Motivation and emotion/Book/2020/Cocaine and emotion regulation

Overview
Cocaine is an illegal substance that can be taken through smoking, snorting, rubbing on to gums, and injection, as well as being added to foods or drinks depending on the form of it (Headspace, 2020). It can be produced in different forms such as:
 * Cocaine hydrochloride: also commonly known as 'coke' (Goldstein et al., 2009) is a powdered form mixed and diluted with substances such as lactose and glucose.
 * Freebase: a powdered, more pure form than cocaine hydrochloride.
 * Crack: crystals that are a white or cream colour which may contain impurities (Alcohol and Drug Foundation, 2020).

People who choose to take cocaine for its euphoric effects are seeking an emotional high that holds great pleasure (Hartney, 2020). But most of us know that with whatever 'high' is associated with a drug, there are some pretty serious lows. This chapter will be looking into the effects of cocaine dependency on emotion regulation and the role that this can play in emotional wellbeing. To provide an understanding of cocaine this chapter gives a brief historical background of cocaine before explaining the range of effects that cocaine has within the body. Before looking at emotion regulation in relation to cocaine, it is defined and explained as an individual concept. Then the chapter delves into the effects of cocaine-dependency on emotion regulation with the assistance of some case studies as a practical way of showcasing the relationship between cocaine and emotion. Lastly, the chapter touches on cocaine addiction and its treatment, revealing whether a cocaine-dependent individual can regain their ability to regulate their emotions once becoming abstinent.


 * The neurological, physiological and psychological effects of cocaine


 * Understanding emotion regulation


 * The effects of cocaine dependency on emotion regulation


 * Cocaine addiction and treatment

Historical background of cocaine


Cocaine has been around as early as the 1400s, harvested from the leaves of a plant called Erythroxylum coca. It has been utilised in many ways over time such as being used as a substance to increase physical stamina in Spanish mine workers in 1492. In 1884, Germany used cocaine as the first anaesthetic in medicine. Figure 1 shows an advertisement for cocaine in the form of toothache drops where they were accessible at all drug stores. Most people are aware that cocaine was used in John Styth Pemberton's original recipe for Coca-Cola in 1886. By 1916 cocaine could no longer be sold over the counter in the United States. Today, cocaine is one of the most commonly used illicit substances (Goldstein et al., 2009).

The effects of cocaine within the brain, body and mind
Cocaine imposes a wide range of effects on the human body in terms of chemical reactions in the brain, physical reactions in the body, and psychological reactions in the mind. This section covers these effects of cocaine on the body before exploring the relationship of cocaine and emotion in regard to the neurological, physiological, and psychological responses that take place during cocaine use.

Cocaine in the brain: neurological effects
A key short-term effect from the initial use of cocaine is an overwhelming sense of euphoria which provides a intense experience of pleasure and reward. This feeling is what often causes an addiction to take place. Euphoria when using cocaine can be explained by the effects that it has on hormone receptors by inhibiting their natural cycle (Hartney, 2020). The mesolimbic dopamine system acts as the brains reward pathway. It can be stimulated by food, sex and drugs such as cocaine. As shown in Figure 2, the dopamine system is located in the ventral tegmental area (VTA), and extends to the nucleus accumbens which is a key reward area involving components such as pleasure and euphoria. This circuit provides the brain with the ability to regulate emotions as well as motivations. When the brain is influenced by cocaine, its ability to express or perceive emotions can often be altered from its normal state (National Institute on Drug Abuse, 2016). The table below provides a comparison between the brain's dopamine process normally, and when effected by cocaine.



When the nucleus accumbens is producing feelings of pleasure and reward it is doing so as a survival response to keep us focused on activities that encourage meeting biological goals such as reproduction. For example, when someone has an orgasm, the nucleus accumbens is flooded with dopamine, making us feel a great sense of pleasure, resulting in wanting to engage in that behaviour again.

The feeling of pleasure that stems from cocaine can be so powerful that survival and biological needs are forgotten. Some studies have shown that laboratory animals chose to take cocaine instead of eating food until reaching starvation.

Cocaine in the body: physical effects
Some immediate physical effects of cocaine use include increased body temperature and heart rate, reduced appetite, nausea, dilated pupils, dry mouth, greater alertness and energy, and desensitisation to pain (Alcohol and Drug Foundation, 2020; Hartney, 2020; National Institute on Drug Abuse, 2016).

When extended use of cocaine occurs and a person becomes addicted, they may experience withdrawal symptoms that can have physical effects on the body. These include agitation, sleep deprivation and exhaustion (Headspace, 2020).

Cocaine in the mind: psychological effects
As stated before, the main psychological effect of cocaine when experiencing a cocaine high is euphoria. This heightened state of pleasure can cause a range of other psychological effects such as increased levels of confidence, excitability, and sociability (Hartney, 2020). This all sounds very exciting, although there are a range of negative psychological affects that can cause harm to the person using the drug or others around them such as restlessness, aggression, paranoia, anxiety, hallucinations, loss of libido, risky or violent behaviour and delusional thoughts (Department of Health, 2004).

