The High Price of Abuse

Crack is cocaine intensified. Its effects are cocaine's--but amplified, sharper, meaner, uglier. The assault on the body, brain and nervous system occurs in swifter, more profound fashion. "Crack, even more than plain cocaine, puts users at extremely high risk," says Dr. Nicholas Masi of the cocaine addiction treatment center in Plantation, Fla.

Crack's immediate effects are readily observable: chronic sore throats and hoarseness are common. Crack can leave a user gasping for breath and vulnerable to emphysema. But these complaints pale in comparison with the even more dangerous changes that crack triggers in the body. Crack, says Masi, "throws the entire cardiovascular system into turmoil. Your blood vessels rapidly constrict. You're a key candidate for respiratory failure." Dramatically increased blood pressure and heart rate can lead to coronary attacks, and the intense stimulation of the brain may trigger convulsions.

Far sneakier and subtler are the drug's invisible psychochemical changes. Dr. Ronald K. Siegel of UCLA outlines four stages to cocaine addiction. First comes euphoria, a feeling of stimulation and sexual excitement, soon followed by sadness and depression. Much later come irritability, sleeplessness and paranoia. The fourth stage, says Siegel, "is a schizophrenic-like psychosis, complete with delusions and hallucinations." One nightmare common to addicts is that bugs are crawling over their skin. Heavy crack smokers can go through all four stages in a single drug binge.

The stronger the craving for cocaine, the less a crack user cares for food. "You don't eat when you're smoking," says one California addict. Rats supplied with unlimited cocaine will use the drug until they die, ignoring food and water. Such intensely addictive behavior has helped change scientific opinion about cocaine's grip. Says Dr. Jeffrey Rosecan of New York City's Columbia-Presbyter ian Medical Center: "If anyone had doubts as to whether cocaine is physically addicting, all he has to do is look at a couple of crack users."

Crack's addictive qualities affect the brain's biochemistry. The nerve cells of the brain communicate with one another with the help of chemicals called neurotransmitters. Crack triggers the brain to release these substances, chiefly dopamine, serotonin and norepinephrine, at once. This overstimulation, says Rosecan, "probably results in the euphoria experienced by the user."

But the effect is the same as overdrawing a bank account to go on a spending spree. Cocaine blocks the return of the neurotransmitters to the nerve cells for reuse. Eventually the brain is squeezed dry and craves stimulation. Addicts who try to recapture the high by smoking more crack only aggravate the neurochemical deficiency. Says Rosecan: "We think these physical changes correspond to the psychological changes of the crash--depression, irritability, paranoia and craving."

The higher someone soars on crack, the lower he falls. Says Dr. Arnold Washton of the National Cocaine Hotline: "It's impossible for the nonaddict to imagine the depth and viciousness of depression that an advanced cocaine addict suffers from." Users become anhedonic, all but incapable of pursuing or feeling normal pleasure. Addicts are prone to suicide, accidents and drug overdoses. Drawn by the prospect of a brief, inexpensive thrill, a user may find that he pays for crack with his life.

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