Certo. Ecco la traduzione in inglese, mantenendo il tono medico-divulgativo e la struttura del testo.
Scrittura
Characteristics and Effects of Cocaine
Cocaine is a naturally occurring substance that is processed in various ways and marketed illegally. Its effects are generally described as “stimulant” or “euphoric.” Unlike mild stimulants such as nicotine and caffeine, it is classified as a narcotic drug because it is capable of altering a person’s relationship with reality. Unlike other narcotic drugs, such as opioids, however, it is not characterized by sedative (narcotic) effects.
Cocaine is one of the substances capable of inducing a loss of control over its use. When this does not remain limited to a short, circumscribed period, it constitutes drug dependence. Its negative effects on mental functioning also include other syndromes, as is the case with all drugs of abuse.
Continued use produces a certain degree of tolerance to some effects, particularly the pleasurable ones, while other effects become more likely. This may occur because they are not subject to tolerance and therefore increase as doses are increased, or because of the opposite of tolerance, namely sensitization—for example, aggression, paranoia, and withdrawal from the surrounding environment.
Abrupt discontinuation of cocaine after a period of regular use is followed by withdrawal. This is not always obvious, however, because it typically takes a “depressive” form, characterized by sleepiness, inactivity, and a general slowing of mental functions.
Through mechanisms similar to those involved with other drugs of abuse, cocaine induces drug dependence. Because of a number of misunderstandings and false ideas about what addiction actually is, one often hears—even in medical texts—that cocaine dependence is “psychological” or “all in the mind,” whereas dependence on substances such as heroin or alcohol is both “physical” and “psychological.”
This distinction does not actually exist. Dependence is a psychological expression of persistent alterations in the microstructure of certain areas of the brain, and this is true of all forms of dependence, including “non-chemical” addictions.
Course of Cocaine Use and Cocaine-Related Disorders
“Recreational” cocaine use generally occurs intranasally or by inhalation (smoking), but it may also occur intravenously.
Smoking and intravenous administration produce more rapid effects and more quickly induce a progressively increasing pattern of consumption. The onset is already extremely rapid when cocaine is smoked, while the dose reaching the circulation is obviously greatest when the substance is injected directly into a vein.
Rather than seeking a particular dose in itself, the user tends to seek a rapid rise in cocaine levels, dividing the dose in such a way as to produce several successive “rises” or flashes.
Cocaine consumption typically varies considerably in quantity. Withdrawal corresponds to a cessation of use, while active consumption tends to occur in waves lasting several consecutive hours or days, until the available supply is exhausted.
Cocaine is the most popular stimulant in several parts of the world, but it is not the only one. In some areas, for example, the market is dominated by amphetamines, particularly those used by inhalation or injection, as in Eastern Europe and Japan. These substances are also present in our country but are much less widespread; shaboo, for example, is one such form.
Over the years, the market has offered, in addition to the powder intended for snorting, a form intended for smoking, known as crack or freebase cocaine, which has also been present on the Italian market for many years.
There are also mixtures of heroin and cocaine, sometimes referred to as speedballs.
Cocaine users may combine it with other substances. The most common are alcohol and cannabis, as well as benzodiazepines.
The purpose of these combinations varies. Some users follow an alcohol-to-cocaine sequence, experiencing increasing levels of euphoria and disinhibition, at the peak of which cocaine is introduced, partly to counteract alcohol’s side effects while maintaining the euphoric state.
Others use calming substances to reduce excessive anxiety or paranoia caused by cocaine itself, either toward the end of the episode or as a way of being able to continue using cocaine.
Using cocaine on top of alcohol causes the body to produce a combined substance called cocaethylene, which acts as a stimulant with a longer duration of action.
The combination of the two substances can therefore prolong cocaine’s effects while altering both its toxicity and its behavioral consequences.
The number of cocaine users is increasing, as is the number of cases being treated by physicians.
It is nevertheless incorrect to think that there has been a shift from heroin to cocaine, because cocaine has never replaced heroin, nor has it ever represented the majority of cases of drug dependence.
Drug Dependence
After repeated exposure, a cocaine user may experience an increasing desire to use the substance. This becomes a source of problems because the time and resources devoted to cocaine interfere with other activities and, above all, no longer correspond to a deliberate plan for pleasurable use.
