What Is a Crack Addiction?

Crack addiction refers to a substance use disorder where an individual is physiologically dependent on the substance; they lose control over their use and continue to use the substance despite negative consequences, says Jeanette Tetrault, MD, an addiction medicine specialist at Yale Medicine.

Substance use is recognized as a brain disorder. People who are addicted to crack have a chronic medical condition that requires treatment. It’s often not as simple as expecting a person to stop using it on their own, or thinking they'll be better if they stop using it for a few days.

Approximately 1.3 million people in the United States over the age of 12 have a cocaine use disorder, which means they use cocaine or crack.

What Is Crack Cocaine?

Cocaine is a stimulant drug that is extracted from the leaves of the coca plant. The purified form of the extract, which looks like fine, white, powdered crystals, was initially used for medicinal purposes. 

Cocaine is currently classified as a Schedule II drug. It can be legally used for certain medical purposes, including local anesthesia for some ear, throat, and eye surgeries. However, it has high potential for abuse. People rub cocaine in their gums, snort it through their nose, or dissolve it and inject it into their veins.

Crack is a freebase form of cocaine that is processed using water and either ammonia or baking soda, until it forms a rock crystal that can be smoked. Crack cocaine is also known as "rock," because it looks like small, hard shards of rock. People typically smoke crack by heating it in a glass pipe; however, they may also add it to tobacco cigarettes or marijuana joints.

Signs and Symptoms of a Crack Addiction

These are some of the signs and symptoms of a crack cocaine addiction, according to Dr. Tetrault:

• Experiencing intense cravings for the drug
• Needing to take the drug to feel “normal”
• Using more of the drug to achieve the same effect
• Losing control over one’s drug consumption 
• Continuing to use the drug despite the harm it causes
• Willing to do anything to get more of the drug
• Experiencing withdrawal symptoms, such as fatigue, irritability, sluggishness, increased appetite, depression, and insomnia when the high wears off

Additionally, people who are addicted to crack cocaine may also experience the following:

• Severe depression
• Weight loss
• Insomnia 
• Lack of interest in their work, friends, and family
• Lack of attention to personal hygiene
• Negative consequences to their job, relationships, and daily life
• Loss of control over their life
• Considerable expenditure to fund their habit 

What Causes Crack Addiction?

Research suggests that the progression from use to addiction is strongly influenced by genetics. Studies suggest that the heritability risk for cocaine use disorder is 65% in women and 79% in men. Having a co-occurring mental health condition and exposure to environmental factors can also increase the risk of developing a crack addiction.

Cocaine and crack are powerful stimulants that give users a euphoric feeling and increased energy, says Dr. Tetrault. Using these substances floods the brain with dopamine, a natural chemical that is part of the brain’s reward system; it stimulates the brain, numbs pain, and helps us feel pleasure.

Smoking crack can cause the drug to reach the brain faster than snorting powdered cocaine. The high is stronger but only lasts five to 10 minutes. As a result, the person experiences an intense rush, followed by a hard crash that can feel depressing and lead to intense cravings for more of the drug.

Dr. Tetrault explains that repeatedly using crack or cocaine can cause changes in the brain’s reward circuitry, which can make people use it compulsively, despite the harm it causes. This is because repeated use of the drug causes the reward circuit of the brain to adapt and become less sensitive to its effects.

As a result, people need to take more of the drug more frequently in order to achieve the same high and prevent withdrawal symptoms. This is known as developing a tolerance.

Effects of Crack Addiction

While using crack or cocaine, people may experience a high that is characterized by:

• A surge of energy
• Extreme happiness
• Mental alertness
• Sensitivity to sound, light, and touch
• Irritability
• Paranoia
• Strange, unpredictable, or even violent behavior

The high is also accompanied by physiological changes, such as:

• Dilated pupils
• Nausea
• Raised blood pressure
• Increased body temperature
• Rapid or irregular heartbeat
• Muscle tremors or twitches
• Restlessness  

Crack Addiction Has Serious Risks

However, using crack cocaine can damage the person’s heart, brain, or other vital organs, says Dr. Tetrault. She says it is particularly harmful for people with heart problems. These are some of the side effects of frequent crack cocaine use:

• Brain seizures
• Sudden cardiac death
• Heart attack
• Stroke
• Coma
• Elevated blood pressure
• Sexual dysfunction 
• Depression
• Respiratory conditions such as cough, asthma, bronchitis, and pneumonia

A person may also overdose on crack cocaine, especially if they mix it with alcohol or heroin. Dr. Tetrault explains that cocaine is sometimes adulterated with other drugs, such as amphetamines or synthetic opioids like fentanyl, which can make it particularly dangerous. A person can overdose the first time they use crack cocaine, or any time thereafter.

How Is Crack Addiction Diagnosed?

Crack addiction is diagnosed by clinicians, says Dr. Tetrault. She explains that the diagnostic process could involve:

• A physical examination
• A detailed medical history
• A series of screening questions

The clinician will evaluate whether the person meets the criteria listed for addiction in the Diagnostic and Statistical Manual of Mental Disorders (DSM), a guiding manual published by the American Psychiatric Association.

Treating a Crack Addiction

Treating a crack addiction may involve detoxification and therapy. Treatment may occur in hospitals, in therapeutic communities, or in clinical settings.

Detoxification

The treatment process often begins with detox, where the person is not allowed to consume crack and may experience severe withdrawal symptoms as a result.

The physical symptoms of withdrawal can start shortly after the person’s last use of the drug and continue for up to a week. Working through the emotional challenges that accompany addiction can take a lot longer.

Therapy

Several evidence-based counseling options have been shown to treat crack addictions, says Dr. Tetrault. These can include:

• Cognitive behavior therapy (CBT): CBT involves challenging negative thought processes that lead to unhealthy behaviors, such as using drugs.
• Contingency management: Also known as motivational incentive, this form of therapy involves rewarding people for not using drugs.
• Community-based treatment: This can include support groups or 12-step programs.

Medication

There are no medications currently available to treat cocaine use disorder or cravings associated with crack cocaine, says Dr. Tetrault.

However, she says that if the person is experiencing an opioid overdose that is caused by using cocaine adulterated by high-potency opioids, the drug naloxone can help reverse the overdose.