Mapping the trajectory from use to abuse: perspectives of individuals with a cocaine use disorder

Abstract

This study aimed to explore how individuals with a cocaine use disorder (CUD) perceive their transition from recreational to problematic use, with a focus on the biopsychosocial processes that shape this trajectory. Nine participants were recruited through purposive sampling from rehabilitation services across Malta, with eligibility based on DSM-5-TR criteria and treatment engagement. Semi-structured interviews were conducted, and Reflexive Thematic Analysis was employed to identify patterns across participants’ experiences. Findings revealed that cocaine use often began in socially sanctioned contexts, with initial use perceived as manageable or recreational. However, a gradual shift toward psychological dependency, compulsive behaviours, and interpersonal deterioration was consistently described. The transition to problematic use was not linear, but marked by accumulating vulnerabilities including trauma, emotional dysregulation, and neurodiversity. The biopsychosocial model and Five P’s idiographic framework were applied to capture the complexity of these processes. Participants identified social reinforcement and internalised denial as key perpetuating factors, while protective influences, such as structured support and therapeutic intervention, were often activated only in moments of crisis. These findings underscore the importance of person-centred and contextually grounded approaches in treatment planning and highlight the need for earlier psychosocial intervention. This study contributes to local addiction literature and supports the call for culturally attuned, evidence-based policies in addressing CUD.