The last two days’ news have made it feel like cocaine week: President Obama finally signed a long-overdue law equalizing mandatory sentencing between powder cocaine and crack cocaine users. On a truly tragic note, a 21 year old UC student is reported to be brain damaged and living on life support after lying for three hours unresponsive in a UC Berkeley cooperative house, after suffering an irreversible heart attack, with cocaine and marijuana in his blood. Cocaine is a well-documented cause of heart attacks, even in the very young and healthy. And Lady Gaga apparently told Vanity Fair that she still uses cocaine “occasionally,” adding that she really doesn’t want her fans to follow her example. She also told Rolling Stone about struggling with a drug habit in her past, including a time when she bottomed out in New York “laying in my apartment with bug bites from bedbugs and roaches on the floor and mirrors with cocaine everywhere and no will or interest in doing anything but making music and getting high.”
With cocaine so much in the news, is Lady Gaga right? Can a person – or most people – use cocaine “once or twice a year”? And be fine?
Cocaine
That, my friends, is the 20-kilo question. Before we go into the scientific frenzy behind this issue, we must take a moment for a word from our ethics sponsor: I am obligated by numerous oaths, karmic clauses, legal hand-wringers, and crushing waves of my own personal angst to remind each and every one of you that, yes, you can die from using cocaine. Even once. Just once. When you “try” cocaine, what you’re doing is actually beginning to “use” cocaine – which can also destroy your life in oh so many other longer-suffering, tortured-beyond-human-endurance, eighth circle of humanity-stripping-hell-ish ways. As we see so tragically in the news, it happens.
But someone will probably tell you (most likely the person handing you the mirror and a line) that cocaine-related death (or rapid, malignant addiction) is rare. I’m here to say that it’s not that rare – numerous case studies are reported. In fact, it’s so common that most doctors wouldn’t think it merited a new report. More importantly, my experience has been that telling a grieving family that death was statistically unlikely is not actually that reassuring. To anyone. Or, if you’re still pondering the absolute risks, you could think of the issue this way – when something rare happens to you, it happens to you 100%. In fact, as you’re suffering untold torment, it doesn’t feel rare AT ALL.
The specter of death haunts any discussion of cocaine use. For the young, that specter may seem vague and distant. But there’s a certain comfort in reaching an age, or a level of self-awareness, where you’re able to frankly ask yourself – really, what am I willing to die for? In fact, when it comes to addictive substances, a “yes” answer (“yes, I’m willing to risk dying for that”), could be a sign that you have a problem.
If that thought occurred to you – congratulations! Now you’re thinking like an addiction-medicine-specialist. One of the most studied, and reliable ways to define addiction (whether you’re talking about cocaine, or exercise, or porn, or any other human endeavor) is by its impact on the rest of one’s life. Are you aware that you’re risking a lot by doing something – but you’re still unable to stop yourself? Is your habit interfering with your family, your friends, your health, and your job? Are you able to walk away and stay away?
By these criteria, most people – even the purists – would probably say that Lady Gaga has a problem, no matter how “occasionally” she’s using cocaine. You could make an excellent argument that her cocaine use already is threatening her livelihood (just by announcing it), and that she’s been unable to stop completely, even after her own bottoming out experience – one that ripped her family apart.
Or, if you’re just looking for cocaine use’s possible impact on her health, check out the difference in her body between her first popular video (Just Dance) and her more recent ones (Bad Romance, Telephone). She’s become, in a very short time, more and more appallingly skeletal (even by Hollywood’s warped standards). Given the pressures of her Fame Monster life, her past history of drug use, and the visual evidence of her physical changes, many of us weren’t surprised by her cocaine-use admission. But a little of your heart breaks when you hear her – not just by the fact that she’s using again when she knows she has a problem, but also because she’s trying to justify and exonerate her use (“only once or twice a year” – as though that’s somehow within the range of “normal”).
Anecdotally, those of us who work in this field hear this kind of talk every day – “how much do you use?” Answer: “not much.” “Well, sure, but how much is that to you?” Real answers: “Only on weekends.” Or “only at night.” Or “only when my check comes in the mail.”
The definition of “normal” gets re-set and re-set over and over to accommodate the user’s shame and need.
But what about our original question – can someone just use every now and then? What if you’re not talking about someone who had a serious problem before, and is risking a lot, and says she understood how horrible it was, but is still using and showing the effects of using? Say you’re not at all like that person. CAN you (or me, or your cousin Kevin) use cocaine “occasionally”?
