Motivation and emotion/Book/2019/Cocaine use and motivation

Overview


Cocaine is a psychotropic substance that has recreational qualities and as such has been historically used, misused and abused by many types of people in different societies. Throughout this chapter we will examine the motivation behind first using cocaine, why users continue to use, and why some may find themselves addicted and unable to stop using.


 * Focus questions:
 * 1) How do we understand why one would consume cocaine at one time and/or regularly
 * 2) The neural pathways of the nucleus accumbens and striatum can explain cocaine consumption
 * 3) Sigmund Freud's (a key figure in the understanding of modern psychoanalysis) cocaine habit: case study
 * 4) Conclusion: what does the evidence suggest?

History


The first documentation of the cultivation and use of the psychoactive substance that is found in cocaine is by the indigenous peoples of Peru (Dillehay et al., 2010). Dillehay and colleagues found evidence in archaeological digs in Peru that ancient farmers had used calcite to extract the alkaloids that enable the extraction of the psychoactive properties in coca (Erythroxylum coca) leaves approximately around 8000 cal BP (Dillehay et al., 2010). It is suggested that the chewing of these coca leaves for ancient Peruvian farmers was done for nutritional and medicinal benefits (Dillehay et al., 2010).

It is unclear whether the ancient indigenous Peruvians used the coca for recreational purposes. It is however likely that they used it to assist them in arduous hikes and in working in harsh conditions, as we know that present day indigenous Peruvians chew the coca leaf for these purposes (Pacini & Franquemont, 1985).

The first synthesis of pure cocaine as we know it today was inspired by Paolo Mantegazza, an Italian physicist who published works detailing the remarkable anaesthetic and medicinal properties of the coca leaves (Wahrig, 2009). It is likely that as the beneficial properties of coca were widely coming to the forefront in the 1850s that these publications by Mantegazza lead to synthesis of cocaine in powder form by chemist Albert Niemann in 1859, who named the product cocaine with the "ine" being added to coca as "ine" is a common suffix in chemistry for alkaline compounds (Wahrig, 2009). In the 1860s cocaine was put into "coca wine" and marketed as a tonic for fatigue (Karch, 1993). This lead to the remarketing and conception of the world renowned "Coca-Cola" which did indeed (as is commonly discussed in popular culture) have pure cocaine in it when it was first sold to the public (Karch, 1993). It's initial usage in medicine was as an anaesthetic. Carl Koller, an opthamologist used cocaine to assist pain in his patients when performing eye surgery (Altman, Albert & Fournier, 1985). In the 1980s the extraction of cocaine free-base via "cooking", commonly with bi-carb soda, lead to producing the substance we know as crack cocaine (Karch, 1993).

Physiological effects
Cocaine is most commonly administered intranasally (through snorting it), but it can also be smoked or injected (Zimmerman, 2012). There are many physiological effects that can occur as a result of cocaine use. Here we look at the immediate effects of a single dose, as well as the effects of long-term use, and also the effects that may occur as a result of withdrawal from a physical dependency to cocaine. Note that all effects are viewed from the perspective of recreational use; as cocaine is an illegal narcotic its potential for medicinal uses are not discussed.

Neurologically, the brain area that has receptors with the greatest affinity for cocaine is the striatum (Karch, 1993). The frontal cortex and the occipital lobe are areas that also have sensitivity to cocaine uptake (Karch, 1993).

Immediate effects
Much alike many other recreational stimulants cocaine use affects the brain primarily via the dopamine pathway, but also affects receptors sensitive to noradrenaline (Shorthouse, 2013). The action that takes place at a cellular level is "via prevention of cell-membrane depolarization due to sodium ion channel blockade" (Shorthouse, 2013).

The state government of Victoria's better health website lists immediate symptoms as;


 * an increase in heart rate
 * an elevated feeling, euphoria and a boost of confidence
 * pupil dilation
 * an increase in body temperature
 * loss of appetite
 * a boost of energy
 * an increased sex drive

Shorthouse (2013) and Barceloux (2012) also note some other symptoms:


 * vasoconstriction
 * pain reduction
 * enhanced psychomotor activity
 * anxiety similar to that which can result from other stimulant (e.g., amphetamine) use
 * increased perspiration

and at higher dosage:


 * depression
 * potential for addiction/dependence
 * anaphylaxis
 * hallucinations
 * hyperpyrexia (high fever)
 * heart attack/stroke

Note that Barceloux (2012) says the nature of effects is determined by "individual sensitivity, acute tolerance, cocaine purity and the types of impurities and adulterants" (p. 812).

Effects from a single dose wear off very quickly. Cocaine has a biologic half-life of approximately 1 hour in the human bloodstream (Barceloux, 2012).

