Why cocaine triggers sexual violence

It is a classic of the weekend hospital shifts: the patient is brought in early in the morning by his fellow partygoers, some frightened and others childishly giggly. The young man has pupils like two black holes, is sweaty, tachycardic, and can’t stop moving. Behaviorally, he is challenging, defiant, looking for a fight. At a given moment, at the slightest frustration — a short wait to be seen by medical staff or a request for a urine tox screen, for example — he raises his voice, hurling insults, denigrating everyone present, and brutally kicks a vital signs monitor. He doesn’t know the cost, nor does he care. He is approached by a nurse who tries to calm him down but instead he escalates, sometimes pretending to be offended: “Don’t touch me!” he repeats. One that I remember noticed the young female medical intern who was with me and made a number of crude and sexist remarks to her. “I’m going to rip your head off,” he said to me.

These nocturnal scenes are not pleasant and require a great deal of patience, dedication, and a calm spirit from the medical staff. But the most shocking thing is to visit the patient the next morning and find a helpless little lamb wrapped in sheets, dazed from having slept little, sobbing and repentant.

Cocaine is by far the most widely used illegal psychostimulant in the world, with an estimated 23 million users, a number that is growing. Cocaine triggers extracellular concentrations of dopamine, noradrenaline, and serotonin in the brain, acting especially on reward pathways. This is why it initially produces increases in energy, positive emotions, and confidence. It is highly addictive and can have serious medical, psychosocial, and psychiatric consequences. As many as half of all users develop psychotic symptoms in their lifetime, including paranoid reactions, delusions, or terrifying visual or tactile hallucinations.

It is also associated with panic attacks, depression, and emotional deregulation. But another effect of cocaine is especially relevant for the coexistence and health of the victims: it is strongly associated with irritability, aggressiveness, dominating behaviour and crime. In a state of intoxication, primary instincts are unleashed, along with verbosity, grandiosity and the desire for dominance, and can be applied ferociously against the people who are closest.

Domestic violence is frighteningly common: one in five American women has experienced it. And some studies indicate that 92% of men who assaulted their female partners had consumed substances on the day of the attack, of which 67% had consumed the explosive mixture of cocaine and alcohol. A derivation of the theme is the aggressions facilitated by drugs administered to the victim, usually high amounts of alcohol.

In a Spanish study of 1,600 young women, half reported having been victims of unwanted sexual acts, comments, or advances, ranging from verbal harassment to forced penetration, with toxic substances involved. The risk increases in foreign women, women with low educational level, and non-heterosexual women. The snapshot of the study shows that alcohol consumption by the victim and alcohol and cocaine consumption by the aggressor are a breeding ground for sexual violence. Of course, it is not just a chemical effect. Contexts associated with drug trafficking, poverty, social exclusion, and lack of opportunities increase the likelihood of violence. Think of the shocking cocktail of cocaine and prostitution, where women are considered sexual objects and where violence against them is normalized.

The use of alcohol, cannabis and cocaine is dramatically rooted in our society. Someone would have to provide me with many compelling arguments to accept that tolerating or encouraging drugs is left-wing: it ruins the lives of the most vulnerable. In the 1980s, the “old professor” Enrique Tierno Galván — admirable, from what people say, in everything else — encouraged the masses with his comment that “whoever is not high, should get high.” The devastating epidemic of heroin and crime had already broken out in the working-class neighborhoods, to the misfortune of the suffering mothers. The cocaine boom was to follow, with the illusory label of a winner’s drug, and because it generated that hyper-activation so conducive to the frenetic pace of our times. With cannabis, we still have political parties that minimize its damages, against the available scientific evidence, and it is consumed by 28% of Spanish adolescents; all of them, with developing brains. Socially, taking intoxicants seems to be a sign of being cool, knowing how to have fun, and feeling part of a group.

The anti-drug discourse, on the other hand, sounds puritanical, retrograde, and punitive. So let the party continue, right? It depends on what we care about, for example mental health problems, the phenomenon of gender-based violence, or child abuse, in which alcohol and cocaine seem to be relevant. Preventing the consumption of these substances would reduce exposure to traumatic experiences, which are a risk factor for developing serious mental disorders. If as a society we really commit to prevention, one of the objectives has to be to try to reverse this distorted social perception of drugs, openly inform citizens about their neurobiological effects or the long-term consequences of their consumption, and offer treatment and help to addicted people.

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