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Smoked crack acts more quickly than snorted cocaine and has more intense
effects. Like snorting cocaine, smoking crack leads to a sense of well-being, energy,
and mental clarity. However, this “high” usually lasts only minutes (NIDA, 2007b).
As with other stimulants, when the high from crack evaporates, it leaves in its wake
a sense of depression and craving for more of the drug, as related by Mr. R. in
Case9.3. These aftereffects may lead the user to take more of the drug, and may
lead to dependence. Moreover, whereas dependence on cocaine may take months or
even years to develop, dependence on crack can develop extremely rapidly—within
weeks (NIDA, 2004; Rebec, 2000).CASE 9.3 • FROM THE INSIDE: Crack Dependence
Mr. R, a 28-year-old man, describes his dependence on crack.
I fi rst started using cocaine about 4 years ago. I don’t remember the fi rst time I smoked the
crack cocaine. It puts you in another world. I can’t explain this euphoric feeling that it gives
you, but it’s a feeling I had never experienced before. I just want to sit there and enjoy the feel-
ing and not think about anything or do anything. I have to keep doing it constantly to keep up
the high.
I actually started staying out all night. I was smoking about 5 times a week and lost my
apartment, lost everything. Everything was falling apart with my relationship, and I was
starting to miss work a lot. But I just couldn’t control it. You know, it overtook me. That’s all I
thought about and all I wanted to do was to keep smoking. Everything else was secondary.
An intense craving for me is when my heart starts beating fast—actually, I get a little
sweaty—and all I think about doing is just going to smoke. That’s it. Nothing else—everything
that’s on my mind just kind of disappears. First you start thinking about it, then your body
almost reproduces the feeling that you get from a high.
The treatment center was an inpatient, intensive treatment program. It was a 6-month
program and I stuck it out for 5 months. Then I moved into a halfway house and got myself a
job. And one night, I wanted to smoke. I just said, “I want to smoke again. I want that feeling
again.” And I went out and picked up again.
From pretty much then on, I have been using regularly about once a week, once every 2
weeks. Today I have 9 days clean. During the past month, I’ve used only 2 or 3 times, so I’m
curbing it down. I’m getting really sick and tired of it, honestly, of the consequences and of
the using. And I don’t think the high is what it used to be. It’s kind of getting monotonous to
me. It’s getting old. I don’t know what it’s going to take [for me to stop]. I know I’m the only
one who can do it. You know, everyone can tell me to do this and do that, but not until I make
that decision that I’m going to get clean 100%.
(Hyman, 2001, p. 25–87)
As often happens when people become dependent on a drug, Mr. R.’s life became
focused on obtaining and using crack, and his intense cravings made it diffi cult for
him to stop using the drug.Amphetamines
Amphetamines typically produce the same effects as does cocaine, although these
effects last longer. Common amphetamines include benzedrine (racemic amphet-
amine sulfate), dexedrine (dextroamphetamine), and adderall (a combination of
amphetamine salts). Amphetamines are usually available as pills, which typically
are swallowed, although the contents of the pills may be snorted or diluted and
injected. Amphetamines are legally used to treat some disorders, particularly ADHD
and the sleep disorder narcolepsy, in which the sufferer spontaneously falls asleep
for brief periods of time.
With repeated use of amphetamines, people may become hostile toward oth-
ers or develop a sense of grandiosity, as well as exhibit disorganized thinking or
behavior (Krystal et al., 2005). Because tolerance develops, repeat users may take
high doses, which can cause amphetamine psychosis, a condition characterized
by paranoid delusions and hallucinations (symptoms similar to those of paranoid