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{Cocaine has been around since the: + 1400s - 1800s - 1900s
 * type=""}

{The dopamine system is located in the ________ and extends to the ________ which is a key reward area involving components such as pleasure and euphoria. - Hippocampus, nucleus accumbens + Ventral tegmental area (VTA), nucleus accumbens - Nucleus accumbens, ventral tegmental area (VTA) - Frontal cortex, ventral tegmental area (VTA)
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{Some withdrawal symptoms of cocaine addiction include: - Greater alertness, energy and agitation + Agitation, sleep deprivation and exhaustion - Desensitisation to pain, confidence and sociability
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Emotion regulation


Emotion regulation occurs when someone is able to control their emotional responses to a situation (Decker et al., 2016). It involves an individual influencing the emotions that they have, when they occur, how they are experienced and how they are expressed (Kobylińska & Kusev, 2019).

Figure 3 shows a diagram of Richard Lazarus' theory of cognitive appraisal. This theory explains how the initial interpretation of a situation in terms of its benefit, threat or harm causes an individual to experience an emotion in relation to it (Campbell et al., 2013). This can help to understand concepts such as:


 * Cognitive reappraisal (CR): when a person changes their emotional state by changing their thoughts towards a situation.
 * Emotional suppression (ES): when a person alters their emotional state by restraining their response to a situation (Decker at al., 2016).

The role of cocaine in emotion regulation
Multiple studies have found that cocaine has effects of impairment on emotional intelligence. This includes one's ability to perform emotion regulation which can have serious effects on social functioning and emotional wellbeing (Albein-Urios et al., 2014; Hulka et al., 2013; Kuypers et al., 2015; Preller et al., 2014).

Emotion regulation during cocaine dependency
Research has shown that when a person is dependent on cocaine, their ability to regulate emotions is significantly lower than that of a person who is not cocaine-dependent. Some studies say that cocaine-dependent individuals lack a clear understanding of their own emotions, struggle to use emotional coping strategies such as cognitive reappraisal and emotional suppression and have difficulty controlling inappropriate or impulsive behaviour when experiencing stress (Decker et al., 2016; Fox et al., 2007). The following case study extends on this with some significant findings on the effects of cocaine on emotion regulation.



Albein-Urios et al., (2014) conducted a study to investigate negative emotion regulation in cocaine-dependent individuals who were abstinent for at least 15 days compared to a control group of non-drug-users. This study used functional magnetic resonance imaging (fMRI) during a re-appraisal task involving a range of negative affect or neutral pictures. Test subjects could observe the pictures, or maintain or suppress the emotions inflicted by it.

In this study, the cocaine-dependent individuals showed increased activation in areas of the brain associated with negative emotional appraisal and severity of depression. It was also found that cocaine-dependent individuals may appraise negative emotional states as actual drug cravings. Other areas of the brain in cocaine-dependent individuals had reduced activation that could cause a lowered ability to emotionally regulate strong negative emotional states. This study concluded that cocaine-dependent individuals have a low ability to exhibit emotion regulation resulting in a range of issues such as persistent negative affect, emotional lability, poor anger management and intolerance to frustration.

So far, it can be understood that cocaine-dependent individuals lack skills in emotion regulation. Research has shown that there are other areas of emotional intelligence that cocaine-dependent individuals have impaired ability. One of these areas is emotional empathy. Preller et al., (2014) found that cocaine users faced impairments in empathy and understanding the emotions of others. This can have serious impacts on social functioning and plays a role in the size of a person's social and emotional support network.

Poor emotion regulation and its impact on emotional wellbeing
Cocaine has serious effects on one's ability to regulate their emotions and in particular, negative emotional states. Some of these include fear, anger and sadness (Rowe & Fitness, 2018). A main outcome of not being able to regulate negative emotions is negative affectivity. This can have serious implications on emotional wellbeing. Negative affectivity can cause feelings of worry, helplessness, and low self-esteem (Heinström, 2010). Poor emotion regulation often means poor emotional coping strategies. Studies have shown that when coping with negative emotions poorly, outcomes such as social isolation can occur as a person withdraws themselves from social situations. This can create a vicious cycle for people with cocaine dependency as individual's with drug dependency generally experience greater social and emotional feelings of loneliness which can cause the maintenance of drug abuse (Hosseinbor et al., 2014; Puente-Martínez, 2018).



Toby is 32 and works a high stress office job. Since his mother passed away last year Toby has been using cocaine to stay focused on his work. Toby has noticed that he has been getting angry at his wife and children over small issues that don't warrant large outbursts of anger. Toby usually feels guilty for his behaviour afterwards and feels concerned about his family's wellbeing, as well as his own. He is feeling extremely helpless over the whole situation. Toby's most recent outburst of anger caused him to hit a glass off the kitchen bench, his 3 year old daughter ran into the room and cut her foot on a piece of glass. This was the last straw for Toby's wife, she told him she was taking their children to stay with her parents for a couple of weeks so Toby could sort out his issues.

