Well, what is cocaine’s intended purpose? It’s not used in medicine anymore…
It is both simple and extremely complex. If you drink a glass of wine, you aren’t abusing it. If you get hammered after 12 glasses of wine, even one time, you are abusing it during that time. Abuse indicates using a mood altering substance with potentially harmful effects in excess. It is possible to use cocaine in very small quantities to get effects like caffeine and I suppose that wouldn’t be abuse. Using it to get high is. The key is using a substance to purposefully induce an abnormal behavioral and psychological effect.
We can nitpick these definitions all day long but that is basically it and I won’t participate. You know what I am referring to enough to understand the vast majority of real cases.
Dependence and addiction are subsets of abuse but they are seperate on the continumn. Not all abuse leads to dependence and addiction but abuse is required for addiction to develop.
Aren’t you getting high when you feel the effects of caffeine?
Against the background of the US “War on Drugs” anf global prohibition of most recreational psychotropics, the debate on drugs is heavily politicized. From most prohibitionists’ PoV, any consumption for purposes of intoxication is ‘abuse’. From most consumers’ and reformers’ PoV, there’s a legitimate category of ‘use’ distinct from ‘abuse’. Here, ‘abuse’ is when the drug use interferes with other important priorities of the consumer (health, work…etc). The issue arising from this outlook is that the difference is sometimes subjective. The consumer may be willing to spend $100 on cocaine instead of some other commodity. The wife, say, may not appreciate that and consider her husband abusing cocaine, whereas the husband doesn’t.
Yes, it is. It’s a very good local anesthetic. My ex had it after surgery for a deviated septum, of all things.
Very short and simplistic answer. Technically, by your definition, I am a Trileptal (oxcarbazepineoxcabazepine) abuser. It is scheduled as an epiliptic medication, and I took it for bipolar disorder. “But I don’t mean that kind of other purpose…” No, but it counts whether you meant it or not.
IM(totally civilian)O, “abuse” comes into play when it interferes with your day-to-day life. Most substances being used today to get high are as safe as Coors Light (without the foul taste) when administered at the proper dosage.
Saying “ANY cocaine/crack/heroin/marijuana is ABYOOOOOOSE!” is inaccurate and is the speaker’s opinion, not a scientific fact.
**Crack?!?!?!??!
::raising hand:: I am a mental health professional, hold multiple degrees and certifications, have worked in the field for over a decade in state hospitals, forensic units, crisis assessment, inpatient and outpatient treatment (including substance abuse), and other sites, and I have a very fluid idea of what is and is not acceptable drug use. Watch where you’re painting with that brush, please, unless you’d like to derail this thread into a discussion of the disparate world views of “professionals who can understand the difference between recreational and abusive intoxicant use” and “pseudo-professionals who are little more than drunks with a piece of paper (MACs in particular) who think all use is terrible, horrible and unacceptable because it didn’t work out for them.”
To answer the OP: from a professional standpoint, I would say your question has already been ably answered. When the use becomes a hindrance in some way- impacts relationships, work, finances, etc- it is abuse. We make the same distinction in personality disorders; flip open a copy of the DSM, and you’ll probably find a lot of your own “quirks” in any number of the disorders, but you wouldn’t get an official diagnosis unless those quirks became obstacles. If you’re knocking back 5 drinks in a night every single night regardless of what you have to do the next day, you’re abusing. If you’re knocking back 5 drinks a night on a Saturday two or three times a month, that might be either use or abuse, depending on the circumstances. If you’re knocking back 5 drinks a night on a Saturday once every two months, that’s probably recreational use.
Dependence in this conversation is a red herring; one can become dependent on a perfectly legal substance without going outside of the label use or above prescribed dosage.
So, what is your level of acceptable cocaine use? :dubious: I have also worked in inpatient & outpatient substance abuse centers doing therapy, intake/asessment, etc, and have yet to hear any therapist, anywhere, suggest that there was an acceptable level of use for cocaine. Marijuana, alcohol, sure. Cocaine? Fuck no.
What is an MAC? Are you referring to an MFT or similar (Master’s level therapist)?
You may be conflating powder cocaine and crack. Cocaine and alcohol fall into roughly the same ballpark (just check the slides in Part I).
