People in treatment for cocaine addiction gain weight because the drug triggers a lasting preference for fatty foods, according to recent findings from a team of British researchers. Weight gain is a common complication of treatment for cocaine addiction, and people who react negatively to their increasing body weight have increased chances of relapsing back into active consumption of the drug. In a report published in March 2015 in The American Journal of Drug and Alcohol Abuse, researchers from the United Kingdom’s University of Cambridge assessed the potential explanations for the weight gain found in abstinent cocaine users. These researchers identified a previously overlooked possible cause: a cocaine-induced preference for high-fat foods that remains when intake of the drug ceases.
Cocaine Addiction and Recovery
Cocaine is addictive because its repeated presence in the brain can lead to ongoing alteration of neurotransmitter production in the pleasure center, a network of structures that controls the amount of rewarding sensation associated with various activities. This alteration can make the brain perceive the presence of the drug as a “normal” operating condition, a situation that marks the onset of a physical reliance on cocaine use (i.e., cocaine dependence). The vast majority of people dependent on cocaine rapidly develop the uncontrolled pattern of drug intake that signifies the arrival of full-blown cocaine addiction. Despite longstanding research efforts, doctors have no medication-based option to reliably help people affected by cocaine dependence/addiction. This means that cocaine treatment programs lean heavily on non-medication-based psychotherapeutic options commonly known as behavioral interventions. One form of behavioral intervention, cognitive behavioral therapy, seeks to help program participants identify and change dysfunctional stress reactions that increase the likelihood of turning to substance use as a coping mechanism. Another approach, called contingency management, uses some form of incentive system to improve recovery participants’ desires to follow program rules and meet treatment objectives. Some people receive treatment in residential settings, called therapeutic communities, which rely partially on client-/patient-established social norms to promote ongoing program compliance and participation. Abstinence-based 12-step programs and other mutual self-help organizations also often play a role in cocaine treatment.
Weight Gain and Cocaine Relapse
Cocaine abstinence is frequently accompanied by an uncomfortable and potentially physically and emotionally detrimental amount of weight gain. Unfortunately, significant numbers of people in treatment relapse back into active cocaine consumption as a conscious or unconscious response to a substantial increase in body weight. Researchers have proposed a range of possible explanations for the spike in weight associated with cocaine abstinence, including a return of normal appetite after a period of cocaine-induced appetite suppression. However, in a study published in 2013 in the journal Appetite, researchers from the University of Cambridge proposed a new mechanism for cocaine abstinence-related weight gain: a cocaine-induced reduction of the body’s natural ability to store fat. Under the terms of this theory, active cocaine users undergo a metabolism change that lowers their fat storage at the same time that they experience a shift in dietary preference to higher-fat foods and weight-promoting carbohydrates. When cocaine consumption ends, the new dietary preference remains and leads to weight gain when the body’s metabolism experiences a return to its normal function.
Underlying Reasons for Weight Gain
In the report published in The American Journal of Drug and Alcohol Abuse, the same University of Cambridge research team responsible for the 2013 study in Appetite further refined and explained the theory of altered fat metabolism and a cocaine-induced preference for fatty food as the underlying reason for significant weight gain in addicted cocaine users who successfully establish a pattern of abstinence. The researchers concluded that cocaine-related alterations in normal fat metabolism may be the result of changes in the levels of naturally occurring human proteins that control fat storage, as well as the result of changes in the function of the sympathetic nervous system, an involuntary nerve network that helps maintain the body’s “fight-or-flight” response and plays a role in food digestion. The researchers note that abstinent cocaine users often don’t make any substantial changes in their daily diets, and therefore can’t understand why they’re suddenly putting on weight. The lack of an explanation for their situation can potentially consciously or unconsciously increase the desire to return to cocaine intake. The researchers also note the need to incorporate expectations of weight gain into cocaine treatment programs, as well as increased understanding of the reasons why such weight gain occurs.