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Cocaine is a powerfully addictive stimulant 

drug. The powdered hydrochloride salt form 

of cocaine can be snorted or dissolved in 

water and then injected. Crack is the street 

name given to the form of cocaine that has 

been processed to make a rock crystal, 

which, when heated, produces vapors that 

are smoked. The term “crack” refers to the 

crackling sound produced by the rock as it is 

heated. 

How Is Cocaine Abused? 

Three routes of administration are commonly 

used for cocaine: snorting, injecting, and 

smoking. Snorting is the process of inhaling 

cocaine powder through the nose, where it 

is absorbed into the bloodstream through 

the nasal tissues. Injecting is the use of a 

needle to insert the drug directly into the 

bloodstream. Smoking involves inhaling 

cocaine vapor or smoke into the lungs, 

where absorption into the bloodstream is as 

rapid as it is by injection. All three methods 

of cocaine abuse can lead to addiction and 

other severe health problems, including 

increasing the risk of contracting HIV/AIDS 

and other infectious diseases. 

The intensity and duration of cocaine’s 

effects—which include increased energy, 

reduced fatigue, and mental alertness—

depend on the route of drug administration. 

The faster cocaine is absorbed into the 

bloodstream and delivered to the brain, the 

more intense the high. Injecting or smoking 

cocaine produces a quicker, stronger high 

than snorting. On the other hand, faster 

absorption usually means shorter duration 

of action: the high from snorting cocaine 

may last 15 to 30 minutes, but the high from 

smoking may last only 5 to 10 minutes. In 

order to sustain the high, a cocaine abuser 

has to administer the drug again. For this 

reason, cocaine is sometimes abused in 

binges—taken repeatedly within a relatively 

short period of time, at increasingly higher 

doses. 

How Does Cocaine Affect 

the Brain? 

Cocaine is a strong central nervous system 

stimulant that increases levels of dopamine, 

a brain chemical (or neurotransmitter) 

associated with pleasure and movement, in 

the brain’s reward circuit. Certain brain cells, 

or neurons, use dopamine to communicate. 

Cocaine
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Normally, dopamine is released by a 

neuron in response to a pleasurable signal 

(e.g., the smell of good food), and then 

recycled back into the cell that released it, 

thus shutting off the signal between neurons. 

Cocaine acts by preventing the dopamine 

from being recycled, causing excessive 

amounts of the neurotransmitter to build up, 

amplifying the message to and response 

of the receiving neuron, and ultimately 

disrupting normal communication. It is this 

excess of dopamine that is responsible for 

cocaine’s euphoric effects. With repeated 

use, cocaine can cause long-term changes 

in the brain’s reward system and in 

other brain systems as well, which may 

eventually lead to addiction. With repeated 

use, tolerance to the cocaine high also 

often develops. Many cocaine abusers 

report that they seek but fail to achieve 

as much pleasure as they did from their 

first exposure. Some users will increase 

their dose in an attempt to intensify and 

prolong the euphoria, but this can also 

increase the risk of adverse psychological 

or physiological effects. 

What Adverse Effects 

Does Cocaine Have on 

Health? 

Abusing cocaine has a variety of adverse 

effects on the body. For example, cocaine 

constricts blood vessels, dilates pupils, and 

increases body temperature, heart rate, and 

blood pressure. It can also cause headaches 

and gastrointestinal complications such 

as abdominal pain and nausea. Because 

cocaine tends to decrease appetite, chronic 

users can become malnourished as well. 

Different methods of taking cocaine can 

produce different adverse effects. Regular 

intranasal use (snorting) of cocaine, for 

example, can lead to loss of the sense 

of smell; nosebleeds; problems with 

swallowing; hoarseness; and a chronically 

runny nose. Ingesting cocaine can cause 

severe bowel gangrene as a result of 

reduced blood flow. Injecting cocaine 

can bring about severe allergic reactions 

and increased risk for contracting 

HIV/AIDS and other blood-borne diseases. 

Binge-patterned cocaine use may lead 

to irritability, restlessness, and anxiety. 

Cocaine abusers can also experience 

severe paranoia—a temporary state of 

full-blown paranoid psychosis—in which 

they lose touch with reality and experience 

auditory hallucinations. 

Regardless of the route or frequency of 

use, cocaine abusers can experience 

acute cardiovascular or cerebrovascular 

emergencies, such as a heart attack or 

stroke, which may cause sudden death. 

Cocaine-related deaths are often a result 

of cardiac arrest or seizure followed by 

respiratory arrest. 
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Added Danger: Cocaethylene 

Polydrug use—use of more than one 

drug—is common among substance 

abusers. When people consume two or 

more psychoactive drugs together, such as 

cocaine and alcohol, they compound the 

danger each drug poses and unknowingly 

perform a complex chemical experiment 

within their bodies. Researchers have found 

that the human liver combines cocaine 

and alcohol to produce a third substance, 

cocaethylene, which intensifies cocaine’s 

euphoric effects. Cocaethylene is associated 

with a greater risk of sudden death than 

cocaine alone.1

What Treatment Options 

Exist? 

