Substance Abuse Cocaine

Cocaine and crack cocaine are addictive stimulants derived from the erythroxylon coca plant, a South American bush found mostly in Peru and Bolivia. Cocaine is the most powerful naturally derived stimulant on the planet.

South American Indians have chewed the leaves of the coca plant as a stimulant for centuries, but cocaine abuse really became an issue only in the 1880s, when cocaine hydrochloride, the pure psychoactive ingredient found in the coca plant, was extracted from the leaves.

Cocaine is classified as a Schedule II drug in the United States, indicating that, while cocaine has some limited medical applications, the potential for cocaine abuse and addiction is high. Crack cocaine, a derivative of cocaine developed in the 1980s, is a smokeable form of cocaine.

U.S. Cocaine Abuse Statistics

The 2003 National Survey on Drug Use and Health estimated that 34.9 million Americans over the age of 12 have used cocaine at least once. Out of this number, 5.9 million survey respondents reported cocaine or crack cocaine abuse in the 12 months preceding the survey, and 2.3 million reported cocaine abuse within the last month. The number of first-time cocaine users in 2002 was estimated at over one million.

Cocaine and Crack Cocaine

Cocaine available on the street comes in two forms: a fine powder and “freebase” or crack cocaine.

Powered cocaine is usually “cut” or diluted by dealers. Cocaine is commonly cut with cornstarch, talcum powder, sugar or other drugs. Other additives found in cocaine have included chalk, caffeine, laundry detergent, baby laxatives, meat tenderizers and rat poison.

Freebase, or crack cocaine, also called crack, is made by processing cocaine with ammonia or baking powder and water to remove hydrochloride salts. What is left is crack cocaine, a solid, smokable form of cocaine. Crack cocaine gets its name from the “crackling” noise it makes when heated.

Methods of Cocaine Abuse

Cocaine abuse comes in many forms. Cocaine may be taken orally (known on the street as “chewing”), or intranasally (snorting). When dissolved in water, cocaine can be injected into the bloodstream (mainlining). Crack cocaine abuse usually involves smoking the drug, which delivers cocaine to the brain as quickly as mainlining the drug.

Both cocaine and crack cocaine may be combined with other drugs, most commonly marijuana, heroin and PCP.

Treatment for Cocaine/Crack Cocaine Abuse

Cocaine and crack cocaine abuse is the third most common reason for admission into drug treatment programs. Treatment for cocaine addiction, at present, is confined to counseling and behavioral therapy in either individual or group settings. No medications are approved to treat cocaine or crack cocaine abuse, although antidepressants can help recovering cocaine addicts cope with the erratic mood swings that often characterize the early recovery period.

Cognitive behavioral therapy helps recovering addicts identify triggers for cocaine or crack cocaine abuse and relapses, and also helps the patient develop healthy coping strategies to handle drug use triggers without resorting to cocaine.

Contingency management is a reward-based therapy designed to keep addicts in treatment and cocaine-free. Participants receive vouchers for staying in treatment programs and not using cocaine. Vouchers may be redeemed for positive rewards: dinners, free movies and other positive, drug-free experiences.

Although no medication is approved for cocaine or crack cocaine addiction recovery, several promising medications are under review. Disulfiram (Antabuse®), a medication used to treat alcoholism, has shown some effectiveness as a cocaine abuse treatment in clinical trials. Topiramate (Topamax®), modafanil (Provigil®), and baclofen (Loresal®) may prove helpful in cocaine abuse treatment. One medication in particular, selegiline (Eldepryl®), has promising applications for cocaine abuse treatment, but researchers have yet to determine an appropriate delivery method for the drug.

Effects of Cocaine

Cocaine causes euphoria by blocking the brain’s ability to limit dopamine levels, especially in the brain’s pleasure centers. As dopamine levels accumulate, the cocaine abuser feels a sense of euphoria and overall stimulation that may last from minutes to hours.

Physiological effects associated with cocaine or crack cocaine include constricted blood vessels and an increased heart rate. The pupils of the eyes dilate, and both body temperature and blood pressure rise.

Low doses of cocaine or crack cocaine generate euphoria and mental alertness. The abuser may become talkative and energetic. Cocaine abuse also increases a person’s sensitivity to visual and tactile stimuli during the acute effects of the drug. Some cocaine abusers take cocaine to complete simple tasks faster.

High doses of cocaine or crack cocaine can produce violent and paranoid behavior. A pattern of cocaine abuse called binging (repetitive cocaine abuse at increasingly higher doses) causes increasing restlessness and paranoia that may culminate in hallucinations and paranoid psychosis.