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{Based on what you've learnt about negative affectivity and its effects on emotional wellbeing in conjunction with cocaine-dependency, what is Toby likely to do next? - Stop taking cocaine as he is scared he will loose his wife and children for good - Continue taking cocaine but learn to better control his emotions so that his wife feels comfortable being around him with their children + Continue taking cocaine as his feelings of loneliness cause him to cope through maintaining his addiction
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''' If you got that correct, well done! '''

The case study of Toby's cocaine dependency allows for an understanding of how cognitive reappraisal and emotional suppression provides someone with control over their emotions and the ability to behave in a way that is socially acceptable. If Toby were exhibiting cognitive appraisal he would be attempting to change his thoughts towards his mothers death. An example of doing this could be thinking about the fact that one day he may not be around for his children, therefore it is important he makes the time spent with them valuable and memorable rather than full of anger. If Toby were to use emotional suppression in his situation, he would be able to limit behaviours such as outbursts of anger (Decker at al., 2016). Unfortunately, Toby is lacking in emotional intelligence due to his cocaine dependency inflicting on his cognitive functioning, this is why he is more likely to make the choice of continuing to take cocaine (Puente-Martínez, 2018), rather than addressing his issues and getting his life back on track.

Cocaine addiction and treatment
A range of academic studies have found that around half of a person's risk for drug addiction is genetic (Nestler, 2005). Other risk factors involve an individual's environment or social setting and may include poverty, abuse, peer pressure, drug availability or early use (Tyler, 2016). Cocaine addiction occurs when a person craves the euphoric effects of the drug. The more a person uses the cocaine, the more they become adapted to it, therefore needing a stronger dose to reach the same sense of euphoria that was once brought on. This is what creates the risk of a dangerous addiction or overdose (Sclar, 2019).

Detoxification is the first step of treating cocaine addiction. This can last as long as a week (Regan, 2020). When going through detoxification there are phases of withdrawal that a cocaine-dependent individual will experience. Although detoxification can last as long as a week, withdrawal symptoms may extend for as long as ten weeks (Alcohol and Drug Foundation, 2020). The Alcohol and Drug Foundation (2020), outlines the three phases of withdrawal:


 * 1) Crash: involves the person feeling agitated, depressed and anxious with feelings of intense hunger and cravings for cocaine. They may also have trouble sleeping and feel extremely tired. This is usually experienced within the first week.
 * 2) Withdrawal: this involves symptoms that may last up to ten weeks after detoxification such as cocaine cravings, low energy levels, feeling anxious, angry and lacking the ability to feel pleasure.
 * 3) Extinction: this is the final phase that is usually ongoing for a person who has faced addiction. It involves recurrent cravings for cocaine.

Once detoxification is completed, a person can be rehabilitated in an inpatient or outpatient facility. The majority of methods used in treating cocaine addiction are behavioural and include:


 * Motivational interviewing: occurs early in treatment to allow the patient to understand how their addiction has impacted their goals and relationships. The intention of this is to help the patient feel motivated in their recovery.
 * Contingency management: this aims to repair faulty patterns created in the brain from the cocaine. This method involves positive reinforcement for good behaviours in relation to the patients recovery.
 * Community reinforcement: In alignment with the positive reinforcement in contingency management, community reinforcement provides the patient with a social and emotional support network to emphasise positive behaviour. This support network may also assist the patient with their personal relationships or getting a job.
 * Cognitive behavioural therapy: This provides patients with the knowledge and skills to avoid or manage barriers to their sobriety and allow them to achieve healthy thought patterns in relation to their recovery and day-to-day cognitive functioning (Regan, 2020).

When cocaine addiction treatment is successful patients often regain emotional awareness of themselves and others. Research has shown that cocaine-dependent individuals becoming abstinent has resulted in an increased ability over time to gain control over their emotions when in a state of stress (Fox et al., 2007).

Conclusion
Cocaine is an illicit substance that is well-known for its euphoric effects on the mind and body. It has been around since the 1400s, although its uses today are very different from when it started out as the world's first anaesthetic (Goldstein et al., 2009). Today, cocaine is an addictive substance that has serious effects on human biology in areas such as the brain by interrupting the normal dopamine process causing an inability to regulate and perceive emotions (National Institute on Drug Abuse, 2016); the body, through physical effects such as an increased heart rate and body temperature (Alcohol and Drug Foundation, 2020); and the mind, which causes psychological effects that may be positive or negative, such as confidence, sociability or aggression and anxiety (Department of Health, 2004; Hartney, 2020). The range of effects that cocaine dependency has on the body have a role to play in the lack of ability to perform emotion regulation. This chapter aimed to allow readers to see how a lack of emotion regulation plays a role in the vicious cycle of addiction when other factors come into play such as negative affectivity and social isolation (Puente-Martínez, 2018). Cocaine addiction is an issue that occurs when a person chases the euphoric effects of the drug (Sclar, 2019). Addiction can be treated through a range of behavioural treatment techniques (Regan, 2020). It can be difficult for cocaine-dependent individuals to undergo treatment as their body faces a range of withdrawal symptoms (The Alcohol and Drug Foundation, 2020). People who are dependent on cocaine can regain the ability of emotional regulation over time through the use of treatment facilities (Fox et al., 2007).