Bre Sullivan

Psychology of Substance Abuse

4/8/2015
Substance Abuse Treatment Research Summary Paper : Cognitive Behavioral Therapy Use on
Cocaine Abuse
Cocaine is an extremely dangerous, highly addictive drug that is much easier to obtain
than one would think. The federal government has scheduled cocaine as a schedule II controlled
substance (Drug Scheduling). This group contains drugs that have been given the label of
dangerous with a high potential of abuse, but less potential than schedule I drugs. The
highlighted differentiating characteristic between the classes of schedule I and II is the fact that
controlled substances labeled as schedule I have absolutely no recorded medical use, along with
the already apparent high potential for abuse and are dangerous. Prolonged use of these drugs
can bring about symptoms of physical or psychological dependence. Albert Niemann was the
first to come across the knowledge of the extraction of cocaine from delicate coca leaves in 1859
("Cocaine: A Short History"). Before this, the leaves had been regularly chewed for their
stimulant-like properties which caused increased heart rate and breathing. Cocaine became so
popular around the 1880s that a well renowned psychiatrist, Sigmund Freud, was actively
advocating for its use. Suspicion arose highly about the effects on the body and mind from the
drug, especially after a patient of Freuds died from an overdose of cocaine. Reportedly at the
time, Freud thought there was no amount of cocaine that would have a reaction enough to be
lethal. A brief look into the recent past use of cocaine needs to be brought to light in order to
understand how the drugs use has evolved in recent years. Approximately 12.5 percent of people
ages 18 to 25 have used cocaine at least one at some point in their lifetime (Cocaine). This

percentage leaps to almost 17 percent for the age group of 26 and older. This data has been
recorded from 2013 it is a genuine look at current drug use.
Cocaines effects as a drug work as a reuptake inhibitor. According to the cocaine
presentation in class, cocaine works by blocking the locations where dopamine would normally
be taken back into the presynaptic cell. This prevents the action of the reuptake transporter, and
results in more dopamine accumulating in the synapse (Doyle, "Transcript of Cocaine"). The
dependence and potential for abuse that can form around cocaine is evident as well. Data from
from 2012 that shows 1,119,000 people over the age of 12 had either a dependence upon cocaine
or had developed an abuse of it ("7.1 Substance Dependence or Abuse"). Another chart from the
same findings show data regarding abuse from further back on its timeline: in 2002 an
astounding 1.5 million people reported abusing or being dependent upon cocaine who were over
the age of 12. This look into the recent past of cocaine use shows the prevalence has barely
waivered compared to the aforementioned data from 2012.
A study was done to research the effects of cocaine on mice. Results show that after one
single dose of cocaine, the amount of dendritic spines the mice had increased depending on the
context the mice learned the drug was being distributed as well as how it feels. Over a four day
period, the mice were place in different situations to see their long term reactions with respect to
one per day. First, given a choice to wander in a chamber with either the smell of vanilla or
cinnamon, the mice would prefer one over the other and wander into that room. The second day,
a saline injection was given to the mice and placed in the chamber that mouse had willingly
preferred to go into on the first day. The mouse stayed in this chamber for 15 minutes, during
which the door between the two rooms was closed. On the third day, the mice were given an
injection of cocaine and placed into the chamber they did not choose themselves initially for 15

minutes. Again, the door between the two chambers was shut. This was part of the conditioning
process. However on the fourth day, the mice were not given any sort of injection and the door
between the two chambers was open. When given the chance to choose again, the mice chose the
room with which they associated the cocaine with. In other words, the room opposite they chose
on the first day out of preference. This shows that the mice remembered being given the cocaine
in this room and paired it with the smell of that same room. When given the choice of where it
would like to go, the mouse would scramble towards the rewarding room, in hopes to seek out
the same sensation and receive cocaine again as compared to the saline. In conclusion, this study
shows that drug cues have the ability to dominate decision making behavior, and this is
applicable across species to humans as well (Anwar, "Cocaines effect on mice may explain
human drug-seeking behavior") .
Because of the large role dopamine plays in the consumption of cocaine, both the short
term and long term effects are related to it. Speaking in short term, physiologically the blood
vessels constrict, pupils dilate, and body temperature, heart rate, and blood pressure all increase.
Psychologically, anxiety, panic, irritability, and sometimes intense paranoia can occur although it
is noted that the intensity and duration of cocaines effects depend greatly on the route of
administration sometimes lasting up to 30 minutes per dose if snorted. After long term use, a
continuous amount of dopamine is present in the brain. This specific neurotransmitter is
associated with pleasure and reward. Because consumption of cocaine overproduces an artificial
dopamine, there is an eventual downregulation of dopamine in the brains natural production of
it. This is equivalent to experiencing bouts of extreme happiness and joy following a segment of
depression and despair, followed by the same extreme elation. The emotional cycle continues
and cripples the user, driving the intensity for the craving and need of the drug through the
roof. Cocaine is then used to achieve the happy feeling. Tolerance is the next phase, where the