You are hearing a clinical professional suggesting it right now. Yes, if you are limiting yourself to therapists, an overwhelming majority are not going to be supportive of any level of drug use, for exactly the reasons deevee stated: when all you see are bottomed-out, strung out, incapable of functioning drug addicts, it colors your perception of anyone, anywhere being capable of recreational use. I started my career on a forensic unit that was overpopulated by pedophiles; you better believe it’s colored how I respond to that particular population and my hope for their recovery.
As Gyan suggests, you are possibly broadening the term “cocaine” to include crack. Of course there is no acceptable level of recreational crack use; its very nature defies such a thing. But snorting cocaine once a month with a bunch of friends (or, indeed, alone) does not an addict make, and if one of my clients told me they engaged in such a practice, and it did not appear to impact their ability to function day-to-day, I would not freak out about it and call them an addict.
Masters Addiction Counselor, or their evil twin Licensed Addiction Counselor. In my experience, little more than someone who got sober and decided to share the wealth by 1) getting the absolute minimum amount of training possible, and 2) setting out to make everyone Just Like Them. I refer to them as a drunk with a piece of paper, but they are infinitely more dangerous than that (almost along the lines of so-called Christian Counselors, but that’s really a debate for another thread).
I wouldn’t necessarily call them an addict, but I would have a very serious discussion about how much, frequency, and why they are using coke, which is incredibly addictive, whether as blow or crack. IMHO, where there’s smoke there’s fire, especially concerning substance use. Clinical practice varies widely- you clearly will see a person who states they “recreationally” use cocaine. I would not. I know of several clinicians, including my former supervisor (during my doctoral internship) who refuses to see anyone using any substance, whether marijuana, smack, or coke. She also makes them sign an agreement not to drink within 72 hrs of their appointment. Her practice is Jungian analysis, primarily. This is more of a hardline than I take, myself, but my point is that there is a range of how clinicians work.
The DSM-IV is very clear, however. We can argue about whether the DSM is a quality diagnostic tool, and about it’s proper use and applicability, but for the purposes of this thread, it’s probably the simplest and clearest measure. Drug use/abuse/addiction does ramain a somewhat murky area, IMHO, as it is inherently more political and charged than say the diagnosis of panic disorder or depression.
So what we are left with, I believe, is the following:
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Clinicians who are not quacks (see below), such as MDs, psychologists, and those licensed by their state to diagnose, also having experience and supervision in the area of addiction, have a wide range of what they may consider acceptable use for the clients they see for therapy, assessment, or other scope of practice purpose.
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The standard measures and diagnostic tools to make the assessment may include, but are not limited to, the following:
- DSM-IV (Substance Abuse | Behavenet)
- CAGE questionaire (https://www.merck.healthinkonline.com/merckTools/AssessMerckSourceCAGE.asp)
*Short Michigan Alcoholism Screening Test (S-MAST) determines general alcohol abuse.
*Short Alcohol Dependence Data Questionnaire (SADD) determines dependence severity - 12 step questionaires
- various flavors of inventories
- Professional judgement
Obviously, there are others, and some use none of the above. The DSM-IV though, at this time, remains the standard for diagnosis. “Acceptable” can vary highly- from clinicians who are involved in hallucinogenic research and theraputic use of substances to those like my old supervisor who take extremely hard lines about what is acceptable in life and particularly if the client wishes to remain in treatment with them.
Gar! This is getting very lame! Drugs a bad idea! Cocaine is immensely stupid! If any thing whether coke, alcohol, toothpaste, coffee, or crossword puzzles gets you in trouble at work, home or school, and you spend a lot of time figuring out when and how you’ll get your next one, you have a problem.
Just say no. Live like a buddhist monk with only one robe and a bowl and no posessions or vices and things will be just fine. Boring and distinctly lacking in fun, but fine.
I agree. I used to work with a lot of them, and it drove me crazy. Their clinical “experience” was 2 years or so of NA/AA meetings. CA has licensed addiction counselors that hold little more than associate degrees, if that. It’s all bad. Especially on dual diagnosis units where they are providing “treatment” to people with serious MI such as schizophrenia or personality disorders, way, WAY out of scope of practice. They can and do cause serious damage, in my experience, especially when they start monkeying around with marriage therapy and DBT. My rant about them and about Christian “Counselors” or worse, “Spiritual Counselors”/ “Energy Workers”/ “Hynotherapists”* is likely to be preaching to the obviously converted, and not part of this thread.