When using a mix of cocaine and alcohol, a metabolite called cocaethylene is produced, which affects the same dopamine pathways that cocaine does alone, however because cocaethylene has a much longer half-life than cocaine it can result in much stronger intoxicating effects (Karch, 1993).

Effects of chronic use
Chronic, prolonged abuse of cocaine by addicts can lead to a plethora of adverse effects. It has been found that the heart tissue of long-term cocaine abusers can become thickened, leading to higher susceptibility to heart attack and stroke (Karch, 1993).

According to Karch (1993) physical symptoms of abuse include;


 * perforated nasal septum
 * dental erosions
 * evidence of terminal seizures (e.g., bite marks on the lips/tongue)

and abusers are susceptible to:


 * coronary artery disease
 * scleroderma
 * coronary artery spasm
 * myocardial diseases
 * pulmonary diseases
 * renal diseases
 * hepatic diseases
 * sudden cardiac death
 * agitated delirium
 * and neurological disorders

Withdrawal symptoms can be quite severe when coming down from a cocaine or crack binge. Users often experience feelings of paranoia, depression and occasionally tactile hallucinations as direct result of physical dependency to the drug (Karch, 1993).

Motivation
The motivation to engage in any activity is incumbent upon neurological and psychological drives and desires. Generally, the basis of all human motivation to perform any given action is determined by synapses that occur via the nucleus accumbens that link to limbic cortical structures also linking to the striatum (Miller, 1999). A realistic personal drive to change and correct behaviour directly and indirectly related to cocaine consumption is the first proper step to reducing cocaine consumption and the resulting problematic behaviours that occur as a result of such behaviours (Miller, 1999).

Nucleus accumbens


The nucleus accumbens forms part of the ventral striatum, which in turn is a part of the whole striatum. The nucleus accumbens is a brain structure specifically related to the adoption and adaption of addictive behaviours (Robbins & Everitt, 1996). It has been found in research (Ikemoto & Panksepp, 1999) that the nucleus accumbens is a mediator in the dopamine pathway system that facilitates the transmission of the neurotransmitters released from cocaine that effect all motivational behaviour. When chronic abuse of illicit substances occurs (e.g., cocaine) the nucleus accumbens can mutate somewhat to adjust to the reception of dopamine, which can lead to addiction to the neurotransmitters released by the an narcotic, in our case cocaine (Robison & Nestler, 2011).

Striatum
The striatum is the powerhouse when it comes to mediating addictive behaviour (Robbins & Everitt, 1996). The nucleus accumbens is a lesser part that combines to make the whole striatum has a significant role to play when considering engaging in the consumption of illicit substances (Miller, 1999). The striatum is a larger cortical structure that largely contributes to the decision making process when considering any short-term or considerably short-term process (Taylor, Lewis & Olive, 2013). The striatum is a strong mediator between success and reward (Miller, 1999). Key to understanding the striatum's role in motivation when an organism is effected by cocaine is that it has an overflow effect on all other dopamine pathways (Liljeholm & O’Doherty, 2012).

What motivates people to use cocaine?
Neurologically speaking, it is evident that there are neurological pathways that may be susceptible to cocaine. the exact nature of why one may decide to use cocaine is obviously dependent on a number of factors. It is clear from a myriad of research that one of the main factors that contribute to continuous cocaine use is its highly addictive nature (Sanvicente-Vieira, Kluwe-Schiavon, Corcoran & Grassi-Oliveira, 2017).

Neurobiological
Cocaine, being a stimulant illicit drug, that is easily permeable through the blood-brain barrier (Robbins & Everitt, 1996) can have many effects on the physical and mental state of any user. It has been seen through studies as the phenomenon of cocaine addiction has come to the forefront of modern research that cocaine is not only a psychologically addictive substance but also a physically addictive substance (Dackis & Gold, 1985). It has been hypothesised that constant, extensive consumption of cocaine can lead to a general lessening of the affinity of dopamine receptors to uptake dopamine in some neural pathways (Dackis & Gold, 1985).

When one is unable to function without the constant ingestion of cocaine this can lead to total dependence.

The prefrontal cortex is often associated with executive decision making. It is probable according to research (Morein-Zamir, Simon Jones, Bullmore, Robbins & Ersche, 2015) that executive decision making, mediated largely by the prefrontal cortex is inhibited in recreational cocaine users. Interestingly, the study by Morein-Zamir et al. (2015) suggests that cocaine dependent individuals may show better cognitive control in the prefrontal cortex than others that are also dependent on another stimulant. However these results do imply that the functions in the prefrontal cortex associated with executive decision making are still impeded by cocaine users when compared to a control (Morein-Zamir et al., 2015).