Behavioral interventions—particularly, 

cognitive-behavioral therapy—have been 

shown to be effective for decreasing 

cocaine use and preventing relapse. 

Treatment must be tailored to the individual 

patient’s needs in order to optimize 

outcomes—this often involves a combination 

of treatment, social supports, and other 

services. 

Currently, there are no FDA-approved 

medications for treating cocaine addiction; 

thus, developing a medication to treat 

cocaine and other forms of addiction 

remains one of NIDA’s top research 

priorities. Researchers are seeking to 

develop medications that help alleviate the 

severe craving associated with cocaine 

addiction, as well as medications that 

counteract cocaine-related relapse triggers, 

such as stress. Several compounds are 

currently being investigated for their safety 

and efficacy, including a vaccine that would 

sequester cocaine in the bloodstream and 

prevent it from reaching the brain. Current 

research suggests that while medications are 

effective in treating addiction, combining 

them with a comprehensive behavioral 

therapy program is the most effective 

method to reduce drug use in the long term. 

How Widespread 

Is Cocaine Abuse? 

Monitoring the Future Survey†

According to the 2009 Monitoring the 

Future survey—a national survey of 8th, 

10th-, and 12th-graders—there were 

continuing declines reported in the use of 

powder cocaine, with past-year†† usage 

levels reaching their lowest point since 

the early 1990s. Significant declines in 

use were measured from 2008 to 2009 

among 12th-graders across all three survey 

categories: lifetime use decreased from 
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7.2 percent to 6.0 percent; past-year use 

dropped from 4.4 percent to 3.4 percent; 

and past-month use dropped from 1.9 

percent to 1.3 percent. Survey measures 

showed other positive findings among 

12th-graders as well; their perceived risk 

of harm associated with powder cocaine 

use increased significantly during the same 

period. Additionally, survey participants 

in the 10th grade reported significant 

changes, with past-month use falling from 

1.2 percent in 2008 to 0.9 percent in 

2009.

Use of Cocaine by Students 

2009 Monitoring the Future Survey

8th Grade 10th Grade 12th Grade 

Lifetime 2.6% 4.6% 6.0% 

Past Year 1.6% 2.7% 3.4% 

Past Month 0.8% 0.9% 1.3% 

Crack Cocaine Use by Students 

2009 Monitoring the Future Survey 

8th Grade 10th Grade 12th Grade 

Lifetime 1.7% 2.1% 2.4% 

Past Year 1.1% 1.2% 1.3% 

Past Month 0.5% 0.4% 0.6% 

National Survey on Drug Use and 

Health (NSDUH)†††

According to the 2008 National Survey 

on Drug Use and Health, the estimated 

percentage of persons aged 12 or older 

who used cocaine in the past month (0.7 

percent) was similar to the percentage in 

2007 and 2002. However, the percentage 

of past-month crack users in 2008 (0.1 

percent of the population) was lower than 

in 2007 and all other years going back 

to 2002, with the exception of 2004. 

From 2002 to 2008, rates of past-month 

cocaine use among youth aged 12 to 17 

declined significantly, from 0.6 percent to 

0.4 percent. Past-month cocaine use also 

dropped significantly among young adults 

aged 18 to 25 during this time period, 

from 2.0 percent to 1.5 percent. 

Significant declines in the number or 

percentage of past-year cocaine initiates 

were also estimated among several age 

groups measured, including persons 12 

or older and those aged 18 to 25. The 

percentage of past-year initiates also 

dropped significantly from 2007 to 2008 

for crack use among the 12–17 age group.
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Other Information Sources 

For additional information on cocaine, please 

refer to the following sources on NIDA’s Web 

site, www.drugabuse.gov:

•	 Cocaine: Abuse and Addiction— 

Research Report Series 

•	 Various issues of NIDA Notes (search 

by “cocaine” or “crack”) 

For street terms searchable by drug name, 

cost and quantities, drug trade, and drug 

use, visit www.whitehousedrugpolicy.

gov/streetterms/default.asp. 

Data Sources

† These data are from the 2009 Monitoring the Future survey, funded by the National Institute on Drug Abuse, National 

Institutes of Health, Department of Health and Human Services, and conducted annually by the University of Michigan’s 

Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 

1991, 8th- and 10th-graders were added to the study. The latest data are on line at www.drugabuse.gov. 

†† “Lifetime” refers to use at least once during a respondent’s lifetime. “Past year” refers to use at least once during 

the year preceding an individual’s response to the survey. “Past month” refers to use at least once during the 30 days 

preceding an individual’s response to the survey. 

††† NSDUH (formerly known as the National Household Survey on Drug Abuse) is an annual survey of Americans 

aged 12 and older conducted by the Substance Abuse and Mental Health Services Administration, Department of 

Health and Human Services. This survey is available on line at www.samhsa.gov and can be ordered by phone 

from NIDA at 877–643–2644. 

Reference 

1 Harris DS, et al. The pharmacology of cocaethylene in humans following cocaine and ethanol administration. Drug 

Alcohol Depend 72(2):169–182, 2003.