Undoubtedly, Hollywood and the papped party scene glamorised the substance, but it's the everyday settings in which it's consumed that we need to talk about: as a pick-me-up on a Friday night after work in that all too familiar pattern of a drink, a line, a cigarette.
This behaviour is showing no signs of slowing, with the annual European Drug Report for 2016 (released yesterday) estimating that 3.6 million adults (aged 15-64) consumed cocaine last year in Europe. 2.4 million under 34 – which equates to 1.9% of this age group had done it. Only three countries – the United Kingdom, the Netherlands, and Spain – reported “prevalence of cocaine among young adults of 3% or more.” Meaning that, along with Spain and the Netherlands, the UK has the highest percentage of cocaine use among young people in Europe.
Everyone knows that cocaine – like other drugs – is highly problematic, not only because of what it does to our health, but for the way it is sourced and transported to Europe. According to VICE, drug cartels in Mexico account for roughly 55% of the country's murders and the continued demand for recreational drugs from the UK and Europe only helps to perpetuate that staggering rate. And yet, sadly, ethical culpability is rarely something one considers on a Friday night around 11pm. So why is it that Brits are habitually ignoring the very real origins and resultant fatalities elsewhere in the world and handing over a fistful of cash in exchange for a baggie of who-knows-what + a little cocaine each weekend?
We spoke to Nicky Walton-Flynn, Founder of Addiction Therapy London and Co-Founder of Wellness Hub UK, about why women in particular might be more susceptible to casual misuses of cocaine, and what the side-effects of a causal habit might be. She levelled that: "The pressures placed on women now, whether perceived or actual, drive lots of people to extreme measures. For obvious reasons, such as increased confidence and energy, cocaine has become to the go-to recreational substance of choice for young women and it's relatively cheap."
Here's a run-down from Nicky on what that once-or-twice a week coke intake is actually doing to our individual and collective physical and mental health...
Firstly, can you tell us a bit about your work? How do you help addicts?
I work in private practice and offer an integrative model of talking therapy. I mostly work with people who are interested in stopping taking cocaine. I rarely work with harm minimisation models, simply because my experience is that they don’t work when addressing cocaine addiction. My clients aim to work towards a lifestyle of abstinence. Initially, I help people understand that, once addicted to cocaine, returning to being an occasional user is unrealistic. Psycho-education is an essential aspect of initial addiction therapy. I encourage my patients to identify the wider consequences of their cocaine use. For example: physical illness, lost days at work, loss of job, being estranged from friends and family, being in debt.
What constitutes an addiction?
Addiction is often referred to as a ‘progressive condition’, so once tolerance levels build up, an increased amount of the substance is required to achieve the same effect. It is not possible to say that if you use X grams of cocaine weekly over a six month period that you will become addicted. It is possible to be a 'functional cocaine addict' for a period of time before needing to seek help.
Addiction doesn’t happen to everyone. There is no certainty that if you use cocaine, you will develop an addiction, but probability is high due to its interference with reward pathways in the brain. The propensity to addiction is linked to a range of contributory factors; for example family history of addictions, childhood experiences, recent or historical trauma. These will influence motivation for taking cocaine and one’s propensity to become addicted.
Cocaine is one of the most psychologically addictive drugs because of how it stimulates and increases levels of the feel good neurotransmitter dopamine in the brain
Through continued and increased use over a period of time. Cocaine is one of the most psychologically addictive drugs because of how it stimulates and increases levels of the feel good neurotransmitter dopamine in the brain. It interferes with the pleasure and reward pathways in the brain.
Because cocaine affects the reward pathways in the brain, increased use over time results in an inability to gain pleasure and reward from what would be considered “normal” pleasures. An example is sex. If cocaine is used repeatedly in sex, the ability to enjoy and experience sexual pleasure without cocaine becomes diminished. As well as affecting the reward pathways, cocaine also affects the brain pathways that respond to stress. In my experience, I often see a presentation of cocaine addiction co-occurring alongside a stress disorder. Cocaine use elevates stress hormones, but people then seek out more cocaine to alleviate their stress, creating the addictive cycle.
In most cases, people will experience an intense euphoria followed by intense flatness of mood and depression
Loss of appetite, malnourishment, increased heart rate and blood pressure, constricting blood vessels, increased rate of breathing, dilated pupils, headaches, disturbed sleep patterns, nausea and abdominal pain and hyper-stimulation. As well as bizarre, erratic, sometimes violent behaviour and risky sexual behaviour. Hallucinations, hyper-excitability, irritability, anger. In most cases, people will experience an intense euphoria followed by intense flatness of mood and depression. In extreme cases: tactile hallucination that creates the illusion of bugs burrowing under the skin, itching and scratching, as well as high levels of anxiety and irritability paranoia; depression matched with an intense craving for the drug, panic and psychosis, convulsions, seizures and in rare cases, sudden death from high doses.
