The reality of using cocaine

Cocaine is a powerful stimulant with anaesthetic properties and an extremely long history of use and abuse. Its ability to create euphoria, boost mood and increase confidence has made it the second most-used drug in the UK. However, its popularity masks the serious implications that come with its use.

We’re going to delve into history and pharmacology to unravel the harsh realities of cocaine addiction, providing a comprehensive understanding of its risks and impacts – both on users and on wider communities.


In the 1970s and 80s, the process of turning cocaine into crack was discovered. While crack and powder cocaine come from the same source – the coca plant – our focus will remain on powder cocaine.

Cocaine use and cultivation have a long history. Evidence of the use of leaves from the coca plant for chewing dates back to 5000 BCE, and in the 15th Century, Incas paid their taxes to their Spanish colonists in coca leaves. Cocaine was first synthesised from the coca leaf in the 1860s and was hugely important in moving forward the field of anaesthesia.

Before the dangers of cocaine addiction were known, Sigmund Freud advocated for its use in treating morphine addiction and regularly took it himself. Freud recommended cocaine to his friend Fleischl Marxow to treat his morphine addiction. Marxow became addicted and eventually died from a combination of cocaine and morphine addiction.

Like many other recreational drugs, cocaine has legitimate medical uses, but these applications are heavily restricted now that its addictive properties are well-known. It is still occasionally used as a local anaesthetic for procedures involving the ear, nose and throat.

Why does cocaine feel the way it does?

While cocaine has many effects on the body and brain, it is its effect on dopamine that is considered the most important for understanding its addictive properties. Cocaine acts as an indirect agonist at dopamine receptors, inhibiting dopamine transporters. This means dopamine sticks around longer in the brain. Dopamine plays a huge role in how we feel pleasure – it keeps us focused, interested and motivated.

Many less damaging activities, such as exercise, meditation, sunlight and certain foods, are promoted for their ability to boost dopamine. Unfortunately, these natural dopamine boosters do not work as quickly or as powerfully as illicit drugs do. This means cocaine can be particularly appealing to people with underlying mental health problems, such as depression. However, cocaine can cause or rapidly exacerbate underlying depression – the two are strongly correlated according to community and clinical surveys. Tolerance also rises extremely rapidly – from just a single dose – meaning more and more is needed very quickly to achieve the same results.

The toll on the body

The energising effects of cocaine, like heightened awareness and euphoria, are extremely seductive but come at a hefty price.

The effects of cocaine on the heart and circulatory system are well known. Increased heart rate, high blood pressure, strokes and heart attacks in young, otherwise healthy individuals are all potential outcomes. The impact on the respiratory system can be especially distressing, causing chest pains and difficulty breathing.

Less well known is the fact that cocaine is capable of inducing multiorgan toxicity – via structural changes in the brain, lungs, liver and kidneys. Snorting cocaine can also lead to nasal perforation.

Mental health implications

When suffering acute withdrawal, cocaine users can experience intense paranoia, anxiety and sleep disturbances. Longer term, cocaine addiction is strongly associated with depression.

Initially, cocaine enhances dopamine in the brain, which feels euphoric. However, over time, the brain’s dopamine system is disrupted. This is particularly cruel for people who fall into cocaine addiction due to underlying depression, as depression is already associated with lower levels of dopamine in the brain. This has the potential to make a bad situation worse, leading to even lower levels of dopamine in the brain, lower mood, and an increasing dependence on cocaine to feel ‘normal’.

For those entering cocaine addiction treatment, these effects of cocaine addiction will be challenging, as often the things that led them to take cocaine in the first place are exacerbated by their cocaine use, making getting cocaine addiction help harder for them.

Cocaine and alcohol

Alcohol misuse is extremely common among people addicted to cocaine. A meta-analysis of reports on concurrent versus simultaneous cocaine use found a 24–98% range of simultaneous cocaine and alcohol use. This leads to the creation of a third compound in the body called cocaethylene. This is the only known example of the body producing a third psychoactive drug by co-administering two drugs of abuse.

Cocaethylene may cause users to experience longer-lasting and more intense psychoactive effects. Users also report that cocaine and alcohol synergise well, allowing them to drink more alcohol for longer and ‘taking the edge off’ the discomfort from coming down from a cocaine high. Unfortunately, cocaethylene is capable of making the cardiotoxic effects of cocaine and alcohol alone worse and is also correlated with an increase in violent thoughts and threats, potentiating the dangers of both drugs taken on their own.

Social and economic effects

Cocaine purity has increased in the UK over the last 10 years, meaning its relative cost has fallen. While not cheap, cocaine is now more accessible to people who would have previously been priced out of using it.

Nevertheless, due to its highly addictive nature and relatively high cost, a cocaine habit is expensive. The addictive nature of cocaine can drive individuals to prioritise drug use over personal responsibilities, leading to strained relationships, job loss, and financial instability.

The secrecy and deceit often associated with substance abuse can erode trust within families and partnerships, leading to isolation and social withdrawal.

Economic and social inequality

Cocaine is still grown primarily where it was first discovered – Latin America and the Caribbean. As the dangers of cocaine have become more widely known, drug enforcement has increased, leading to stricter policies to enforce its prohibition.

Coca is a valuable cash crop, which makes it attractive to grow, especially in poorer countries. This leads to ‘drug wars’ as states crack down on cocaine production and trafficking, attempting to stem the flow of cocaine to affluent countries where it commands a high price. Not only have these drug wars failed to reduce supply, but they have also resulted in an increase in homicides, incarceration rates and gang violence in communities on the American continent.

Vulnerable people are exploited in the production and trafficking of cocaine, leading to ethical concerns about complicity in these systems. Users in richer countries may inadvertently perpetuate violence, poverty, and instability in places where cocaine is produced.

How to quit cocaine – cocaine rehab and detox

Cocaine use doesn’t just affect the user – it impacts their relationships, their own communities and the people living in the areas where it is produced.

Cocaine rehab clinics such as UKAT give the best chance of beating a cocaine addiction.
We offer a supported journey through the cocaine detox and rehab process, which has a higher success rate than going through cocaine withdrawal alone, and a better chance of avoiding relapse.

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