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A mother wrote and asked about her adult daughter and whether certain drugs can damage the brain?

She wrote: My daughter had been stable and working part time for the past 5 years after 20 years of illness (a serious mental illness with psychotic episodes and co-occurring substance abuse problems). She had been taking 15 mg of Abilify (an antipsychotic medication) and was doing pretty well, functioning at a relatively high level. She relapsed into drugs last October and began using cocaine even while on 70 mg of methadone. She never completely stopped the Abilify although she took much lower doses.  She was voluntarily hospitalized in a psychiatric facility for 4 weeks in January.  She is now back living in the community and attending a day program where she is tested for drugs 3x a week.  She went back on the Abilify but she has not really stabilized.  Her doctor at the hospital said that her brain was very sensitive to using cocaine and methadone at the same time.  He suggested further damage to her brain. 

She asked: Is that possible?  Have you heard of someone not returning to a previous state of functioning due to the use of cocaine and methadone simultaneously?  Are we not waiting long enough?

My reply: Two troubling ways in which a person’s brain can be badly affected by using street drugs are from 1) the drug and what it is mixed with and 2) from untreated mental illness.

1)   Abuse of cocaine, in its pure form, leaves the brain depleted of dopamine, a neurotransmitter that affects many parts of the brain’s function. Repeated use of cocaine also appears to have an effect on the blood vessels in the brain. The more cocaine used, the longer it takes the brain to recover from this depletion or vessel damage. On top of that, when someone takes cocaine there is no knowing what they are taking. Street drugs are cut with all kinds of additives and impurities. Some are just filler but others are meant to give the drug more kick since it has been diluted before it is sold. So, using cocaine, or any other street drug, means using more than what a person intended. The additives themselves may cause damage. Since we cannot know what else was in the white powder, we cannot say what else might be doing harm to the brain – but the risk is there.

2)   Psychotic illness has been called “neurotoxic”. This means that the illness itself, untreated and unchecked, can cause damage to the brain. Serious mental illnesses, like schizophrenia and schizoaffective disorder, are characterized by psychotic symptoms – or loss of reality and the presence of hallucinations and delusions. Individuals who have repeated episodes of psychosis and refrain from getting effective treatment are at risk to do more poorly in their lives over time. Hypertension is an example of a progressive disease that produces mounting damage if untreated (to blood vessels, and ultimately to the heart). The brain, like our blood vessels, needs to be protected from disease. While debate exists as to how cocaine causes problems in the brain, whether directly to the nerve cells or the way they connect to one another, the consequences can be grave.

Treatment can and does work, but far too often those who can benefit do not get the care they need. As I say on my home page, less than 20% of people with a serious mental disorder get properly diagnosed and effectively treated. Understanding mental illnesses and what treatments work are essential in rebuilding a life (as it is for families to know how help your loved one). It is never too late to start.

For more information on cocaine and other street drugs, go to The National Institute on Drug Abuse website at

For more information on untreated psychosis, a major psychiatric journal reported on important findings that pertain especially to people early in the course of their illness. The journal citation is: Perkins, DO, Gu, H, Boteva, K, Lieberman, JA: Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia; American Journal of Psychiatry, 2005;162:1785-1804

Dr. Lloyd

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