brain has become accustomed to having a certain amount of dopamine (which is composed of the
natural dopamine supplemented with the effects of cocaine while using). A higher dose of the
drug will need to be taken and more dopamine will need to be present to have the neuron fire, or
have the same feeling again (What are the short term effects of cocaine?). This is the vital sign
of dependence.
An important part occurring after the establishment of tolerance and dependence is
withdrawal. This occurs whenever prolonged use and dependence has happened, and the intake
of cocaine abruptly stops. This can occur by accident, meaning the user simply cannot gain
access to cocaine, or voluntarily, such as attempting to get clean of the drug. Symptoms of
withdrawal include pains and aches all over the users body, fatigue, chills, depression, and
increased anxiety (" Cocaine Abuse & Addictions Side Effects, Symptoms, Signs & Causes").
While usually cocaine abuse or dependence is combatted with psychopharmacology,
cognitive behavioral therapy or CBT can be just as easily implemented. Cognitive behavioral
therapy is a definite go-to for treating mental illnesses such as depression, bi-polar, and
schizophrenia. The process is half mental, half behavioral the main goal is to identify faulty
thinking patterns and self-destructive thoughts and challenge them. Attempts are made to
rationalize why they do not make sense even though at the time that very thought feels like it is
law. The ability to remove this frame of mind allows the individual to behave in ways they
previously thought impossible. It is also a benefit of cognitive behavioral therapy to remove
negative self-talk and thoughts that could set one up for negative and possibly self-destructive
situations (Cognitive Behavioral Therapy (CBT)?). For a cocaine abuser undergoing CBT, this
could mean identifying false thoughts of needing to intake more cocaine. Cognitive behavioral
therapy involves goal-directed thinking and behavior. The cocaine abuser can plan rewards for

positive actions for disregard to cocaine and cocaine activities. For example, a therapist can plan
out personal rewards (things the individual gives value to) that shape behavior directing away
from stimulus prompting or cocaine use. CBT has been seen to be proven effective in the
treatment of cocaine abuse. A JAMA Psychiatry article describes a study done looking at 121
cocaine abusers who had been under ambulatory care due to cocaine while the users underwent
different types of treatment. A follow up was done with the participants over a year. Subjects
were separated into groups getting treatment of either CBT and desipramine hydrochloride, or
CBT and a placebo for a 12 week out-patient treatment plan. The participants were interviewed
at one interval with options being 1, 3, 6, or 12 months after the termination of the treatment. The
results showed a delayed emergence of the effects of cognitive-behavioral relapse prevention,
or in other words the effects of CBT along with the combined efforts of desipramine
hydrochloride showed most effectiveness and prevalence in means of long term. The coping
patterns learned during therapy were not seen to be recorded as effective at first because the
situations calling for the individual to use those coping patterns in everyday life had not occurred
yet. But when presented with a situation that held a stimulus to use cocaine, individuals were
quick to fall back on coping strategies learned from CBT (Carroll, et al.).
Another JAMA article supports the idea of the effects of cognitive behavioral therapy has
beneficial long-term, withstanding effects. This study was specifically done with 120 cocaine
dependent individuals who were separated into one of four treatment groups: contingency
management alone, CBT, combined CM and CBT, or methadone maintenance. Results showed
that while contingency management showed less chance of relapsing on cocaine short term,
when abusers were checked in with at the 26 and 52 week cognitive behavioral therapy proved to
be just as effective. Results were gathered with a urinalysis to determine if cocaine was ingested

as well as self-reporting (Rawson et al.). Studies show CBT as a promising way to promote
coping strategies which show effective for cocaine abusers and their self-destructing habits.
As already discussed, cocaine is an illegal controlled substance with the federal label of
schedule II. That being said, there are no recognized FDA drugs that effectively cure cocaine
abuse or dependency. The main method of treatment is usually preferably in-patient or outpatient, regardless if the plan involves cognitive behavioral therapy. The main problem lies in the
cost of treatment for these individuals. In 2012 there was a recorded 6.5 million people aged 12
or over who were in need of treatment but did not receive it (Results from the 2012 National
Survey on Drug Use and Health: Summary of National Findings). Furthermore, of these people
who felt they were in need of treatment and were in deed in need of treatment but did not receive
it, some of the most commonly given reasons as to why treatment did not happen had to do with
money, fear of being without the drug, and fear of negative stigma of those around the individual
such as neighbors and co-workers. Either the abuser had no health care to cover it or could not
cover it out of pocket themselves, or the treatment was simply not a part of their current health
care plan. Generally an inpatient stay for drug rehabilitation can be anywhere from $20,000$30,000, while the out-patient rings up at $10,000 ("Top 5 Most Frequently Asked Questions").
Conclusively, cocaine abuse and dependence is a very complex addiction that requires
extensive supervision and professional help to remedy. This in turn can be expensive, even for
those with health insurance. With the added stigma of going to rehab, users are much less
likely to seek help even if they do have the proper resources. Cognitive behavioral therapy has
been proven to be effective in treating cocaine abuse and dependence along with successfully
teaching long-term coping strategies. It has been proven to be significantly more effective when
paired with a drug in therapy, such as the previously mentioned article.

Resources
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