A number of studies have provided observations of contemporary patterns of cocaine use in the period 1970 to 1983. These studies have concentrated on selected populations of users that were seen at only a single point of time during this period. When reviewed chronologically, these observations suggest that patterns of cocaine use were changing rapidly throughout the period 1970 to 1983 and in particular for long-term users. For individuals engaged in continued use this change was characterized by increased dosage and frequency of use resulting in decreasing positive effects and increasing negative reactions including physical and psychological dysfunction. This changing pattern is also examined () in a series of longitudinal observations made on a sample of users studied at multiple points of time during this sane period.
Users entered the 1970s with attitudes that supported their beliefs that cocaine was a “safe recreational drug.” Gay and Inaba () suggested that the rediscovery of cocaine in the 1970s was inevitable because its effect of euphoria and stimulation “reinforces and boosts what we recognize as the highest aspirations of American initiative, energy, frenetic achievement, and ebullient optimism” ().
Phillips and Wynne () interviewed and observed a group of cocaine users and dealers in 1975 in a study of user beliefs and myths regarding cocaine. Among the myths endorsed by users were: cocaine is an aphrodisiac; cocaine increases creative and physical performance; there are no bad effects associated with cocaine use; the cost of cocaine is related to its purity; and a cold shower is an antidote for cocaine intoxication. Widespread belief in these “street” myths appeared to support continued use of cocaine.
Gottlieb (1976) also interviewed and observed a number of cocaine users who expressed similar beliefs: cocaine is an aphrodisiac; cocaine facilitates the learning process; cocaine improves physical activity; and cocaine “is not addictive.” While users preferred the intranasal route of administration, Gottlieb reported the growing experimentation with intrabuccal and sublingual routes of administration, the rediscovery of drinking cocaine in alcoholic beverges such as cordials, and the smoking of cocaine hydrochloride alone or in combination with marijuana or tobacco.
The consequences of this early use were repotted by Ashley () who interviewed and observed 81 cocaine users, all of whom reported experiencing euphoria, sexual stimulation, increased energy, and reduced fatigue and appetite. His respondents also reported a wide range of other positive effects including increased mental lucidity and muscular strength. Not surprisingly, these users agreed “that cocaine was a ‘good’ drug, and virtually all were certain it should be used in moderation” (p. 156). Reports of adverse effects were more variable and appeared to be dependent on the pattern of use. In this regard, Ashley observed three patterns of use: moderate, chronic moderate, and heavy. Sixty of his respondents were moderate users (0.25-0.50 grams/day for “a few” days) who reported minor adverse reactions such as lassitude. Fourteen were chronic moderate users (0.25-0.50 grams/day for prolonged periods) who reported mild insomnia, occasional impotency, irritability, and personality changes. The remaining four heavy users (chronic use of 2.0-4.0 grams/day) reported insomnia, impotency, irritability, personality changes, and paranoia. Importantly, Ashley’s respondents noted a tendency to escalate dosages which resulted in increased adverse reactions. Consequently, they reported adjusting dosages or abstaining for brief periods in order to control use. Lassitude was the only withdrawal symptom noted by these users.
Using a more careful interview and questionnaire study, Resnick and Schuyten-Resnick () described five profiles of typical cocaine-using behavior, based on the patterns of drug use established by the National Commission on Marihuana and Drug Abuse. These patterns included experimental (short-term and nonpatterned); recreational (use in social settings among friends); circumstantial (use for specific effect); intensified (daily use); and compulsive (high frequency and intensity). These researchers described intensified users as using from 3 to 20 times a day. Compulsive users were characterized as having a high degree of psychological dependence: “The most striking feature of this pattern is that the drug use dominates the individual’s life and precludes other social functioning” ().
As Ashley had predicted, consequences of adverse reactions appeared dependent on the pattern of use. Users following the more intensified and compulsive patterns of use started to show up in treatment centers seeking clinical attention. Gay and Inaba () traced an increase in cocaine users seekity clinical attention beginning in the middle of 1970. Chronic cocaine abuse was marked by psychological dependence, a withdrawal depression, and sleep disturbances.
In an interview study of 17 recreational users, Grinspoon and Bakalar () found that even intranasal users experienced common psychological problems including insomnia, irritability, and anxiety. Physical problems included rhinitis and weight loss. Toxic eftects, psychosis, and loss of psychomotor control were considered rare reactions for these users.
