COCAINE ADDICTION AND EARLY RECOVERY

In the following pages some suggestions are offered that may help facilitate the early recovery from cocaine addiction.  Since cocaine presents some unique challenges to the newly recovering person it is hoped that you will take note of these suggestions and put them to use.

          Initially it helps to understand some basics of cocaine addiction and the effects that cocaine has on the brain.  During treatment you will learn more about this, but even in the first few days of recovery it is important to understand some of what may be happening to you in order to get through the beginning stage successfully.

          Cocaine and similar drugs, such as amphetamines (Speed), are believed to affect the brain in an area called the “Pleasure Center”.  The nerve cells in the Pleasure Center are capable of producing feelings of intense euphoria which is why cocaine is used--to feel good.  The way in which this works is very complex but simplified: one nerve cell in the pleasure center is stimulated sending an electrical charge from one end of the long nerve cell to the other end of the cell.  This electrical charge stimulates the release of chemical messengers in the end of the cell which communicate across the tiny space between the cells to another nerve cell.  This sparks the same reaction in that cell setting off a chain reaction of “Feel Good” in the brain.

          When cocaine is used, it acts directly on these nerve cells setting off a chain reaction of “Feel Good”.  During this process, one of the brain’s natural chemical messengers (Dopamine) is released in excess.  The dopamine as-well-as the cocaine is expended in causing the feelings of euphoria.  The problem begins as cocaine is used more frequently the brain’s supply of natural “Feel Good”, dopamine, is depleted causing depression and the inability to feel good naturally when not using.  As cocaine is used more often in attempts to feel good, the brain’s internal mechanism for manufacturing dopamine is turned off because of the presence of cocaine giving the user the need for more and more.  This drastic change in brain chemistry and functioning ability is at the root of many problems associated with relapse in the early and middle stages of recovery.  This is a source of cravings for the drug.

          Another source of cravings that can lead to relapse comes from what is known as Behavioral Conditioning.  A Russian scientist, Pavlov, found that when he consistently rang a bell before feeding his dogs,  the dogs would salivate in preparation for eating.  The dogs would be stimulated to eat by the sound of the bell.  After a time the dogs would salivate when they heard the bell whether they were fed or not.  Pavlov found that if he fed the dogs only occasionally after he rang the bell the dogs would still salivate every time they heard the bell.  It wasn’t until a long period of time had elapsed after Pavlov completely stopped feeding the dogs following the sound of the bell that the dogs stopped salivating.  The implications this has in addiction science is that there are many environmental and behavioral “triggers” that can set up the craving for cocaine; just like Pavlov’s dogs were stimulated to eat at the sound of the bell.  This means that as long as you give into the cravings, even once, you will maintain the triggers that set up the cravings.  Until cessation of drug use is complete for a sustained period of time there will continue to be cravings for the drug.

        What this means for recovery is that there are biochemical, environmental, and behavioral changes that need to occur in recovery to help prevent relapse.

         There is “Good News and Bad News” concerning the biochemical dysfunctions in the cocaine user’s brain.  The Good News is the brain chemistry will self regulate and get back to normal after complete cessation of all drug and alcohol use.  The “Bad News” is that this will take time.  Some people will experience normalization of their brain chemistry almost immediately.  For some users the process could take up to two years.  Following will be found some ideas that could help speed up the process or compensate, in part, for the dysfunction.

  Conditioning Factors in Cocaine Use

1.     Cocaine cravings are a predictable result of chronic cocaine use and usually continue long after the cocaine use is stopped.

2.     Cocaine cravings can be triggered or set off by people, places, things, feelings, situation, etc., previously associated with cocaine use.  Anything that is a reminder of cocaine can be a trigger for cravings.

3.     Cocaine cravings tend to be strong during the early abstinence period and then fade away over time, but lose their power only when not reinforced by cocaine use.

4.     The strength of cocaine cravings does not diminish merely through the passage of time, but rather as a person successfully and consistently refuses to give in to cravings each time they occur.  Cravings lose their power little by little, each time the person does something other than take drugs in response to the craving--a process known as extinction.

5.     Complete abstinence from cocaine and all other drugs is the best way to insure the most rapid and complete extinction of cocaine cravings.

6.     The extremely high potency of potential cocaine cravings in the early abstinence means that it is extremely dangerous and inadvisable for the newly abstinent addict to purposefully expose him/herself to drug cues/triggers in an attempt to speed up the extinction process.  The result is usually counter-productive and self-defeating: strong cravings are elicited, the patient is unable to resist them, he/she uses cocaine and the cravings are strengthened by the drug use.

7.      Determination and willpower are poor defenses against cravings--specific actions must be taken to counteract cravings and urges whenever they occur.

