Drug-induced ego states. I. Cocaine: phenomenology and implications.

The ego state experienced by chronic users of cocaine is described in terms of sensorimotor functioning, cognitive functioning, emotionality, spatiality , temporality , causality, and materiality . At low use levels the state is pleasurable, but at high levels fear, anxiety, and paranoia increase, and ultimately reality contact breaks down. Q-sort, Semantic Differential, and other data suggest that low-level users take cocaine to overcome personal insecurities and relieve boredom. Heavy users take it to support overvaulting ambitions and intense strivings for self-sufficiency. Psychotherapy with such persons must deal with their counterdependency , anger, and despair, and with their underlying sense of betrayal . These persons have unacknowledged needs for spiritual experience that must be dealt with openly. A description of persons most vulnerable to heavy use of cocaine is provided, and recommendations for research and social policy are presented.