You may be surprised to know that’s a question, after almost half a century of illicit drug culture, that scientists have yet to answer. What is known is surprising to a lot of lay people, but not that shocking to people who’ve been exposed to drug culture – either professionally (in many capacities) or personally. Let’s start with what kind of drug are we talking about. Most people who use a drug frequently tend to use a “class” of drugs – you’re either a stimulant user (cocaine/meth), or a narcotics-type user (heroin, prescription drugs like OxyContin). Alcohol, as another category, can be the exclusive drug-of-choice for many people, regardless of relatively easy access to other types of street drugs. In fact, statistically, the people who use anything and everything – willy-nilly – are actually not as common as users who stick to one class of drugs. Lady Gaga fits this profile, saying she “mostly” uses cocaine and is “terrified” of heroin. So is there something in the brain driving the desire for one type of addiction? After all, if you have an “addictive personality,” and money is no object, shouldn’t you be addicted to anything and everything? Why abstain from anything, ever? Again, the answer’s not altogether there, but it is very well known that long-term exposure does change the morphology (or cellular shape) and firing of the brain – and many scientists are saying it may change the brain forever, even if you quit and never touch the stuff again.
And, each substance probably has it’s own addiction pattern. What does that mean? Well, the speed of developing an addiction is both substance and age-of-the-growing-brain dependent. For example, it’s clear that most people become addicted to cigarettes in a fairly predictable way – first, through relatively rare, group-social use, than to more regular, but not daily, social use (every weekend, for example), then on to daily use and then to unable-to-go-a-day-without-smoking multiple times use. The younger you are, the more rapidly (or inevitably) you march through these steps. For some drugs (anecdotally, heroin and cocaine) it only takes a few exposures to accelerate your way through all the steps. It’s not quite the One Hit And You’re Hooked legend, but very close to it for many people. And, if you’ve had a problem before with many, if not most types of addiction (cigarettes, alcohol, illegal substances), you’re likely to jump to using constantly without any stages in-between. It’s like you’ve become hard-wired to use. Which science is showing, more and more, your brain probably is, at least after a certain point.
And it’s clear that identifiable risks for addiction exist, even before a person has been exposed. These risk factors are remarkably consistent – almost regardless of the substance, even though some substances are WAY more addictive to a population of people than others. If you have a family history of addiction, if you have a past history of trauma (emotional and/or sexual/physical), if you have a tendency to become obsessively out-of-control with rewarding behavior (whether it’s the Internet, or exercise, or texting) to the point where it is affecting your relationships and work – then you, my friend, are at high risk, with even minimal exposure, to potential addictions.
But also surprisingly, studies (historical, natural history, and animal) show that most people who quit highly addictive drugs do so on their own. Usually over time. Without any formal substance abuse treatment. Here’s a study looking at the natural history of cocaine and meth use in rural communities. And many people may not know that most soldiers who used heroin in the Vietnam War quit on their own – although we see every day, often on the streets, the Vietnam vets who weren’t able to self-recover. What role environment, trauma, family and/or brain/genetics played in long-term outcomes to heroin exposure/addiction, no one (yet) knows. No one even knows if, among a population of drug users, the observed gradual (or cold-turkey) reduction in use over time is based on bad drug experiences, increased awareness of negative effects of a habit, or even just a change in social dynamics.
So is Lady Gaga working her way out of her addiction? Or hopelessly trying to hide a rapid slide back into one? Since judgment is, by definition, destroyed by addiction, and secrecy is the norm, probably no one could say for sure – perhaps not even her. But it’s one or the other – because a stable-erratic drug habit is very very rare. In other words, people often will be using at a high-intensity stable (addicted) rate (half pack a day of cigs, cocaine three times a week, etc. – usually limited by finances). Or they may use sporadically and then quit. But it is extremely rare for a person to NOT, over time, experience a creeping increase in their drug use. They may claim otherwise, and be, intentionally or unintentionally, oblivious about the change over time. But the old saying holds true – the more you use, the more you use. That is, by definition, the nature of an addictive substance. The act of using changes your brain over time, in its most basic structure and signals.
Keep in mind that science shows that our brains are capable of changing like this, throughout our lifetime, for any repetitive task, including driving a taxi. The difference between an addictive substance and any other re-enforcing task is basically, in its simplest terms, two things. First, how much more rapidly and responsively the brain change occurs. And second, whether or not, over shockingly rapid, or relatively long, slow periods of time, a repetitive act causes brain changes that are ultimately destructive, or are, instead, ultimately rewarding for our lives, relationships and health. It’s the difference between lying in bedbug-riddled twitching stupor, versus the longer, slower burn of exercise endorphins, altruism or stand-up comedy. In the end, neuron-wise, we all, literally, become what we do.
And clearly, the easiest way to recover from a destructive addiction is…to never start. So if the siren song of “occasional” cocaine use sounds alluring to you, thumping its way into your thoughts like a Bad Romance earworm, here’s refrain you may want to chant to yourself. It’s the brainstem bottom line: choose your addictions wisely.
And pass along the info! An informed choice is a better choice.
What do you think? Is the legend of the “occasional” cocaine user a myth? Or reality? Doc Gurley is the only Harvard Medical School graduate, ever, to be awarded the coveted Shoney’s Ten Step Pin for documented excellence in waitressing, and is a practicing board-certified internist. You can get more health posts at www.docgurley.com, or jump on the Twitter bandwagon and follow Doc Gurley. Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your personal wellth.