The pattern of consumption changes. Use becomes solitary, and the people with whom cocaine is used increasingly tend to be other people involved in cocaine use.
The effects become progressively shorter and less useful. The original purposes—functioning better, having sex, having fun—gradually disappear, and consumption may eventually become isolated, taking place in environments where the only activity is using cocaine, or where ordinary activities are performed while the person remains in a state of “mental isolation.”
At this stage, people typically become difficult to reach. They disappear, turn off their phones, return at strange hours after unexplained absences, are in a hurry to interrupt whatever they are supposed to be doing in order to go to unspecified places, and fail to keep commitments.
The ability to lie develops in relation to cocaine use. Initially it may be effective; later it may become little more than a denial of obvious facts.
Doses and patterns of use vary, including according to the quality of the substance available.
It is common for the person to report that the cocaine available on the market has “gotten worse,” claiming that it is excessively adulterated or mixed with “synthetic” or improvised substances.
Although this may sometimes be true, what is actually happening is that the brain no longer experiences cocaine as pleasurable, almost as though the substance itself were no longer of the same quality.
The effect becomes too short-lived; depression appears sooner; anxiety emerges too quickly and may become dominant; paranoia occurs at lower doses when previously it appeared only at higher doses, and so on.
The immediate effect of cocaine is to create a sense of omnipotence and optimism, together with an impression of ease in thinking and planning the future.
In this state, people make errors of judgment because of superficiality, omission, overestimation of their actual abilities, and underestimation of risks.
Their attitude toward anyone who challenges this state of mind may become arrogant and condescending, or frankly aggressive.
Their behavior may become accelerated and frenetic, with muscle jerks or tremors, although this does not always occur. A cocaine user cannot necessarily be identified simply by the way they move or speak.
During the dependence phase, mood becomes unstable, with characteristic periods of “coming down” after use, accompanied by depression, guilt, desperation, and profound dejection.
This is due not so much to a restoration of judgment and self-control as to the temporary depressive state produced by intoxication.
The person does not consistently report the symptoms of dependence. When in a good mood, they tend to shift attention elsewhere and may easily deny, persuade, or conceal their behavior.
When their mood deteriorates, they may urgently ask for help and may be more honest about acknowledging their use.
The same pattern affects their ability to follow treatment or accept financial or logistical measures taken by others to limit the damage caused by their cocaine use.
Other Psychological Effects
Depression
People who stop using cocaine may go through prolonged periods of depression, focused particularly on the distress caused by the absence of motivation, an apathetic mood, and a lack of interest in opportunities.
The person focuses on the damage caused by cocaine and expresses their distress as though asking others to do something to give them new opportunities or motivation. They often fail to understand the inevitable mistrust or difficulty involved in resuming social activities.
When this insistence is primarily directed toward obtaining money, continued use—or at least continued craving—should be suspected, even if it is denied.
Aggression
During cocaine use, recurrent episodes of aggression may occur that are otherwise foreign to the person’s usual behavior or that go beyond what the person intended.
The foundations of aggression in a person under the influence of cocaine include delusions and hallucinations, but also the simple presence of heightened suspiciousness, impulsivity, and the confrontational attitude the person adopts.
Persistent Psychosis
In some cases, delusions and hallucinations continue even after cocaine use has stopped.
From a biological standpoint, it is not surprising that the return to normal functioning may involve a period of vulnerability to these phenomena.
Persistent psychosis, however, is less common.
In such cases, concomitant use of other substances, such as cannabis, should also be considered.
Bipolar Disorder
Bipolar disorder is the psychiatric condition most frequently associated with cocaine use and dependence, in its various forms and manifestations.
During cocaine use, it is relatively easy for a physiological or temperamental form of bipolarity—such as cyclothymia or hyperthymia—to develop into a full-blown disorder.
When cocaine use stops, bipolar symptoms are expected to improve.
However, the depressive component associated with dependence, resembling that seen in bipolar II disorder, may persist for a long time and may easily recur whenever cocaine use resumes.
If cocaine use continues, the disorder may reach its most severe levels, including psychotic manic or otherwise highly activated phases.
Typically, these phases tend to be shorter, with their intensity decreasing and then increasing again depending on the level of cocaine consumption.