Cocaine Addiction

Taken from the book: "Cocaine de Legend" by Jorge Hurtado(psyquiatrist)

Cocaine base ( the south american Crack or "pasta")

This is the first step in the extraction of the alkaloid.From the chemical point of view, the impure base, is infact a coca concentrate.  The sulfuric acid is the principal reagent, in this first stage and it is also responsible for the anhydridesulfurous that is made when pasta is smoked.  Lime, sodiumcarbonate and kerosene are also necessary components of the pasta, as well as many impurities that result from this rudimentary production, such as: plastic containers, gumboots (not always acid resistant) and, in the majority ofthe cases, the bare feet of the "pisa coca" (a "coca leavepresser"). 

The protein, vitamin and mineralogical components, generate countless numbers of chemical compounds whose influence in human physiology is totally unknown yet. In the best of cases, cocaine represents only a 30% of sulfate.  This chemical diversity of the pasta is enough to explain the serious toxic effects of this phase, a prior state of cocaine.  But I believe that it is also the way of administration that is responsible for this substance's devastating effects on the organism.

The cocaine pasta is consumed through the pulmonary passage.  The drug mixed with tobacco is burned as a common cigarette.  It contains approximately 30% pasta and 70%tobacco.  This "loaded" cigarette is manufactured by the user and it is known as pitillo o bazuco in the Bolivian oriental region.  Another frequent way of trade within the high land (altiplano) people is a little pipe, made from tin paper called "toco", adding another toxic element to the already venomous pasta.  The burned tin-plated paper,along with the smoke coming from the burning pasta, is absorbed and retained in the lungs for a few seconds.

EFFECT OF PASTA IN LOW DOSES

A 100 mg dose, is what we can call a low dosage.  It produces the same effects of cocaine crystal in the organism: general acceleration or increment of basal energy and of the emotional tone.  Nevertheless, the effect is much faster and briefer.  Just as the dosage and time increases, the pasta effects differ radically from the effects of cocaine crystal.  In just a few minutes, the effects start to disappear, and one has the desire for a new dose to maintain the "level".

EFFECTS OF PASTA IN HIGH DOSES

On the other hand, if the initial dose is around 200 mg. or more, depending on the user, the famous flash or high of pasta is reached: a broadening of the forehead and basically, a pleasant state similar to a sexual orgasm,although not genital, is felt. 

The sensation localized mainly in the chest is one of plenitude, satisfaction or peace.  There seems to be a closer unity or contact with life, a greater perception of oneself, that lives and perceives that exact moment.  "A sweet taste of sex impregnates the immediate atmosphere, but not a normal sex,a prohibited sex, sinful, as the thousand promises of the exotic Babylonian prostitute" (Lucifer).