Psychological
It is often found that with any individual that compulsively abuses any narcotic that a distinct pattern of behaviour can be established. Cocaine can have adverse effects on healthy diet (Henry, Murnane, Votaw & Howell, 2010). A real and salient issue that should be addressed with cocaine use is the normality (especially amongst teenagers) of usage of the drug (van der Poel, Rodenburg, Djikstra, Stoele & van de Mheen, 2009). For chronic abusers of cocaine a lack of feeling of the initial "high" from the first ingestion may lead to further and further overindulging and subsequent negative effects may follow (Lowison, 1997).

Although it would be rather simplistic to reduce Sigmund Freud's comprehensive and groundbreaking contributions to his cocaine habit, it cannot be denied that the learned psychoanalyst had a lengthy experience of experimenting with various doses of the drug (Oliver, 2017). This case study of Freud's slightly extreme attachment to the white powder demonstrates that cocaine can administer delirious grandiosity that can have an effect on even the most cerebral of individuals. Sigmund Freud (1976) began experimenting with the effects of cocaine to attempt to understand the cause of the behaviours he himself described when he first brought psychoanalytic psychiatry to the forefront. Sigmund purports in these papers (Freud, 1976) that cocaine can be used the alleviate a myriad of diseases and symptoms (i.e. heroin addiction). Freud also details his personal experience with usage he describes the first time he did it with experiences of "a sudden exhilaration and feeling of lightness" (Freud, 1976). Freuds frequent use is also indicative in his own papers; describing the typical loss of hunger and thirst he says "I have tested this effect of coca, which [...] steals ones intellectual effort, some dozen times on myself" (Freud, 1976). Freud's contributions to modern psychology can only be described as monumental, however it is clear from the anecdotal evidence of his personal experiences with cocaine consumption that it can be highly addictive to any individual. This case study of Freud's dabbles in self administering should give caution as to how cocaine can have a great effect on one's motivation and can surely result in the grandiose and delusional cognitions that are evident in modern literature.

Although the aforementioned effects that cocaine can have on motivation, a few small caveats to this research are as follows;


 * 1) In most studies the participants listed as "cocaine dependent" are listed due to criteria determined exclusively by the researcher(s) conducting the study. This therefore implies that there could possibly be no real difference in physiological and psychological motivational disposition between the control groups and the research groups. Contrarily it is also possible that as the extent of the psychological dispositions of the so-called "cocaine dependent" participants was not quantified, these participants may have been much more qualitatively different than their control groups in their respective studies, and therefore the effects that were observed may indicate a real, generalisable, moderately different result from the respective control groups.
 * 2) Observational, behavioural data may seem to give a more succinct, accurate and clearer picture. The case in reality in scientific psychological study however is that readily quantifiable neuropsychological data (i.e. topography of MRI scans) may more accurately reveal the real reasons behind human motivation, albeit these data may be harder to explain in simple terms (Frazer, Richards & Keith, 2018).

What effects does it have on motivation for other behaviours?
Cocaine effects motivational behaviour for tasks that require attention. Liu et al. (2011) found that when participating in attention tasks, cocaine dependent subjects only performed to a satisfactory level when the stimuli were related to cocaine, and overall the cocaine dependent subjects had significantly higher impulsivity and impaired inhibitory control. This finding was also replicated in the study by Vadhan et al. (2007), namely that cocaine dependent subjects only have enhanced attention when it comes to cocaine related words. Copersino et al. (2004) in a similar study also found participants that were cocaine dependent were also likely to pay more attention to cocaine related stimuli, but they also found it difficult to direct attention to any other stimuli. The implications of these findings suggest that cocaine dependent individuals may have difficulty in a wide variety of practical tasks when directed attention is required if the tasks have no relevance to attaining more cocaine or being able to use cocaine.

Conclusion
The factors contributing to why one may feel motivated to use cocaine are abundant. Cocaine as a stimulant affects the brain via the dopamine pathway, and the motivation to use cocaine is determined by the neurological makeup of the users brain, especially their susceptibility to dopamine related rewards (Dackis & Gold, 1985). The general effects of euphoria, grandiosity and increased energy are factors that contribute to the urge that one may feel to use cocaine (Shorthouse, 2013). Motivation to use cocaine may also be reliant on ones belief that it may enhance performance in other situations (e.g., Freud's possibly delusional suggestion that it enhanced cognitive function). Despite the obvious and recognisable negative physical side effects it is clear that the motivation to use cocaine can overpower these signals via pure and extreme addictive urges brought on by the dopamine rush that cocaine gives (Robison & Nestler, 2011). It is indicated that due to susceptible synapses in the striatum and nucleus accumbens that cocaine can also impose a noticeable effect on how one may be motivated to engage in other behaviours.