8.      Cravings and urges are always temporary.  They are usually fleeting sensations that last no more than a few minutes and tend to disappear quickly when immediate action is taken to remove oneself from the situation that has set off the craving response.  It is wrong to think that once a craving begins it’s intensity will automatically increase to the point where using cocaine becomes unavoidable.  Using cocaine at the peak intensity of a craving maximally reinforces the connection between cocaine and cravings and is the surest way to increase both the frequency and intensity of future cravings.

Achieving Abstinence

 1.   Identify external cues and internal feelings that trigger drug cravings.

 2.   Establish a support system, daily structure, and substitute activities to replace drug related time.

 3.   Have specific action plans for handling cravings.  (See attached “ Handling Cravings.”)

 4.   Get educated about disease of addiction.

 5.   Have specific plan to stop dropping out.

 6.    Have plan for getting off cocaine.  (See guidelines for getting off cocaine)

Avoidance Strategies

1.    Get rid of all drugs and supplies.    All alcohol and drugs must be destroyed/discarded so they are no longer accessible.  They are not to be given or sold to friends.  Have a friend or family member help in this “search and destroy mission.”  If this is too dangerous for the addict let someone else do it.

 2.    Break contact with Dealers and Users.  You will not be able to stay clean being around old using buddies.  The temptation to use  becomes too great.

 3.    Avoid “High-Risk” Places .  Being at places you used at will trigger cravings and eventual drug use.

 4.    Learn to say “NO”.   Learn and practice three different ways to say “no” if asked to use drugs.  Examples include;  “No thanks, I don’t do that any more.”, “ No thanks, I’m sorry I have to leave now.”

  Establish Structure and Support

 1.   Set realistic goals.  I will not use one day at a time and be clean one week.  Do not start off saying you will never use the rest of your life.

 2.    Have frequent counseling sessions.  The more the structured counseling the better.

 3.    Frequent urine tests.  This helps with accountability and can help prevent using.

 4.   Other external controls.  No one can make you stop using but family and true friends can help by controlling money,  having curfews, and commit to residential treatment if outpatient is not successful.

 5.    Solid Support System.  It is essential to go to NA, CA, or AA meetings frequently.  People can not recover alone.  Clean and sober friendships are a must.  Have buddies you can call in time of crisis.  Call   before you use!!

 6.    Time Planning.  It is important to keep busy and plan your days.  This avoids fantasizing about using.

 7.    Handling Craving and Urges.  See chart for handling cravings.

 8.    Do not drop out of recovery.  Handle “slips” as mistakes to be learned from and not tragic failures.  Review your recovery plan, understand the slip, and continue your program of recovery.

 9.    Avoid a “cure me” attitude.  A program can not “fix” you.  You are responsible for “working” a program.

 10.   Unresolved Crisis.  There can be many problems created by using, like angry family, work, legal, and financial troubles.  A plan to resolve these later can be made as the focus needs to be on recovery.  These problems can be an excuse to give up and use.

  Methods for Handling Cocaine Cravings

 1.          Leave the situation you are in, if at all possible.

 2.          Get involved in an activity to deflect or “short-circuit” the urge - do physical exercise, take a walk, go to a movie, take a peaceful drive in the country.

 3.          Talk out the urge with someone who is understanding and supportive.  Call or visit a friend, a fellow group member, your sponsor, your therapist, anyone who can help.

 4.          Go to a Cocaine Anonymous meeting.

 5.          Read recovery literature.

 6.          Read your list of reasons for wanting to quit cocaine.

 7.          Think about the negative effects of using cocaine.

 8.          Detach yourself from the urge.  Pull back from the feeling and look at it as if you were an outside observer.  Remember that the urge is a feeling, not an imperative to act out on the feeling.  You do have a choice whether to use cocaine or do something to preserve your abstinence.

  Guidelines for Getting Off Cocaine

1.          Avoid all people, places and things associated with cocaine and other drugs.  Write down the specific people, places, and things that could threaten your ability to stop using cocaine.

2.          Choose a comfortable way to say “no” to offers and temptation to use cocaine.  Write down three statements that you can use comfortably to refuse cocaine.

3.          Identify your available support system - people you can spend “safe” time with and call in an emergency if you get an urge for cocaine.  Write down the names and telephone numbers of at least five such people and keep the list with you at all times.

4.          Spend as little free time as possible by yourself and without structured plans and activities to avoid trouble.  Write down at least one “safe” activity for every evening or other period of free time this week.  List substitute activities in case your original plans fall through.

5.          Put all “heavy duty” personal problems on hold for right now.  Your first priority is to stop using all drugs.  Write down any personal problems that have been bothering you lately which should be addressed after you have stopped using cocaine.

6.          Read at least 10 pages of recovery literature everyday.  Write down the names of at least one book/pamphlet you plan to read from everyday this week.