And the long-term effects of cocaine use?
They're rather varied. From permanent damage to blood vessels of the heart and brain, to high blood pressure leading to heart attacks, strokes, and death, to liver, kidney and lung damage, to destruction of tissues in the nose if sniffed. Infectious diseases and abscesses if injected. Respiratory failure when cocaine is smoked. Malnutrition and weight loss as a result of appetite suppression. Tooth decay. Sexual health issues including reproductive damage and infertility (affecting both men and women.) Disorientation, apathy, confusion and exhaustion. Irritability and high mood disturbances. Auditory hallucinations, increased frequency of dangerous and high risk taking behaviour – especially sexual behaviour and unpredictable and increased irrational behaviour leading to psychosis and/or delirium and clinical depression.
'I just want to have a good time, I’m not hurting anyone else, I’m only young once, I’ll stop when I settle down, when I get married, when I have children, when I’m 25, 28, 35….'. This is denial of one’s addiction.
Media glamorisation combined with low prices makes it more affordable to a wider demographic. It is no longer exclusive to celebrities and high salaried professionals. Cocaine has been glamorised over recent decades in films, songs, media; it’s seen as cool. And importantly it makes us feel good – so we ask ourselves, “How can it be harming me?” There is also a lack of public awareness campaigns that educate young people about the reality of its dangers.
What kind of behavioural tendencies should people watch out for in themselves and in others?
A key indicator of whether a person’s use of cocaine has progressed from being a social habit they are in control of, to dependency, is when they are unable to keep to their decision not to buy cocaine despite having made a decision to have a cocaine free night. This decision will typically happen once alcohol has been consumed. This is a clear indicator that there is a shift in power, i.e. the drug has control over you; you are no longer in charge of your own using patterns and the choice has been taken away. This is dependency/addiction. It is at this stage that we observe denial of the dependency: “I do have a choice, I just want to have a good time, I’m not hurting anyone else, I’m only young once, I’ll stop when I settle down, when I get married, when I have children, when I’m 25, 28, 35….”. This is denial of one’s addiction and is the most common narrative I hear in my rooms. If someone recognises this, I would invite them to seek help.
More obvious signs: it takes longer to get over a night partying using cocaine, hangovers are more severe, there is a need to ingest more of the drug to achieve the same effect, the high doesn’t last as long as it did; feelings of flatness and depression arise sooner after taking a hit. Eventually the euphoria will cease altogether and the user will instead just experience anxiety and paranoia.
Young women are under increased pressure to be smart, funny, charming, sexy, beautiful, thin, clever, professional, high achieving... the list goes on. Cocaine makes young women feel these things and takes away those pressures, replacing them with momentary misguided feelings of success.
Cocaine evokes feelings of confidence and makes people feel “sexy”. Young women (20-35) are under increased pressure to be smart, funny, charming, sexy, beautiful, thin, clever, professional, high achieving... the list goes on. Cocaine makes young women feel these things and takes away those pressures, replacing them with momentary misguided feelings of success. Cocaine is also a disinhibiting drug so young women will feel confident to behave in ways that they might not if they were not under the influence of cocaine. For example, sexually.
How old is your typical client for cocaine addiction?
What are the common misconceptions you think people fall victim to when addressing their own drug habits?
Addiction is a condition that tells you that you haven’t got a condition. Denial. People reassure themselves by comparing their own use to someone they know who uses more than they do. Therefore they are OK. Telling themselves that everyone they know uses cocaine and thereby normalising it. Minimising their own use and the reality of the consequences of their use.
What's in modern street cocaine?
Cocaine has historically been cut with glucose and laxatives. Increasingly the cutting agents of choice are benzocaine, a dental anaesthetic that imitates the numbing effect of cocaine and levamisole, a cow and horse de-worming product. The BBC has a comprehensive list of the impurities found in cocaine.
How can people seek help?
Initial help can be found through your local GP. GP surgeries should have links to community drugs projects although many of these are often over subscribed. The Federation of Drug and Alcohol Professional (FDAP) Accrediting body website (www.FDAP.org.uk) details lists of therapists and support across the UK. My company is based in London (www.addictiontherapylondon.com) but I have nationwide and global links to therapists and rehab centres.