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Guide to Crack Cocaine Addiction and Treatment Options

Is Crack More Addictive Than Cocaine?

Because of its fast delivery to the bloodstream and instantaneous onset of action, crack is potentially more addictive than cocaine used via other routes (snorted powder cocaine, for example). Crack cocaine abuse can quickly lead users to compulsively use the drug at the expense of their personal health, career, relationships, and mental wellbeing. Crack addiction can have a negative impact on all areas of a person’s life, but treatment is available. Through behavioral therapy and a supportive aftercare plan, users can live a sober life free from crack addiction.

What Is Crack?

tweezers holding crack rock cocaineCrack is a smokable, rock form of cocaine and a highly potent, addictive stimulant that provides an immediate and intense high.1 It is prepared by processing cocaine with water and ammonia or baking soda, then heating it to produce the freebase form.

The drug is called crack because of the crackling noise it makes when smoked.2 Crack appears as white, off-white, or yellowish chunks.3 It is broken into small pieces that typically weigh a few tenths of a gram.1

“Crack” is itself a slang term, but other street names include:1

  • Base.
  • Kryptonite.
  • Hard rock.
  • Sugar block.
  • Apple Jacks.
  • Rock.

Crack is almost always smoked, either alone, with tobacco,3 or mixed with other drugs like marijuana or heroin.1 Paraphernalia includes glass pipes, metal screens, and long straight tools used to scrape residue from the pipe.

What Are the Effects?

When smoked, crack is inhaled into the lungs where it is quickly absorbed into the bloodstream. The rapid-onset high only lasts about 5 to 15 minutes, which can leave users with an intense craving to use more.1 When crack enters the bloodstream, it produces a flood of dopamine within the brain, causing the user to feel more energetic, euphoric, alert, and sensitive to stimuli such as sight, sounds, and touch.1

man smoking crack rock cocaine

Short-term physical side effects of crack cocaine can include:1

  • Constricted blood vessels.
  • Temporarily decreased need for sleep.
  • Dilated pupils.
  • Reduced appetite.
  • Anxiety and agitation.
  • Raised body temperature.
  • High blood pressure.
  • Increased heart rate and rate of breathing.

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What Are the Risks?

Long-term use can cause lasting damage to various parts of the body, including the heart, blood vessels, nervous system, gastrointestinal tract, lungs, reproductive organs, and brain. Other long-term health consequences range from moderate to severe and may include:1-2

  • Malnutrition from lack of appetite.
  • Increased risk of heart attack, seizure, or stroke.
  • Abdominal pain, nausea, and ulcers.
  • Greater chance of overdose and death.

Negative behavioral side effects may also result from long-term use of crack cocaine in heavy doses. These can include:1-2

  • Aggression.
  • Bizarre, unpredictable behavior.
  • Irritability.
  • Panic.
  • Extreme paranoia.
  • Hallucinations, particularly of bugs crawling under the skin.
  • Psychosis or delirium.

man panicking portraying crack risksRegular crack use can impair judgment and reduce self-insight into addiction, and may also decrease the ability to manage stress and adapt to other negative consequences associated with drug use.2 Crack users may suffer from shortened attention span, reduced impulse control, impaired memory, poor decision making, and difficulty completing motor tasks.2

Due to the compromised judgment and poor decision making associated with crack cocaine use, individuals may engage in risky sexual behaviors, which can place them at increased risk for contracting HIV or hepatitis C.2

Smoking crack is generally considered to carry a greater risk of addiction than snorting the powder form of cocaine because the drug reaches the brain faster. The immediate yet short-lived high can quickly lead users to develop compulsive drug-seeking behavior.1 Crack addiction can compromise a person’s health, strain relationships, devastate personal finances, and even put them in dangerous situations.

Crack & the Media

The intense high coupled with the affordability and availability of crack led to a surge in the drug’s popularity in the U.S. during the 1980s.2 Since then, media portrayals of the drug and the people who use it have largely influenced public perception, often perpetuating unfounded myths, social stigmas, and racial stereotypes.
Crack use affects all communities regardless of race, criminal history, and socioeconomic background.
Media coverage popularized terms like “crackheads” and “crack babies” to describe those who use the drug and their children. In a 2002 interview with ABC’s Diane Sawyer, singer Whitney Houston coined the phrase “crack is whack,” which would later be popularized as an anti-drug slogan despite Houston’s intended message that she was too wealthy to be accused of crack use.

Media coverage during the initial rise of crack’s popularity largely portrayed it as an inner-city problem affecting minorities and the poor. We now know that crack use affects all communities regardless of race, criminal history, and socioeconomic background. In 2015, an estimated 394,000 people over the age of 12 in the U.S. were considered current crack users.5 Thankfully, the number of current crack users has been on a slow but steady decline since the early 2000s.5

The fate of crack babies raised particular fervor in media coverage of the 1980s, with many dire predictions that these children would have severely reduced intelligence levels and compromised social skills. While crack use during pregnancy does pose serious health risks to both mother and baby, many of these claims were speculative and unsubstantiated.2

Pregnant Mothers & Use

Researchers estimate that there are around 750,000 babies exposed to cocaine during pregnancy each year.2 This can lead to complications, including:2

  • Low birth weight and size.
  • Smaller than normal circumference of the baby’s head.
  • Premature delivery.
  • Miscarriage.
  • Placental abruption (when the placenta lining separates from the uterus prior to delivery).
  • Delivery complications in the mother, such as hypertension or seizure.