Nevertheless, that association to the  "sexually-prohibited", appears to remain as just that, because in the majority of the cases of high doses of pasta, contrary tothe cocaine crystal effect, difficulties for erections and inclusively a manifested rejection to sexual activity occur.  This constitutes one of the facets which I havecalled the pasta's great paradox.
The flash or high of pasta, known as such most likely because of the fugacity with which it happens, disappears in a matter of seconds.  All the sensations that it created"deflate", leaving in its place a unpleasant sensation of emptiness, the "void" of dissatisfaction that vividly contrasts the previous "semi orgasm".  The sensation of having come close to a very pleasant effect with the need to finish, to "fill the void", are more than urgent. It is easy to believe that the next dose will definitely be the one that will reach the ecstasy, rushing to take it. It is the same as an incomplete orgasm that immediately impulses the search to reach one.  The desire flash never arrives, despite the effort and certainty that the user has of reaching it. 
The repeated doses, one after another,aggravate the need for pleasure that it is searched forwith the new dose.  The void grows more each time, like a snow ball effect, that drags the user like a puppet without will. He has put himself in a pendulum that oscillates between reaching pleasure and reaching pain.  The journey is the pasta and the return is absence.The well known fascination that the abyss exerts on the diver, to the point of totally absorbing him, is a good illustration for these strange phenomena of the world of pasta.  In both cases, the drug user, such as the diver,travels fascinated in search for the extraordinary promise of pleasure beyond what already is experienced.  But they only find destruction, a fact that becomes quite evident for the drug user.  At least the divers are adverted fromthis danger, which they learn to overcome.  The pasta user,most of the time, before he realizes it, is caught by the fascinating song of the Great Prostitute of Babylon, as defined by Lucifer.
The new dose leads to the next one and days, weeks and inclusively months of continuous use can go by, in which among few people, some kilos can be consumed.  They become unaware of themselves in search of the ultimate unknown pleasure: the lost paradise.The activity of compulsively repeating the dosage, so appealing of the pasta, acquires grotesque or caricature characteristics within a short time of commencing the use.The ritual of preparing-lighting-smoking monopolizes the user's activity to an incapacitating level.
  All otheractivity becomes second rank.  In best of cases, it is replaced by other equally compulsive acts such as the searching for the drug in their pockets, on the floor, or to revise the body meticulously in search of irregularities, scabs, pimples, etc..  At times it can even reach tactile hallucinations.
In the beginning, the drug may well cause loquacity, but it finishes on sterile verbiage.  When the dose is increased a tendency of non-communication overcomes the user. Isolation is the rule.  The "shut mouth" of the "pitillero"(pasta smoker), may have its origin not only in the high indexes of anxiety that go along with high doses, as we will see later, but also in a contraction of the chewing muscles, to an anesthetic level of the buccal cavity ,specifically on the tongue, and certainly in an acceleration of the train of thought, that does not correspond with the larynx.

The increased state of vigilance and alertness due to the low doses of pasta quickly degenerates, as the dose increases, into an in crescendo anxiety which characterizesthe symptomatology and monopolizes it in advanced stages. With this, the habit becomes a painful and masochistic act. This is why both terms are often utilized by the users in reference to their habit.  If the doses continue to be administered the psychomotor agitation, expression of the highest anxiety and effect in itself of the adrenergic increase of power, becomes more evident, trembling and widespread perspiration occur. The face is characterized by the following: pale appearance, eyes wide open and certain muscular contractions that give the user an appearance of extreme seriousness and fear.  Tension and excess o fenergy, force the user to walk senseless from one place to another, or to do any activity compulsively.  There is the permanent desire to go or to escape. If a conversation occurs, the voice is insecure, whispered, low enough to avoid being heard.  Insecurity and mistrust gain terrain:anything strange is feared and "one looks through the windows moving the curtains slightly ".  There is a stateof hyper-vigilance, an expectation of some undefined but catastrophic event.  That is why, any event out of the normimpacts strongly.  Common noises, normal not long ago, acquire different meaning and are intensely felt, as it was in Michael's case:

  In addition to pasta, he loved a set of music tapes from which he almost never depart from. Some neighbors that knew " Michael's Achilles heel", patiently waited for the afternoon hours, in which he used to puthimself in the arms of the pasta.  Once this occurred, they would enter his room precipitately and making as much noise as possible. Of course, they took more time entering the refuge of our sensitive and selfish pitillero than getting out of it, and not only with the appreciated musical tapes but also with any other thing that these astute and opportunistic friends could get their hands on.

The hyper-stimulated user of pasta will sacrifice anythingto escape from the excessive sensorial stimulus, and above all, from strangers to his world.  For this reason, the long hours of the night are taken advantage of, because the possibility of noisy and foreign interruptions are few. The preferred hour to start using pasta is at sunset and, if he has to sleep, he usually will prefer doing it during the day.When the use is prolonged for several consecutive days, the characteristic hyperactivity of the beginning can reverse itself. Although the tension is higher, movements becomeslow and difficult. The user can remain seated or lay downfor a long time and it seems as if his few movements were made in slow motion, as in Parkinson disease.The fertile terrain, where paranoia will settle and grow,is given.  Final and always present outcome through theprolonged self-administration of cocaine pasta.

