For cocaine users, every high is a little less great. They continue to go back for another high to try and match their last high. The horribly tragic thing about that though is they will never reach those highs again; every next high results in lower highs and higher lows.
There has been a great deal of discussion about healing the addicted brain and whether or not true healing of an addicted brain is possible.
Brain scans like these indicated that in the short term, the revival of dopamine transporter (DAT) binding is not good. One month of discontinuance still shows a stark drop in DAT binding. However, in their example, 14 months of abstinence shows an almost full return of dopamine transporter binding.
When cocaine is first used, the dopamine levels in the brain are found to skyrocket by two or three times. However, once this short high (12 hours) wears off, then dopamine levels are depressed to lower than normal levels. This is why users need that next high to get their dopamine levels back above normal; just never quite as high as previous.
Serotonin is another neurotransmitter that plays a role in the addicted brains propensity towards continued cocaine use. Serotonin is involved in a variety of physiological states impacting sexual behavior and even being culpable for things like depression. When drugs are abused serotonin is elevated. When drug users try to stop their serotonin levels are depressed.
There has been a lot of pharmacological use of selective serotonin reuptake inhibitors (SSRI) to raise a depressed individual’s serotonin levels without the use of the drugs that first elevated their high, like cocaine. That has been helpful for many people, but users still want to try and get their addicted brain fully healed.
These studies find that it’s really the behavioral effects of the addicted brain that never fully return to normal, in some cases. While the brains serotonin can be regulated through the use of SSRIs, and DAT binding returns to quasi-normal levels after prolonged discontinuance, there is always the X factor of whether or not these users will return to their prior behaviors.