Later in life, people who were exposed to cocaine in utero may display subtle deficits in areas pertaining to memory, attention span, and cognitive performance, but more research is needed to fully examine the long-term effects of cocaine exposure during pregnancy.2

Overdosing On Crack Cocaine

Excessive cocaine use can lead to potentially fatal seizures, strokes, or heart attacks.2 In rare instances, sudden death has been reported after a person’s very first cocaine use.2 Early detectable signs of overdose include:3

  • Agitation.
  • Convulsions.
  • Hallucinations.
  • Increased body temperature.

If you suspect that you or someone else has overdosed on crack, call 911 immediately.
Excessive cocaine use can lead to potentially fatal seizures, strokes, or heart attacks.

About Crack Cocaine Addiction

The intense, euphoric high felt by a person after they smoke crack is caused by a rush of dopamine activity in the brain. Dopamine is a neurotransmitter associated with the brain’s pleasure and reward systems, and is typically released in moderate amounts during activities such as eating, having sex, or being nurtured. The large amount of dopamine released in the brain after smoking crack produces an intense high that is short-lived, so many users will smoke crack repeatedly in order to sustain the high.

Frequent use causes the brain to adapt to the higher levels of dopamine, leading the user to need more of the drug to experience the desired high.4 This is known as tolerance, and it can develop after just one use of crack cocaine.1

The drive to use more and more crack can develop into addiction, which is marked by compulsive, drug-seeking behaviors and continuing to use a drug despite negative consequences.

Withdrawal and Detox

Crack users can begin to feel withdrawal symptoms within hours after their last use.6 Symptoms typically include:6

  • Depression.
  • Insomnia or restlessness.
  • Decreased energy.
  • Paranoia.
  • Increased appetite.

Generally, crack withdrawal is not dangerous or associated with extreme physical discomfort, as with other drugs like alcohol or opioids. The greatest risk is suicidal thoughts or behaviors associated depression during withdrawal.

Currently, the best method for detoxification and managing crack withdrawal is to maintain complete abstinence from stimulants and other drugs, including alcohol. There aren’t any medications approved by the U.S. Food and Drug Administration to specifically treat cocaine addiction or withdrawal, so detox often involves managing specific symptoms, such as headaches or insomnia, as needed. Chronic headaches or chest pain should be medically evaluated to rule out more severe consequences of drug use, such as damage to the heart or brain.6

Detoxification is often eased by allowing individuals to sleep more and eat larger portions to compensate for the lack of rest and nutrition associated with heavy crack use. It also helps to cut out unnecessary conflict and avoid stressors. Addiction treatment in a professional rehab facility can help meet these needs.

Treatment Options for Crack Abuse

Crack addiction treatment is available, and often starts with detox in a setting where the person can receive medical and psychiatric supervision to monitor for complications. Once detox is completed, the patient will likely participate in one or more of the following methods of behavioral therapy, which have proven effective in treating addiction to cocaine and other stimulants:7

therapist talking to patient about crack addiction

  • The Matrix Model: This technique is based on drug education, therapist-guided support, and self-help programs. The therapist works to help patients build up their self-esteem, self-worth, and a sense of dignity, which can all suffer through the process of addiction. Through private, group, and family sessions, patients develop the skills needed to prevent relapse.
  • Cognitive-Behavioral Therapy (CBT): This method operates on the premise that thoughts create emotion, which dictates behavior. Patients work with trained therapists to identify unhelpful patterns of thought and behavior in order to change them. CBT teaches skills needed to maintain abstinence and prevent relapse by identifying high-risk situations and planning to manage them if the situation cannot be avoided. CBT practitioners also work with patients to explore the positive and negative effects of continued drug use.
  • Contingency Management: Also known as motivational incentives, this method is an especially effective technique for treating cocaine addiction. Patients who maintain sobriety and participate in treatment receive vouchers that can be traded for incentives that reinforce healthy living, such as food items, gym memberships, or sober activities like going to the movies. This method has been shown to be helpful in assisting patients to get sober and remain in treatment.

Addiction treatment can take place in a variety of settings:

  • Inpatient: Patients reside on-site while receiving intensive group and individual therapy sessions, along with 24/7 monitoring and support.
  • Partial hospitalization programs: This is a transition between inpatient and outpatient treatment. Patients spend the majority of the day participating in intensive group and individual therapy sessions, but are able to return home at night and be with their families.
  • Outpatient: Patients live at home and treatment is provided on a set daily or weekly schedule, depending on the severity of the addiction and any other co-occurring disorders. Group and individual therapy sessions focus on managing stressors, identifying high-risk situations, and developing appropriate coping skills to prevent relapse.
  • Long-term residential facilities: Also known as therapeutic communities, these are places where patients with particularly severe addictions can learn the skills they will need to reintegrate into society while maintaining sobriety. These facilities often offer assistance with vocational, legal, and social issues.
  • Support groups: After leaving formal rehab treatment, support group meetings such as those operated by the various 12-step programs provide ongoing peer support from others in recovery, a place to learn appropriate relapse prevention skills, and further opportunity to explore the underlying issues that contribute to addiction.

Recovery Is Possible

Through addiction rehab and behavioral therapy, people struggling with crack addiction can learn to avoid relapse and rebuild their lives. If you or someone you know is ready to make the commitment to staying sober, don’t hesitate to begin your journey today.


  1. University of Maryland Center for Substance Abuse Research. (2013). Crack Cocaine.
  2. National Institute on Drug Abuse. (2016). Cocaine.
  3. Drug Enforcement Administration. (n.d.). Drug Fact Sheet: Cocaine.
  4. National Institute on Drug Abuse. (2016). Cocaine: What is cocaine?
  5. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
  6. Center for Substance Abuse Treatment. (2006). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45(15-4131), P76-81.
  7. National Institute on Drug Abuse. (2012). Principles of drug addiction treatment: a research-based guide (3rd edition).

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