Cocaine Use Is on the Rise

Cocaine use is increasingly prevalent among high-achieving professionals.

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The stakes for cocaine use are higher than ever due to a dangerous and often unrecognized threat: fentanyl contamination. Fentanyl, a synthetic opioid 50 times more potent than heroin, is increasingly being mixed into cocaine supplies, often without the user's knowledge. Even trace amounts can trigger respiratory failure and death, posing an extreme risk to individuals who never intended to use opioids.

A Growing Crisis: Key Trends to Know

The numbers are stark. According to the CDC, as of 2022, over 50 percent of overdose deaths involving cocaine also involved opioids, primarily fentanyl. This phenomenon is contributing to sharp rises in cocaine-related medical emergencies and fatalities across the country.

What’s particularly concerning is that many cocaine users fall into demographics clinicians may not immediately associate with substance use:

• Functional adults aged 25–45
• Baby boomers and older adults
• Professionals and executives

The prevalence of cocaine use disorder has increased for specific demographics, including older adults and women.

The concurrent use of stimulants and opioids (polysubstance use) increases the health risks associated with drug use and exacerbates the risk of overdose.

Often, private practice psychotherapists are the first point of contact for clients who use cocaine and are seeking help. Functional, educated adults with social and economic status are often hesitant to approach traditional addiction services due to stigma, privacy concerns, or misconceptions about their substance use.

Therapists will need to disentangle cocaine use from co-occurring mental health struggles such as anxiety or depression.

Vignette: A Familiar Story in a New York City Office

James, a 37-year-old corporate attorney in New York City, seemed to have it all—a partnership track at a prestigious law firm, a stunning apartment in Manhattan, and a thriving social circle. But beneath the polished exterior, James was drowning under the weight of his 80-hour workweeks and mounting anxiety. At first, cocaine felt like a solution. A bump before a late-night deadline made him sharp and confident. Soon, the occasional use turned into a regular habit.

James justified it: he was successful, his career wasn’t suffering, and cocaine didn’t “control” him. That is, until one evening, after using cocaine at a party, he experienced a sudden, overwhelming feeling of dizziness, chest pain, and shortness of breath. At the ER, doctors discovered traces of fentanyl in his system, a life-threatening contaminant he never knew he had consumed. It was a wake-up call.

Shaken but alive, James sought help through a psychotherapist. What started as addressing his substance use quickly evolved into tackling the underlying issues: the unrelenting pressure to succeed, his anxiety, and his unhealthy coping strategies. Through integrated treatment that combined motivational interviewing, CBT, and harm reduction, James began to reframe his relationship with both work and substances. Today, he’s healthier, more focused, and better equipped to manage stress without destructive behaviors.

Why Clinician Preparedness Matters

James’s story is far from unique. Cocaine use and its growing association with opioids demand a shift in how mental health professionals approach substance use assessment and intervention. For many clients, substance use isn't just about addiction; it's a complex, psychological coping mechanism.

Key considerations for psychotherapists include:

• Mental Health Comorbidities: Cocaine use frequently exacerbates mood disorders, anxiety, and risky behaviors, including paranoia, suicidal thoughts, and impulsivity. Addressing both substance use and mental health concerns simultaneously is critical.
• Integrated Treatment Approaches: An individualized, client-centered strategy that balances harm reduction goals with abstinence options offers the flexibility clients need to engage meaningfully in treatment.
• Building Trust with High-Functioning Users: Many clients are highly functional and fear judgment. Offering a non-stigmatizing space where clients can openly discuss their use without shame is key to creating treatment breakthroughs.

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What You Can Do as a Clinician

Here are a few actionable steps psychotherapists can take:

• Educate Yourself on Emerging Trends: Stay updated on the intersection of cocaine use and fentanyl contamination. Knowledge empowers you to ask the right questions during intake and ongoing therapy.
• Be Alert to Bias: Men are still the majority of cocaine users, but the share of women who use cocaine is on the rise. Highly functional professionals can be cocaine users. Older adults can be cocaine users.
• Refine Your Assessment Skills: Develop screening strategies to identify not only cocaine use but also possible opioid exposure, even among clients who may not disclose their use readily.
• Adopt an Integrated Approach: Address underlying psychological issues alongside substance use. Tools like motivational interviewing, harm reduction strategies, and CBT can be tailored to clients at different stages of readiness.
• Collaborate with Other Providers: Build relationships with addiction specialists, psychiatrists, and harm reduction programs to offer clients comprehensive care when needed.

Treatment with Nuance and Compassion

Cocaine use, particularly among employed adults, often exists in the gray area between functional use and addiction. The clinician's role is to offer tools for change and understand the deeper psychological and situational factors driving the behavior. Whether clients seek abstinence, harm reduction, or simply support in understanding their patterns, your willingness to meet them where they are can make all the difference.

As this crisis evolves, mental health professionals have an opportunity—and responsibility—to step forward with informed, compassionate care. Your expertise matters. Your awareness could save lives.

© 2024 Dr. Arnold Washton. All rights reserved.