.THE PASTA'S PARANOID SYNDROME.

Slowly, as the consumption of pasta continues, anxiety,hyper-vigilance, fear of being discovered, guilt suspicionand mistrust dominate the individual's psychic until itcompletely separates him from reality. Before he realizes, simple suppositions and fears become certain. He believes that he is being pursued to be hurt; the shadows of the night hide fantastic threats. The neighbor, until this moment affable, turns into a superagent of the law who is able to listen through walls or read his mind. That is why, you must listen attentively before lighting a match, the scratch seems to be amplified by the shadows. The passers-by that come back home very late at night are objects of a very attentive watch through crevices on doors or windows.  Any out of the ordinary action, such as the tying of shoelaces or the lighting of acigarette exactly in that area, are reason enough for paranoia. These are signs or warnings of danger, that should be counteracted by escapades or long minutes of a total and tense immovability.  Fantastic voices are heardthat threaten or insult.  Some times, terror dramas become real, quite elaborated, fantastic stories of blackmail and persecution. The pitillero believes that he is the center of attention, everybody worries about him and his problems. People have made devices to control him at a distance andhe is capable of magical powers on others.The paranoid state, by pasta intoxication, is almost no different from serious mental affections. Contact with reality is seriously affected. The disorganized conduct,contrary to the paranoiac desire, draws people's attention.Because of this, a great number of people detected by narcotics police owe their success to this mental disorder.Because friends or relatives' logical reasoning does not succeed in changing the frenzied (unreal) ideas ofpersecution or harm, the intoxicated individual tries to protect himself by escaping or isolating himself. 

Thejungle of the Eastern part of Bolivia has turned into a pitillero's dramatic resource for an intuitive and desperate "treatment".  Flung by the anxiety of paranoia, he escapes into the forest, from where, sometimes, he returns days later shaken up from his craziness.  In the eastern towns of Bolivia I have seen real zombies.  They escape to the jungle, without any means of protection, the siege of insects and beasts of prey ravages the already debilitated bodies, which surely have some days of fasting. The refusalto eat, effect of the pasta, can be reinforced by their fear of being poisoned and thus aggravating the prognostic.

COLLECTIVE PARANOIA.

The use of paste is full of absurd, improbable and-caricatural stories. Because the use of pasta among somepeople is frequent, the paranoia due to prolonged use can happen collectively. This was the case of five individuals that dedicated themselves to smoke for several hours. Within many of the susceptibilities that began to appear,there was the one related to the pitillo's penetrating smell and the possibilities of having it noticed by neighbors. Soon, the simple supposition became a certainty; panic dominated the atmosphere and after the last and precious grams of paste ended in the drainage, they endedup hiding in the most improbable of places: under the beds, in the attic and, wherever each of them could find security. Some hours of tense and anguished expectationpassed by. The report was never made, the police nevercame.  Surely, the absence of the drug, allows the user to return to a disconcerting reality.

CONTROLLED PARANOIA

Among chronic users, it is common to hear about "controlled paranoia" to denote a previous state to the one described above, which is characterized by certain control that an individual, quite skilled on smoking, can exert over his ideas of harm and persecution.  Certain protective measures, such as buying a limited quantity of pasta, forced feeding, sleep at least some hours during the day and above all not to loose social contact, are taken for this effect.  Of course, it is assumed that such things can be done only by an expert, someone that knows pasta and its effects very well, who also possesses intellectual capacities, and more specifically a certain emotional balance.  The "controlled" paranoia is a very deceptive state and can, due to an unforeseen event, degenerate into a typical out of control paranoia.

