pharmacy

1. ASSIGNMENT 1
TITLE : COCAINE ADDICTION
Definition of addition
Addiction is the continued repetition of a behavior despite adverse consequences, or
a neurological impairment leading to such behaviors. According to many addiction
specialists, potential addictions can include, but are not limited to, drug abuse,
exercise addiction, food addiction, computer addiction and gambling. Currently,
however, only substance addictions and gambling addiction are recognized by
the DSM-5. Classic hallmarks of addiction include impaired control over substances
or behavior, preoccupation with substance or behavior, continued use despite
consequences, and denial. Habits and patterns associated with addiction are
typically characterized by immediate gratification (short-term reward), coupled with
delayed deleterious effects (long-term costs). Physiological dependence occurs
when the body has to adjust to the substance by incorporating the substance into its
"normal" functioning. This state creates the conditions of tolerance and withdrawal.
Tolerance is the process by which the body continually adapts to the substance and
requires increasingly larger amounts to achieve the original effects. Withdrawal
refers to physical and psychological symptoms experienced when reducing or
discontinuing a substance that the body has become dependent on. Symptoms of
withdrawal generally include but are not limited to anxiety, irritability, intense cravings
for the substance, nausea, hallucinations, headaches, cold sweats and tremors.
Introduction to cocaine
Cocaine is a white powder. It can be snorted up the nose or mixed with water and
injected with a needle. Cocaine can also be made into small white rocks, called
crack. Crack is smoked in a small glass pipe. Cocaine speeds up your whole body.
You may feel full of energy, happy, and excited. But then your mood can change.
You can become angry, nervous, and afraid that someone's out to get you. You
might do things that make no sense. After the "high" of the cocaine wears off, you
can "crash" and feel tired and sad for days. You also get a strong craving to take the
drug again to try to feel better. No matter how cocaine is taken, it is dangerous.

2. Some of the most common serious problems include heart attack and stroke. You
are also at risk for HIV/AIDS and hepatitis, from sharing needles or having unsafe
sex. Cocaine is more dangerous when combined with other drugs or alcohol. It is
easy to lose control over cocaine use and become addicted. Then, even if you get
treatment, it can be hard to stay off the drug. People who stopped using cocaine can
still feel strong cravings for the drug, sometimes even years later.
Effect to cocaine addiction
Drug use always has its innocent victims, from those who become prey of addicts
seeking through desperate means to finance their drug habit, to those who die in
traffic accidents caused by drivers under the influence. The most tragic victims of
cocaine are babies born to mothers who use the drug during pregnancy. In the
United States alone tens of thousands of cocaine-exposed babies are born in a year.
Those not addicted often suffer from a variety of physical problems which can
include premature birth, low birth weight, stunted growth, birth defects and damage
to the brain and nervous system. Low-birth weight babies are twenty times more
likely to die in their first month of life than normal-weight babies, and they face an
increased risk of lifelong disabilities such as mental retardation and brain damage.
Cocaine causes a short lived, intense high that is immediately followed by the
opposite intense depression, edginess and a craving for more of the drug. People
who use it often don’t eat or sleep properly. They can experience greatly increased
heart rate, muscle spasms and convulsions. The drug can make people feel
paranoid, angry, hostile and anxious even when they aren’t high. Regardless of how
much of the drug is used or how frequently, cocaine increases the risk that the user
will experience a heart attack, stroke, seizure or respiratory (breathing) failure, any of
which can result in sudden death. The phrase “dope fiend” was originally coined
many years ago to describe the negative side effects of constant cocaine use. As
tolerance to the drug increases, it becomes necessary to take greater and greater
quantities to get the same high. Prolonged daily use causes sleep deprivation and
loss of appetite. A person can become psychotic and begin to experience
hallucinations. As cocaine interferes with the way the brain processes chemicals,
one needs more and more of the drug just to feel “normal.” People who become

3. addicted to cocaine (as with most other drugs) lose interest in other areas of life.
Coming down from the drug causes depression so severe that a person will do
almost anything to get the drug even commit murder. And if he or she can’t get
cocaine, the depression can get so intense it can drive the addict to suicide.
The effect of cocaine can be divided to short term effects and long term effects. The
short term effects are, loss of appetite, increased heart rate, blood pressure, body
temperature, contracted blood vessels, increased rate of breathing, dilated pupils,
disturbed sleep patterns, nausea, hyper stimulation, bizarre, erratic, sometimes
violent behaviour, hallucinations, hyper excitability, irritability, tactile hallucination that
creates the illusion of bugs burrowing under the skin, intense euphoria, anxiety and
paranoia, depression, intense drug craving, panic and psychosis, convulsions,
seizures and sudden death from high doses even more than one time. Cocaine also
causes heart, kidney, brain and lung damage in short term.
Cocaine also shows even an enormous effect in the long term. Some of the long
term effects of taking cocaine are permanent damage to blood vessels of heart and
brain, high blood pressure, leading to heart attacks, strokes, and death, liver, kidney
and lung damage, destruction of tissues in nose if sniffed, respiratory failure if
smoked, infectious diseases and abscesses if injected, malnutrition, weight loss,
severe tooth decay, auditory and tactile hallucinations, sexual problems,
reproductive damage and infertility for both men and women, disorientation, apathy,
confused exhaustion, irritability and mood disturbances, increased frequency of risky
behaviour, delirium or psychosis, severe depression, tolerance and addiction even
after just one use.
Treatment of cocaine addiction
As with any drug addiction, this is a complex disease that involves biological
changes in the brain as well as myriad social, familial, and other environmental
problems. Therefore, treatment of cocaine addiction must be comprehensive, and
strategies need to assess the neurobiological, social, and medical aspects of the
patient's drug abuse. Moreover, patients who have a variety of addictions often have

