Reflections on Psychiatry & Psychology

Cocaine blocks dopamine reuptake in the brain’s reward pathway, causing short-lived euphoria and repeated dosing. It raises heart rate and blood pressure and can cause paranoia, psychosis, heart attack, stroke, and overdose. Mixing with alcohol forms toxic cocaethylene.

Drugs disrupt brain homeostasis by hijacking the dopamine-based reward system, producing powerful reinforcement and cravings. Repeated use causes brain adaptations, impaired impulse control, and stress-driven relapse. Genetics and environment increase risk, but recovery is possible through strengthened top-down control.

Study of 252 cocaine-dependent patients tested whether early therapeutic alliance predicts drug-treatment outcomes across several therapies. Alliance weakly predicted outcomes (better for depression than drug use). Design issues—many variables and mixed treatments—may have limited conclusions.