Generally, pasta produced psychotic paranoid states can disappear naturally, hours or days after having discontinued the use, provided that there is not a previous history of mental unbalance.  In such cases, the psychotic states can establish themselves definitely, the pasta being just one more of the unleashing factors.  The same can happen with other drugs, such as alcohol, hallucinogenicsor serious problems to adapt to his environment  However,in individuals considered normal, if intoxication and subsequent paranoid states last during long periods oftime, permanent personality paranoid or very deep psychosis traits can develop, all rebellious to medical treatment.

Jose's case is quite illustrative (*),a school teacher,born in Beni, (a Department of Bolivia), 24 years old,married.  Known, in his town, for his extroverted and agreeable character.  He started to experiment with"pitillos" (cigarettes made of tobacco and pasta) onweekends, when he was having a good time with friends around the ever present bottles of beer.  Later, problems caused by a premature marriage and financial demands that were impossible to satisfy with his reduced salary, motivated him to increase the use of pitillos to every day of the week trying to draw the sorrows.  Weeks and months of continuos use went by.  The paranoid state started to take root, with briefer and briefer remission periods untilit installed itself into a permanent psychotic state tha tcontinued even through a forced abstinence provoked by alarmed relatives.  In this state, he was brought to LaPaz, where, under my supervision, he was treated at the Social Security Psychiatric Hospital.  The psychotic statewas deep.  Jose was convinced that the government was chasing him to kill him because he knew too much about drugtraffickers.  To him, his confinement at the hospital was an scheme to eliminate him; his roommate was a governmentagent in charge of killing him.High doses of neuroleptics were needed during several weeks to put an end the paranoid ideation and to equilibrate a little of Jose's damaged psychological state.  When he resumed contact with reality, the florid paranoid ideation was replaced by an abulic anhedonia depressive state, alive without colors.  This state is characterized by aserious face, inexpressiveness, uncontrollable susceptibility and irritability. High doses of antidepressants imipramine type drugs were administered until Jose was out of danger.  Nevertheless, he surprisedme with a request: he wanted to remain for some time at the Hospital.  The countless times that he had attempted to leave the pasta in vain, had taught him something: that it was impossible to trust his own will.  He recognized thatit would be impossible to control himself if he had pasta near him.  He also knew that at home, pasta would be within hands' reach.

  Fortunately, relatives that lived in La Paz accepted to take him in for some months, thus prolongingthe withdrawal from the drug.  I saw him again three years later, quite improved.  He had partially recovered his cheerfulness and sense of humor.  He told me that he had recesses, and because of that he decided to accept a job in a faraway hacienda which could only be reached by plane.This was the only way, until today, to get away from the drug.

While the pasta induced resolution of paranoid states, can abate spontaneously once the toxic administration is interrupted or, as we have just seen, through the use of medication and isolation, this is just one of the many problems encountered because of this substance.  As was revealed in the cocaine crystal marathon runners' study, a real abstinence syndrome is non existent.  These states can be interrupted abruptly, without having the habitual user going through the painful "hunger" for drugs state that characterizes the physical dependency.  It is replaced by an automatic or compulsive behavior that can, if the drugis at hands reach, eternalize the usage.  In the last few years, when I was in working at the Health Ministry's DrugAddicts Treatment Center, I was able to ascertain the lackof the abstinence syndrome, typical of the physicaldependency as in the opiates. 
There, we evaluated thepeople detained by the anti narcotics police.  These users, once detained, were brought in for a medical evaluation, many in full and prolonged states of intoxication. Nevertheless, they could manage relatively well and did not show desperation to find the drug, even though they wanted it.

Whoever has been a pasta lover and has enjoyed its voluptuous pleasures, even if it was for a short time, becomes like Odysseus' fascinated crew, incapable of resisting the sirens song even at the cost of their lives.That is why, whoever has lost control, even if only once,to pasta's arms, must do the same as Odysseus and his men: tie themselves to the ship's mast, so that even if theydesire, they will not be able to answer the irresistible call of the undine.