Health Effects of Cocaine and Crack Cocaine

The most immediate health concern associated with cocaine or crack cocaine abuse is a fatal overdose. Any method of abuse may lead to an overdose. Toxic levels of cocaine or crack cocaine in the body can result in acute cardiovascular or cerebrovascular emergencies — severe circulation problems to the heart or brain. Sudden death from cocaine or crack cocaine is a risk with every single dose taken.

Cocaine abuse leads to addiction, causing a compulsive need to re-experience the euphoric effects of the drug. With cocaine addiction comes an increased tolerance of the drug’s effects: Progressively higher doses of cocaine or crack cocaine are required to produce the euphoric “high.” Higher doses of cocaine or crack cocaine, of course, increase the possibility of a fatal overdose.

Symptoms of cocaine or crack cocaine abuse include:

  • abdominal pain
  • blurred vision
  • bowel gangrene (from “chewing”)
  • chest pain
  • chronic malnutrition
  • coma
  • convulsions
  • fever
  • headaches
  • heart attacks
  • heart rhythm disturbances
  • hoarseness (from snorting)
  • impotence
  • loss of appetite
  • loss of smell (from snorting)
  • muscle spasms
  • nasal inflammation (from snorting)
  • nausea
  • nose bleeds (from snorting cocaine)
  • respiratory failure
  • runny noses (from snorting)
  • seizures
  • strokes
  • needle puncture (track) marks from injecting cocaine.

Intravenous cocaine abuse can trigger fatal allergic reactions, either to the cocaine itself or the many additives used to cut the drug. While powdered cocaine dissolves easily, substances added to cocaine often do not. Partially dissolved substances may build up in the arteries and eventually obstruct them.

Cocaine, Crack Cocaine and Alcohol

When cocaine or crack cocaine is taken in combination with alcohol, the body converts both drugs into cocaethylene, a chemical more toxic than cocaine or alcohol alone. Cocaethylene remains active in the brain longer than cocaine. Cocaine or crack cocaine abuse combined with alcohol is responsible for more deaths than any other drug combination.

Hepatitis, HIV/AIDS and Cocaine Use

Hepatitis B, hepatitis C and HIV/AIDS infection rates are very high among cocaine abusers, especially among intravenous drug users. Sharing needles has led to an epidemic of these diseases among cocaine abusers, so much so that an estimated sixty to ninety percent of intravenous drug users are infected with hepatitis C. Intravenous drug use is also considered a leading factor in the spread of HIV/AIDS.

Cocaine and crack cocaine use impairs judgment and triggers risk-taking behavior. Cocaine abusers are more likely than other people to engage in unprotected sex and risky habits such as needle sharing. Many addicts trade sex for cocaine or crack cocaine, further increasing their risk of hepatitis or HIV/AIDS.

Health Effects of Cocaine Use in Pregnancy

Cocaine abuse during pregnancy causes a number of fetal development problems. Babies born to women who abuse cocaine or crack cocaine are often born prematurely, and the risk of spontaneous abortion is high. At birth, cocaine-exposed babies often have below average birth weights and smaller than normal head circumferences. Longer-term health complications from in utero exposure to cocaine are unclear, but subtle developmental delays in concentration have been observed.

Street Terms for Cocaine and Crack Cocaine

Have you heard these terms for cocaine and crack cocaine?

  • all-American drug
  • aspirin
  • Bernie
  • big C
  • coca
  • coke
  • flave
  • Florida snow
  • foo foo
  • gin
  • gold dust
  • happy dust
  • icing
  • Mama coca
  • pariba
  • pearl
  • scorpion
  • snow white
  • sugar boogers
  • zip.

Crack cocaine:

  • apple jacks
  • basa
  • black rock
  • CDs
  • kokomo
  • real tops
  • twinkie
  • yam.

Either cocaine or crack:

  • base
  • coke
  • rocks
  • Roxanne.


National Institute on Drug Abuse. (updated 2004). Crack and cocaine. NIDA InfoFacts.

National Institute on Drug Abuse. (1999, May). Cocaine abuse and addiction [NIH Publication No. 99-4342]. NIDA Research Report Series.

Office of National Drug Policy. (2003, November). Cocaine [NCJ 198582]. ONDCP Drug Policy Information Clearinghouse Fact Sheet.

Office of National Drug Policy. (2002). Street terms: Drugs and the drug trade.