*in CA hynotherapy is an unlicensed practice. Therefore any asshole can say they are “therapists” without any training, licensing, or regulation. Some of these tools restrict themselves to things like smoking cessation, but I know of at least one who advertises her “therapy” to treat people with bipolar disorder, depression, and PTSD, as primary therapy, not adjunct, and actively encourages people to go off their meds and such. Other states may vary in terms of licensing and oversight. Some “hypnotherapists” may be trained, and may do good, but it is a back door to all sorts of bad.
Did you ignore my cite? Let me paraphrase the salient point here:
According to the British govt., there are 588,000 cocaine users (last year) of whom 73,000 are dependent (12.41%). For alcohol, 2,522,000 out of 25,600,000 (9.85%). According to the 1992 National Comorbidity Survey in the US, 17% of cocaine users are dependent, and 15% of alcohol users. So, powder cocaine is “incredibly” addictive compared to what? Ice cream? Sure. Alcohol? No.
The only use I know of for coke is to get high. There are other “'caines” used for medicinal purposes, but I know of no medical use for cocaine.
What about alcohol…what’s the intended use of that drug?
Can somebody please explain to me how there can be an acceptable level of cocaine use, but none for crack? Is this because rich people may snort coke, but never smoke crack, because you are making it sound that way. Why doesn’t the very nature of cocaine defy an acceptable level? It is the number one cause of heart attacts for people between the ages of 16-49. It’s extremly toxic to the heart. Are you implying that it doesn’t get in the way of your health if it doesn’t kill you??
I drink a glass or two of wine a day. It’s intended use is to protect my heart.
It is a Schedule II substance. It is used as a local anaesthetic.
Actually, it’s a matter of probabilities. Dependence rates for crack are 75+%. For cocaine, 12-17%.
Because “nature” of cocaine doesn’t mean anything precise. Dosage, frequency, method i.e. parameters that affect the kinetics/dynamics, all make a difference. Coca leaf chewing and coca tea are legal and embraced in many South American countries.
Doesn’t say much until you provide the prevalence of heart attacks induced by cocaine among the 16-49 cohort.
See the ‘nature’ comment above.
Do those popular legal drugs, alcohol and nicotine, have any *other * purpose? Neither has any nutritional or therapeutic value. The *only * point of using these substances is to enjoy the effect of intoxication. It simply happens that *mild * intoxication (let’s be honest - that’s how alcohol functions as a “social lubricant”) by either of these substances is socially acceptable.
That’s the way I look at it.
I simply say that ANY use that has a statistically harmful value should be considered abuse for any of these substances. That isn’t being preachy, it is just means that use moved you towards a negative outcome. We woke up to the news this morning that my wife’s aunt (45 years old) died from smoking related lung damage. All of her smoking was abuse because it moved her to that negative outcome. Alcohol has some beneficial health effects in small quantities. However, all drinking beyond that is abuse even if it is infrequent. Other things can be abused too. Eating 4 cheeseburgers on a dare is abuse too because it is a move towards a negative outcome. Likewise, running up rocky slopes for hours can be considered abuse on the knees.
Don’t get hung up on the idea that “abuse” is always evil and will end with the more serious outcomes. It often won’t but it is a move, no matter how small, in that direction. Everyone abuses something. It takes a variety of factors to turn that into something more serious like dependence and addiction.
It usually isn’t the single occurences that are a problem. Almost everyone abuses something sometimes and it doesn’t usually end in very negative outcomes.
Which is why some of us suggested early in the posts that the issue turns on the overall economics of the balance of the benefits to cost calculation, a dreadfully simplistic way to look at the thing, but basically that’s about it. If a little nip of the toddy got old Aunt Ethel in a pleasant mood when the family visited her then maybe the whole thing was worth it in the long run, even if it might have shortened her life x number of hours/days/weeks. If Ernest Hemmingway was a hell-bent-for-leather writer whose excesses led to an early death, well, maybe we lost him way too early. But maybe we never would have had those pieces of literature to enrich us. If my friend Erine hadn’t smoked all those doobies every Saturday afternoon of his teaching career, his students wouldn’t have had all those creative experiments to work on during the week. Maybe it would have extended his life a few weeks. But maybe those students who went on to have great scientific careers wouldn’t have. And maybe he wouldn’t have been so happy to have seen his students enjoy learning. Who lost? Abuse? Use? It’s sometimes not so easy to say, is all I’m suggesting. Just putting the stuff in and taking advantage of it, and not suffering directly, or even indirectly, or causing anyone else to, or for a long long time afterward, doesn’t seem like abuse to me. Seems like use. Good use.