cocaine, the rush of feelings you experience (typically known as ‘euphoria’) can be linked to this increase in neurobiological activity.

This may feel positive in the short-term. However, in the long-term, it poses a problem. If your brain begins to associate cocaine with a sudden rush of pleasure, then you will begin to crave the drug in order to feel this again. The more that your brain begins to associate cocaine with this feeling of the reward, the more likely you are to use it – this is often how substance use cycles from recreational use to abuse and addiction.

The Prefrontal Cortex and Impulse Control

As well as impacting the activity of neurotransmitters, cocaine also affects the function of the prefrontal cortex.

Amy F. T. Arnsten describes the prefrontal-cortex as ‘the most evolved brain region’, explaining how it functions to ‘intelligently regulate our thoughts, actions and emotions through extensive connections with other brain regions.’ Many researchers theorise that it is the complex functions enabled by the prefrontal cortex that distinguish human beings and other mammals from other species.

The use of substances can impact the way in which the prefrontal cortex (PFC) executes the higher functions in the brain. Neurobiologists aren’t certain what causes this effect; however, MRI scans have found increased activity in the PFC. This was identified by increased levels of oxygenated blood flow in specific areas of the brain.
The prefrontal cortex is involved in many functions that could be associated with drug use. A key example of this is impulse control. The PFC helps us to control and ‘override’ urges – it helps us to manage dangerous compulsions and cravings. If cocaine acts on the PFC, there is a risk that its ability to manage impulses can be decreased. This decrease can then lead to more frequent use of cocaine and, therefore, the potential development of cocaine addiction.

Neuroplasticity in Addiction

Neuroplasticity is a way of referring to how malleable the brain is. It is, Britannica records, ‘the capacity of neurons and neural networks in the brain to change their connections and behaviour in response to new information, sensory stimulation, development, damage or dysfunction.’

It’s helpful to think of the brain as a complicated system of branches, like a giant tree. If these branches get stimulated through use, they continue to flourish. If they are neglected, the branches can begin to die. In this image, the branches are neural pathways.

As we get older, our brains naturally lose some of their plasticity. This is largely due to the ageing process. Researchers suggest that plasticity can be maintained through the use of various activities, such as the completion of sudoku and various brain puzzles, or by doing tasks in a different way than usual, such as brushing your teeth with your non-dominant hand. These are thought to stimulate specific brain function.

Cocaine Cravings and Neural Pathways

Other than ageing, there are other things that can negatively affect our neuroplasticity, such as using substances. Numerous studies have looked into how consistent ‘cocaine exposure produces persistent changes in neuroplasticity, including dendritic remodelling.’ This suggests that cocaine use can actually work to change our neural pathways, altering the networks of our brains.

Crucially, research into the effects of cocaine rehab treatment has identified that these pathways can be ‘reformed’ through specific therapies, especially forms of treatment that focus on the role of reward.

Working Towards Long-term Recovery From Cocaine Addiction

The research into the ways that cocaine impacts the limbic system is helpful as it can give us insight into the neurobiological functioning of the drugs. If we know how the use of cocaine has affected the brain, then we can start to think about how to change the brain’s relationship with the drug through a range of research-based therapeutic approaches.

There are a multitude of treatments used to treat cocaine addiction. Commonly found among them are:

Detox is the process of a substance leaving your body. A cocaine detox is a positive start to any cocaine rehab treatment as it allows your body to eliminate some of the difficult cravings at an early stage. This can help you to break out of the cycle of addiction where cravings elicit a spiralling response of continuous usage and reliance. Breaking free of this cycle can enable you to get the clarity you need to focus on your recovery.

Contingency management is one of the therapies used to help individuals with cocaine addiction as it is based on rewards systems that work to stimulate the dopamine response system, similar in a way to cocaine, in a more healthy and managed way. This can mean that associations with helpful behaviours that prioritise health and wellbeing and positive coping skills can be developed with the goal of replacing cocaine’s place in the reward system.

Cognitive-behavioural therapy is a kind of psychotherapy. It functions on the belief that thoughts, feelings and actions are connected and that you can impact others by changing one of these factors. It often works through learning specific techniques for dealing with difficult thoughts and feelings that you can practice with a specialist therapist before applying it to your everyday life.

Get Help at Cocaine Rehab

If you are finding that your cocaine cravings are spiralling, or are worried that someone close to you may be struggling with an addiction to cocaine, we can help advise you on the options that are available for you at our UKAT centres.