Crack Addiction: Treatment, Signs of Use, Symptoms and Risks

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What you will learn

• Crack cocaine is a free base form of cocaine that comes in rock or pellet form and is primarily smoked.
• “Crack” gets its name from the crackling sound it makes when heated.
• Smoking or snorting crack leads to an intense and short-lived high, leading people to binge.
• Crack can have serious short- and long-term effects, including hallucinations, mood swings, depression, malnutrition, and possible death.
• Crack addiction is a substance use disorder that can be treated effectively.

One of the most infamous drugs in pop culture since the 1980s, crack cocaine is a powerful stimulant that’s often portrayed in the media and associated with substance abuse. But aside from public image, crack is a serious addiction that can have serious risks.

Learn more about crack cocaine, its history and use, and how you can seek help for a crack addiction.

What Is Crack?

Crack cocaine, or crack as it’s commonly known, is derived from white powder cocaine.[1] This powder comes from the dried leaves of the coca plant in South America.

Cocaine powder is dissolved in water and simple baking soda, boiled to separate the solids, and cooled and cut to produce small pieces known as “rocks.” These pieces are white or tan pellets, similar to dry cat food. When these pieces are heated, they crackle, leading to the name “crack.”

Crack is easy and inexpensive to produce, creates an immediate and intense high, and wears off quickly, leaving the person depressed and craving more, which is why it’s so often abused. The chemicals in crack hit the brain much faster and more directly than powdered cocaine, leading to misuse in an attempt to recreate the sensation.

What Effect Does Crack Have on the Brain and Body?

Smoking crack allows it to enter the bloodstream quickly, heightening the stimulant effects of cocaine. Immediately after smoking, the person may feel intensely happy, energetic, and sociable.

It stimulates the nervous system, increasing the brain’s supply of dopamine [2]. Excess dopamine floods the brain, leading to a feeling of euphoria.

Despite these positive emotions, crack may cause immediate negative effects as well. People who use crack may experience panic, anxiety, and paranoia that’s short-lived. The stimulant effects of crack also increase the heart rate, further compounding feelings of anxiety.

In large doses, crack may cause cocaine-induced psychosis with hallucinations, agitation, and an inability to communicate. In some cases, this is a symptom of an overdose.

With long-term use, crack affects the brain’s pathways in response to stress. People become more sensitive to feelings of stress and struggle to remain calm, leading to mood swings, irritability, paranoia, and anxiety.

Regular crack use floods the brain with an unnatural level of dopamine as well. Over time, the brain becomes less sensitive to dopamine to compensate. Normal activities lose their appeal, so crack is the only thing that makes the person feel happy and satisfied.

There are many negative health effects associated with crack, such as infertility, respiratory problems, poor appetite, malnourishment, weight loss, and heart problems. Smoking crack cocaine is associated with specific risks such as burns on the lips, tongue, or fingers from the crack pipe. However, while smoking crack can lead to severe respiratory issues, there is no direct evidence linking it specifically to lung cancer.

Signs and Symptoms of Crack Use

Crack has obvious signs of use, even in the short term. People who use crack will have sudden bursts of energy and stimulation, often acting excited at inappropriate times. They may talk rapidly, eat quickly (or not eat when they’ve gone without food for some time), or seem nervous and agitated. They’ll look fatigued once the effects wear off and may sleep for long periods.

Cycling between bursts of energy and fatigue significantly impacts behavior. People suffer sleep disturbances and miss work or school. They may have violent mood swings that can become dangerous to people around them, as well as paranoia and hallucinations. When they stop using crack for a time, they may have depression or suicidal thoughts.

Along with bursts of energy, people who use crack may be jittery and fidgety. They can’t control these feelings and sometimes seek out crack, falsely believing that it will calm them.

Crack has obvious physical signs like dilated pupils and bloodshot eyes. This is due to the drug’s effects on how the pupils react to light and the chemical functioning of the brain. People who smoke may have burns on their lips and fingers from the crack pipe.

While crack cocaine is typically smoked, if cocaine powder is snorted, it may cause nosebleeds due to damage to the nasal lining. They may have constant congestion or a runny nose. Over time, they will lose their sense of smell. Snorting also damages the lining of the throat, causing a sore throat and speech difficulties.

Crack Addiction

With its potency, availability, and intense euphoria, crack cocaine is highly addictive. Though crack cocaine and powder cocaine are nearly chemically identical, the method of consuming them can make crack cocaine seem more addictive.

The intensity of the experience with crack is short, leading people to binge on the drug to chase its psychoactive effects. This can lead to a more rapid tolerance, dependence, and addiction.

Crack addiction falls under substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), which includes the following criteria:[3]

• Using more of a substance than intended or using it for longer periods
• Trying to reduce or stop use but being unable to
• Experiencing intense cravings
• Tolerance – needing more of a substance to get the same effects
• Developing withdrawal symptoms when not using the substance
• Spending more time getting and using drugs and recovering from drug use
• Neglecting responsibilities at home, work, or school
• Continuing to use it despite problems in interpersonal relationships
• Giving up activities once enjoyed because of substance use
• Using substances in dangerous environments
• Continuing to use despite health problems

Substance use disorder worsens over time. The diagnostic criteria include a scale for severity based on how many symptoms are present. Two or three indicate a mild substance use disorder, four or five indicate a moderate substance use disorder, and six or more indicate a severe substance use disorder or addiction that needs treatment.

Crack Addiction Treatment

Crack can cause strong physiological dependence and withdrawal symptoms that can make it nearly impossible for someone to quit without help. The symptoms typically begin within a few hours and can last up to a month, gradually tapering off.

Some of the signs and symptoms of crack withdrawal include:

• Depression
• Irritability
• Increased appetite
• Fatigue
• Excessive sleep
• Vivid dreams or nightmares
• Severe cravings
• Anxiety
• Psychosis

Many factors affect the intensity and severity of crack withdrawal symptoms, including:

• The severity of the addiction
• The frequency of use
• The length of use
• Additional substance use like alcohol or other drugs
• Any co-occurring mental health conditions

Unlike addiction to substances like heroin, crack cocaine may not include obvious withdrawal effects like vomiting, sweating, or shaking.

Once the immediate withdrawal symptoms subside, people may experience additional symptoms for days or weeks, such as:

• Panic attacks
• Short-term memory problems
• Depression and anxiety
• Difficulty sleeping
• The inability to experience pleasure, known as anhedonia

Because of the challenges of withdrawal, it may be best for people with crack addiction to be hospitalized and supervised to ensure their physical well-being and reduce the risk of relapse. In some cases, medication may be used to alleviate the physical symptoms of withdrawal.

Once detox is complete, which lasts about a week, the person can address the psychological effects of the addiction. This may be in an inpatient or outpatient program, depending on the level of support needed.

Treatment typically includes a combination of evidence-based modalities and techniques, such as cognitive behavioral therapy, group therapy, individual therapy, motivational interviewing, and experiential therapy. The treatment plan is tailored to the needs of the individual, taking their substance use, medical history, mental health history, and other factors into account.