While overall cocaine use has declined over the last two decades, recent surveys show an uptick in its use on college campuses and people in their early 20s.
For some, cocaine remains the party drug of choice, providing a sense of euphoria and friendliness that smooths social interactions in half-hour bursts. For others, occasional use becomes addiction.
About 1.5 million Americans over the age of 12 currently use cocaine. Of those, about 20% used crack cocaine in the previous month, according to the Substance Abuse and Mental Health Services Administration 2015 report on drug use.1
The use of cocaine among college students has shown more variability in recent years than other age groups, with a significant spike in recent reports. In 2013, 2.7% of full-time college students reported cocaine use. By 2014, the percentage was 4.4%.
Similar trends can be seen off campus too. In 2014, 1.4% of all adults aged 26 or older used cocaine in the past year and 0.5% used cocaine in the previous month. For those aged 18 to 25, the corresponding percentages were 4.6% and 1.4%.
Younger students do not seem to be part of this increase, indicating that the college setting and young adulthood may be particularly conducive to cocaine use. In 2015, the percentage of high school seniors who had used cocaine dropped to the lowest levels since 1998, according to the Monitoring the Future Drug Survey — 2.5% in the last year and 4% in their lifetime.2 In 2008, by comparison, 6% of Americans had tried cocaine by 12th grade.
For college students, a combination of stress, reduced supervision, and easier access combined with the impulsivity of a not fully mature brain may explain the higher use of cocaine. Young adults may not be aware or properly assess the risk of cocaine use.
Cocaine accounts sends more than half a million Americans to the emergency department each year, more than any other drug. All methods of use and all frequencies can lead to absorption of toxic amounts, which can lead to a host of complications ranging from accelerated heart rate, nausea, anxiety, paranoia and tremors to acute cardiovascular or cerebrovascular emergencies, seizures and death. Use in conjunction with other drugs or alcohol can increase the risk of serious adverse effects.
Young adults may also underestimate the addictive power of cocaine and think that a line or two or three now and then will never become a problem. Cocaine exerts powerful effects on the brain, which produce the high users seek. But it also starts a process of adaption that leads to increasing tolerance to the drug, so that the same amount produces less effect over time. Users then need more to achieve the same feeling, leading to increasing use, greater risk of both addiction, and adverse psychological and physiological effects.
Cocaine is a powerfully addictive drug and once someone becomes addicted, the brain continues to crave the stimulation of the drug. Without comprehensive treatment, the risk of relapse is very high.
Effective treatment includes strategies that address the neurobiological, social, and medical aspects of addiction. Many cocaine addicts also have other mental health disorders, such as depression or bipolar disorder that also must be addressed for a sustained recovery. There are no pharmacological therapies approved for cocaine addiction; the treatments of choice are behavioral.
Successful treatment requires recognizing that drug abuse of any kind is a chronic, debilitating condition like diabetes or cardiovascular disease that needs a long-term strategy for management and secondary prevention as well as a shorter-term strategy for sobriety and improved general health.
Cocaine abusers may need medically supervised, hospital-based detoxification and stabilization in addition to an inpatient or residential program to comprehensively address their issues. Others may be able to participate in intensive outpatient programs that require several hours a day for several weeks or months. Evidence-based, customized programs that incorporate education, exercise, nutritional counseling, experiential therapy, and individual and group counseling provide the skills and insights needed for recovery.
Community-based programs such as Cocaine Anonymous can help patients who maintain sobriety and ongoing support structures are essential to prevent relapses later in life.
The sooner someone receives help for substance abuse, the better their chance for recovery and the easier their journey to health. Early referral of individuals who show signs of addiction can enable prompt diagnosis and intervention to prevent addiction in those at high risk or addiction treatment in those who need it.
Signs and symptoms of possible addiction include mood swings, fraying of family and other important relationships, social withdrawal, and deterioration of job or school performance. Immediate assistance should be sought for individuals who show signs of increased tolerance for cocaine, alcohol or other drugs, cannot stop using, even though they say they want to, experience drug cravings, physical dependence or withdrawal symptoms.
1. Hedden SL, Kennet J, Lipari R, Medley G, Tice P. Behavioral Health Trends in the United States: Results from the 2014 National Survey on drug Use and Health. Substance Abuse and Mental Health Services Administration. September 2015.
2. Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Monitoring the Future National Results on Drug Use: 1975-2013: Volume 2, College students and adults ages 19-55.