However, with intravenous patterns of use, the problems appeared to escalate. In a series of in-depth case studies, Spotts and Shontz () examined the lifestyles of nine American cocaine users. The users in their studies were primarily intravenous users with an average of 5 to 9 years of experience with cocaine. They concluded that low levels of usage were associated with use of cocaine to enhance sensory pleasures, to make the real world seem like an imaginary paradise, and to help the user compensate for inability or unwillingness to accept responsibilities. Relatively higher levels of usage were associated with use of cocaine to provide necessary support for the self-concept, as a means to provide the drive and energy needed to succeed, or as a way of inducing a state of blissful oblivion to overwhelming life problems. These researchers found that at high levels of use the sensory pleasure is often counterbalanced by adverse react ions including tension, anxiety , paranoia, hallucinations, and fear of overdose and subsequent death. Interestingly, following completion of the study, Spotts and Shontz report that of the nine respondents “two of them are now dead, one is in prison, and one has been convicted of a felony involving cocaine. These chilling statistics highlight the danger and volatile nature of the world of the heavy cocaine user” ().
Siegel () cited the growing popularity of smoking cocaine free base and a concanitant increase in negative reactions:
Free base parties have became increasingly popular, and the practice has spread, … Unlike intranasal users, cocaine smokers do not appear to titrate or adjust dosage. Consequently, both frequency and quantity of dosages escalate rapidly… This pattern of use is similar to that found with intravenous heroin and cocaine and has an associated high potential for dependency and overdose. ()
User beliefs, however, strongly supported the smoking of cocaine free base with attitudes that it was “the ultimate high,” “the greatest thing since sex,” “gives you the ecstatic illusion of a synthetic heaven,” and is capable of producing mind-expanding experiences (). Smoking of cocaine free base continued throughout this period. Siegel () studied 32 users seeking clinical attention for problems related to cocaine free base. Of the 32 users studied, 20 engaged exclusively in individual compulsive patterns of smoking, seven engaged in exclusively social compulsive patterns (usually with a single smoking partner), and five engaged equally often in both individual and social smoking. All users reporting initial periods of intensified use started with one gram per day (range 0.5-3.0) and escalated over the course of the intensified period to an average of 7.0 grams per day (range 2.0-28.0). All the users were diagnosed as having a Cocaine Smoking Disorder, an organic mental disorder with associated features of euphoria, dysphoria, and schizophreniform psychosis.
While these studies were being conducted on cocaine users in the United States, a series of reports began to emerge on abuse of coca paste in Peru and other countries in South America (). Taken together, these reports suggested that the chronic smoking of coca paste was associated with successive stages of psychopatholgy: euphoria, dysphoria, hallucinosis, and psychosis. Jeri and colleagues () reported a characteristic profile of these coca paste users. Users experienced an initial euphoria followed almost immediately by compulsive anxiety to smoke more paste, depression, irritability, suspiciousness, paranoid thinking, excitement, and visual, auditory, and tactile hallucinations. In addition to toxic effects (e.g., convulsions and seizures) resulting from chronic or high dose usage, psychosocial dysfunction as well as psychological impairment was commonly reported.
Cocaine smokers were not the only users reporting such adverse reactions. As both the dosages and chronicity of cocaine use escalated, these adverse consequences became ubiquitous among all classes of users. Helfrich and coworkers () found a profile similar to the coca paste users after examining a group of cocaine users who sought treatment. Examination of these patients revealed impairment in several areas: psychological, interpersonal, financial, physical, and vocational. The dysfunction appeared to be independent of the route of administration. This latter finding was consistent with a telephone interview study of users seeking help for cocaine-related problems (). In the telephone study, users reported an average use of 8 grans per day, 6 days per week, with 56 percent reporting such use for 2 years. Symptoms included nosebleeds, exhaustion, headaches, seizures, paranoia, panic attacks, and violence towards others.
Selections from the book: “Cocaine: Pharmacology, Effects, and Treatment of Abuse”. John Grabowski, Ph.D., ed. Content ranges from an introductory overview through neuropharmacology, pharmacology, animal and human behavioral pharmacology, patterns of use in the natural environment of cocaine users, treatment, through commentary on societal perceptions of use. National Institute on Drug Abuse Research Monograph 50, 1984.