unedited cocaine story

Cocaine, cocaine,

‘Round my heart and runnin’ ’round my brain,
Cocaine, aw, you ol’ cocaine.

Well, coke’s for horses, Lord, it ain’t for men.
They say it kills you, but they don’t say when.

Cocaine, runnin’ ‘round my brain.

–Dave Van Ronk (1936-2002) adapted from the “Cocaine Blues,” Dr. Gary Davis (1896-1972)
According to a Substance Abuse & Mental Health Services survey, in 2008, 5.3 million Americans, age 12 and older, had abused some form of cocaine. That was a decrease from previous years, but this attractive drug, despite its dire consequences, is still out there.

Because it is so addictive, it’s hard to say no to it. Worse, to date, no medicine exists that successfully quells a cocaine addict’s desire to take the drug, but scientists are working on that.

In August, researchers at the Scripps Research Institute in Jupiter published a paper documenting their findings about vulnerability to cocaine addiction.

Paul Kenny, senior author of the paper and an associate professor at Scripps, said,

“If we can see how cocaine addiction occurs, then we can use that type of information to develop effective drugs to block the cravings for cocaine.”

Here’s a simplified rendition: The Scripps research is centered on the protein MeCP2 and its relationship to the gene MiRNA-212.

When a rat ingests cocaine, both of these substances increase in the rat. They fight each other, so to speak. The “bad guy,” MeCP2, makes the rat want to take more cocaine. The “good guy,” MiRNA-212, tries to protect the rat by preventing addiction.

However, Kenny explained, “What we found out is that MeCP2 shuts down miRNA-212. It’s like a switch.”

So the Scripps team manufactured a very specific virus that attacks only MeCP2, then infected the lab rats with the virus. (Let’s be clear here: “The virus did not hurt the rats. It only went after the MeCP2,” Kenny noted.)

“When the virus knocked down the MeCP2, the MiRNA-212 went into overdrive and became abundant, and the animals had a dramatically diminished desire to take cocaine. We think this is a mechanism that regulates a person’s vulnerability to addiction.”

Sounds well and good, said Stephen Gumley, the addiction-treatment manager of Recover Resources, a drug- and alcohol-treatment center in North Palm Beach. But he has adopted a wait-and-see attitude.

“There are broad perceptions, views and philosophies on the subject of cocaine addiction,” Gumley said.

For example, “The researchers say that a pill will fix everything. The cognitive behavioral therapists say it’s about doing the hard work and reflecting on the behavior changes necessary to address where the cravings come from.

“Then there are the purely 12-step people.”

“There are a broad variety of answers to why, how, how do you cure, and is there a cure?”

Case in point: Here’s Seaside PalmBeach Director of Assessments Michael Weiner’s comment: “Medicines are never gong to replace the need for a recovery program, but we’ve seen that they can help. For example, Naltrexone will make the cravings for alcohol less intense.

“If, through research, a drug can be produced that will reduce cravings, that would make recovery a little easier.”

Michael Counes, executive managing director of Gate Lodge Hanley Center in Vero Beach, said, “We are an abstinence-based program. We use medicines to help detox, but not as long-term protocol.”

Everyone does agree, though, that cocaine is powerfully addictive.

“Cocaine goes directly to the pleasure centers of the brain,” Weiner noted. “Other drugs (and alcohol) go the cortex first, where you think. Cocaine causes a tremendous rush of dopamine to go into the system, and the addict feels smart, slim and sexy.

“Alcoholics will say that alcohol is their best friend. Cocaine addicts will call cocaine their lover.”

It alters brain chemistry, according to Gumley:  “Addicts have no power over the substances they’re using. The substances have power over them. ‘Loss of control’: That’s the definition of an addict.

“How can you explain a mother with three children at home, who’ll sell her body on the street, smoke $300 to $400 a night, recognize the havoc she is creating as the result of her using – and do it again?” he added.

“Cocaine addicts create what I like to call a ‘neural trench’ that reconditions the brain pathways through continuous use of the drug – much like the way you wear down a beaten path.

“The more you tread, the deeper it becomes. And even when you stop walking, it takes a long time to fill in and return to normalcy,” Gumley said.

Eventually, a cocaine addict might seek help, he continued: “At some point, cocaine addicts have to realize that their life is in shambles and that they must change, or they’ll be buried in the ground.”

Each center treats cocaine addicts and offers a program based on its particular philosophy.  Components include a length of stay in a residential inpatient facility where the addict undergoes treatment. Gate Lodge has just added brain scans, a new procedure, as part of its treatment program.

Eventually, the recovering addict leaves the inpatient facility with a long-term plan in place that includes support through 12-step programs as well as outpatient programs.

“It takes a lot of willingness to recover,” Seaside PalmBeach’s Weiner said.  “Are patients willing to follow through with their continued-care plan, go to 12-step programs and use a sponsor?”

Agreed Gate Lodge Hanley Center’s Counes: “Bottom line: People can get over their addiction if they are willing to work on their recovery.”

Here’s an earlier link to another of my stories about the chemistry of cocaine and here’s a link to my back story.