4. other co-occurring mental disorders that require additional behavioral or
pharmacological interventions.
• Pharmacological Approaches
Presently, there are no FDA-approved medications to treat cocaine addiction.
Consequently, NIDA is working aggressively to identify and test new medications to
treat cocaine addiction safely and effectively. Several medications marketed for other
diseases (e.g., vigabatrin, modafinil, tiagabine, disulfiram, and topiramate) show
promise and have been reported to reduce cocaine use in controlled clinical trials.
Among these, disulfiram (used to treat alcoholism) has produced the most consistent
reductions in cocaine abuse. On the other hand, new knowledge of how the brain is
changed by cocaine is directing attention to novel targets for medications
development. Compounds that are currently being tested for addiction treatment take
advantage of underlying cocaine-induced adaptations in the brain that disturb the
balance between excitatory (glutamate) and inhibitory (gamma-aminobutyric acid)
neurotransmission. Also, dopamine D3 receptors (a subtype of dopamine receptor)
constitute a novel molecular target of high interest. Medications that act at these
receptors are now being tested for safety in humans. Finally, a cocaine vaccine that
prevents entry of cocaine into the brain holds great promise for reducing the risk of
relapse. In addition to treatments for addiction, medical treatments are being
developed to address the acute emergencies that result from cocaine overdose each
year.
• Behavioral Interventions
Many behavioral treatments for cocaine addiction have proven to be effective in both
residential and outpatient settings. Indeed, behavioral therapies are often the only
available and effective treatments for many drug problems, including stimulant
addictions. However, the integration of behavioral and pharmacological treatments
may ultimately prove to be the most effective approach.

5. One form of behavioral therapy that is showing positive results in cocaine-addicted
populations is contingency management, or motivational incentives (MI). MI may be
particularly useful for helping patients achieve initial abstinence from cocaine and for
helping patients stay in treatment. Programs use a voucher or prize-based system
that rewards patients who abstain from cocaine and other drug use. On the basis of
drug-free urine tests, the patients earn points, or chips, which can be exchanged for
items that encourage healthy living, such as a gym membership, movie tickets, or
dinner at a local restaurant. This approach has recently been shown to be practical
and effective in community treatment programs.
Cognitive-behavioral therapy (CBT) is an effective approach for preventing relapse.
CBT is focused on helping cocaine-addicted individuals abstain—and remain
abstinent—from cocaine and other substances. The underlying assumption is that
learning processes play an important role in the development and continuation of
cocaine abuse and addiction. These same learning processes can be harnessed to
help individuals reduce drug use and successfully prevent relapse. This approach
attempts to help patients recognize, avoid, and cope; that is, they recognize the
situations in which they are most likely to use cocaine, avoid these situations when
appropriate, and cope more effectively with a range of problems and problematic
behaviors associated with drug abuse. This therapy is also noteworthy because of its
compatibility with a range of other treatments patients may receive.
Therapeutic communities (TCs), or residential programs, offer another alternative to
persons in need of treatment for cocaine addiction. TCs usually require a 6- or 12-
month stay and use the program's entire "community" as active components of
treatment. They can include onsite vocational rehabilitation and other supportive
services and focus on successful reintegration of the individual into society.
It is important that patients receive services that match all of their treatment needs.
For example, if a patient is unemployed, it may be helpful to provide vocational
rehabilitation or career counseling along with addiction treatment. If a patient has
marital problems, it may be important to offer couples counseling.

6. One form of behavioral therapy that is showing positive results in cocaine-addicted
populations is contingency management, or motivational incentives (MI). MI may be
particularly useful for helping patients achieve initial abstinence from cocaine and for
helping patients stay in treatment. Programs use a voucher or prize-based system
that rewards patients who abstain from cocaine and other drug use. On the basis of
drug-free urine tests, the patients earn points, or chips, which can be exchanged for
items that encourage healthy living, such as a gym membership, movie tickets, or
dinner at a local restaurant. This approach has recently been shown to be practical
and effective in community treatment programs.
Cognitive-behavioral therapy (CBT) is an effective approach for preventing relapse.
CBT is focused on helping cocaine-addicted individuals abstain—and remain
abstinent—from cocaine and other substances. The underlying assumption is that
learning processes play an important role in the development and continuation of
cocaine abuse and addiction. These same learning processes can be harnessed to
help individuals reduce drug use and successfully prevent relapse. This approach
attempts to help patients recognize, avoid, and cope; that is, they recognize the
situations in which they are most likely to use cocaine, avoid these situations when
appropriate, and cope more effectively with a range of problems and problematic
behaviors associated with drug abuse. This therapy is also noteworthy because of its
compatibility with a range of other treatments patients may receive.
Therapeutic communities (TCs), or residential programs, offer another alternative to
persons in need of treatment for cocaine addiction. TCs usually require a 6- or 12-
month stay and use the program's entire "community" as active components of
treatment. They can include onsite vocational rehabilitation and other supportive
services and focus on successful reintegration of the individual into society.
It is important that patients receive services that match all of their treatment needs.
For example, if a patient is unemployed, it may be helpful to provide vocational
rehabilitation or career counseling along with addiction treatment. If a patient has
marital problems, it may be important to offer couples counseling.