  In this case is useless to trust inwill power, because the phenomena is independent of it, due to a mechanism that we will analyze later.  At this level,the user is divided in two.  On side that desperately fights against the habit and recognizes it as something absurd, painful and destructive at the same time and as a last resort, the sought after pleasure dilutes itself in the intent, leaving only frustration. 
It is the weak"guardian angel" that wears himself out in promises,despair, reproaches and guilt.  And there, at the bottom,behind the scenes, in the darkness of the unconscious, is the other automatic mechanism: a true mischievous little devil that "casually" steers the car's wheel to the corner where pitillos are sold.

I have heard it been said from more than one pasta lover,that they sometimes find themselves walking and looking for the drug almost not realizing what they are doing.  This is just minutes after making the greatest abstinence promises.The longer the habit lasts, the stronger and more rebellious will the little devil lover of pasta is, and more certain the relapse.  In this manner, an internal fight is established between both sides, of which it is very difficult to escape with out the help of another person that can "tie them to the ship's mast" as the seducing pasta smoke passes by.

Maria N., a young 27 year old, refers her experience.  She had used pasta, routinely for a year.  After she noticed that it was impossible to get out on her own will power,(of which she had always felt sure, until the out ofcontrol relapses demonstrated the opposite), she searched for medical help and was confined for treatment at the Hospital:

..."...today something strange happened to me.  After lunch, as always, I took a nap.  I woke up at two o'clock and automatically got dressed very quickly.  The only idea in my mind was to go out and buy another "sobre" stash (withpasta); it did not even cross my mind where I was.  After I got dressed, and as I was going out of the room, I realizedthat I was confined in this clinic.  My anxiety was so strong, that I even thought of making an excuse so they could give permission to go out. I think my good part won, because I started to analyze my situation and realized that it was ridicule and absurd to go out, and above all, to ruin the effort that I was making and to lose the trust of the doctors that have been supporting me"

The Automatic Drug-Search Behavior manifests itself invaried ways, but it always shows itself in a dissociate state.  In the most severe cases it can be expressed by an absence of one self or by a perturbation, an almost non-perceptible by the conscious, a kind of confusion or lack of mental clarity, like when awakening from a dream, in a state of drunkenness or in an state of rage that characterizes a fight.  In general, it seems that while the habit is more consciously opposed, the more indirec tresources it will find to satisfy itself or, it wil lprovoke more intense interruptions of the consciousness.

That is why, a person trapped by the pasta and who wishes to get out of it, must save their energy.  He should better concentrate in establishing the Odysseus' strategy instead of fighting the habit, and waste his efforts.  This shouldbe done with the help of an honest relationship of a relative, friend or doctor that understands the problem and can serve as loaned will power while the danger lasts.

This of course, is one more of the measures that must betaken in this respect.For all that has been mentioned, it does not surprise me that in different places, in an independent manner, the term "satuquearse" (satuco means the devil, so the term means to drench one self with the devil) is used in reference to the consume of pasta.  Is a direct allusion to the Devil or Satan.  The pitillero suffers a progressive disorganization of his life, abandons his routine obligations, work, social contact and especially personal cleanliness.  There is a noticeable rejection to bathe. The atmosphere around him is dirty, from the handling of the drug, which must be previously mixed with tobacco, to the countless burned matches.  The long hours of nightvigil, added to the expression of fear and seriousness, give the face a cadaverous and wan aspect.  Their also exists a sulfuric and penetrating pasta smell, and excessive transpiration and unkemptness, to the point thatthey are confused with beggars..  All of this added to paranoia, perfectly conform a diabolical picture, in the common sense of the word. Lastly, many users accept to find in pasta a real perverse pleasure that is painful at the same time. 

"Truly,- said apitillos dealer- what we sell is paranoia in smoke. When myclients do not find paranoia in my merchandise, they think that I have cheated them" I have seen this association to go beyond a simple comparison.  A patient, quite deteriorated, reported to me his relapses as evil possessed states and, in his deliriums, he saw me as a dangerous exorcist."