Epidemiological estimates of risk in the process of becoming dependent upon cocaine: cocaine hydrochloride powder versus crack cocaine
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To estimate the risk of experiencing clinical features of cocaine dependence within 1–2 years of starting cocaine use, and to examine whether crack smoking might increase this risk.
A national sample of recent-onset cocaine users was identified within public data files of the National Household Surveys on Drug Abuse (NHSDA) for the years 1995 through 1998. The sample included 572 recent-onset users of cocaine HCl powder but not crack, and 190 recent-onset users of crack, some of whom had also started use of cocaine powder no more than 23 months prior to assessment. A separate group of 93 recent-onset crack users was identified; this comparison group had started using cocaine HCl powder 2+ years before assessment. Cocaine dependence was assessed via seven standardized questions about clinical features experienced within 12 months of assessment, such as feeling unable to cut down. Multivariate response regressions were used to evaluate crack-associated excess risk and clinical profiles of cocaine dependence.
Among persons who had recently started to use cocaine HCl powder but not crack cocaine, about 5–12% experienced clinical features of cocaine dependence. Most clinical features occurred 2–3 times more often among crack smoking users as compared to those using powder only, even with statistical adjustment for frequency of cocaine use (P<0.01). This crack-associated excess risk is more prominent for several clinical features of cocaine dependence, including tolerance associated with cocaine use and narrowed behavioral repertoire attributed to cocaine use.
This new epidemiological evidence suggests that crack-smoking may increase risk of cocaine dependence once cocaine use starts, but we cannot rule out the possibility that crack users start out with a greater susceptibility to become cocaine dependent.
- Adair EB, Craddock SG, Miller HG, Turner CF (1995) Assessing consistency of responses to questions on cocaine use. Addiction 90:1497–502 CrossRef
- Andrade L, Eaton WW, Chilcoat H (1994) Lifetime comorbidity of panic attacks and major depression in a population-based study. Symptom profiles. Br J Psychiatry 165:363–369
- Anthony JC (1992) Epidemiological research on cocaine use in the USA. Ciba Found Symp 166:20–33
- Anthony JC, Helzer JE (2002) Epidemiology of drug dependence. In: Tsuang MT, Tohen M (eds) Textbook in psychiatric epidemiology. Wiley-Liss, New York, pp 479–561
- Anthony JC, Warner LA, Kessler RC (1994) Comparative epidemiology of dependence on tobacco, alcohol, controlled substance, and inhalants: basic findings from the National Comorbidity Survey. Exp Clin Psychopharmacol 2:244–268
- Anthony JC, Neumark TD, Van Etten ML (2000) Do I do what I say? A perspective on self-report methods in drug dependence epidemiology. In: Stone AA, Turkon JS, Bachrach CA, Jobe JB, Kurtzman HS, Cain VS (eds) The science of self-report implications for research and practice. Erlbaum, Mahwah, pp 175–198
- Boghdadi MS, Henning RJ (1997) Cocaine: pathophysiology and clinical toxicology. Heart Lung 26:466–483
- Brady JV, Griffiths RR, Hienz RD, Ator NA, Lukas SE, Lamb RJ (1987) Assessing drugs for abuse liability and dependence potential in laboratory primates. In: Bozarth MA (ed) Methods of assessing the reinforcing properties of abused drugs. Springer-Verlag, New York, pp 45–85
- Chen CY, Anthony JC (2003) The effect of age on reporting of clinical features of marijuana dependence in the National Household Survey on Drug Abuse. Addiction 98:71–82 CrossRef
- Chen K, Kandel D (2002) Relationship between extent of cocaine use and dependence among adolescents and adults in the United States. Drug Alcohol Depend 68:65–85 CrossRef
- Colon HM, Robles RR, Sahai H (2002) The validity of drug use self-reports among hard core drug users in a household survey in Puerto Rico: comparison of survey responses of cocaine and heroin use with hair tests. Drug Alcohol Depend 67:269–279 CrossRef
- Cone EJ (1995) Pharmacokinetics and pharmacodynamics of cocaine. J Anal Toxicol 19:459–478
- Cornish JW, O’Brien CP (1996) Crack cocaine abuse: an epidemic with many public health consequences. Annu Rev Public Health 17:259–273 CrossRef
- Dunn J, Laranjeira RR (1999) Transitions in the route of cocaine administration—characteristics, direction and associated variables. Addiction 94:813–824 CrossRef
- Foltin RW, Fischman MW (1992) Self-administration of cocaine by humans: choice between smoked and intravenous cocaine. J Pharmacol Exp Ther 261:841–849
- Foltin RW, Fischman MW (1997) Residual effects of repeated cocaine smoking in humans. Drug Alcohol Depend 47:117–124 CrossRef
- Gossop M, Griffiths P, Powis B, Strang J (1994) Cocaine: patterns of use, route of administration, and severity of dependence. Br J Psychiatry 164:660–664
- Hatsukami DK, Fischman MW (1996) Crack cocaine and cocaine hydrochloride. Are the differences myth or reality? JAMA 276:1580–1588
- Jones RT (1998) Pharmacokinetics of cocaine: considerations when assessing cocaine use by urinalysis. NIDA Res Monogr 169:221–234
- Johnson AL, Morrow CE, Accornero VH, Xue L, Anthony JC, Bandstra ES (2002) Maternal cocaine use: estimated effects on mother-child play interactions in the preschool period. J Dev Behav Pediatr 23:191–202
- Khalsa ME, Anglin MD, Paredes A, Potepan P, Potter C (1993) Pretreatment natural history of cocaine addiction: preliminary 1-year follow-up results. NIDA Res Monogr 135:218–236
- Liang KY, Zeger SL, Qaqish B (1992) Multivariate regression-analyses for categorical data. JRSS-B 54:3–40
- Nader MA (1998) The influence of behavioral and pharmacological history on the reinforcing effects of cocaine in rhesus monkeys NIDA Res Monogr 169:26–55
- Pottieger AE, Tressell PA, Inciardi JA, Rosales TA (1992) Cocaine use patterns and overdose. J Psychoact Drugs 24:399–410
- Pottieger AE, Tressell PA, Surratt HL, Inciardi JA, Chitwood DD (1995) Drug use patterns of adult crack users in street versus residential treatment samples. J Psychoact Drugs 27:27–38
- Rouse BA (1991) Trends in cocaine use in the general population. NIDA Res Monogr 110:5–18
- Shillington AM, Clapp JD (2000) Self-report stability of adolescent substance use: are there differences for gender, ethnicity and age? Drug Alcohol Depend 60:19–27 CrossRef
- Shillington AM, Cottler LB, Mager DE, Compton WM 3rd (1995) Self-report stability for substance use over 10 years: data from the St Louis Epidemiologic Catchment Study. Drug Alcohol Depend 40:103–109 CrossRef
- StataCorp (2001) Stata statistical software: release 7.0. Stata Corporation, College Station, Tex.
- United Nations Office for Drug Control and Crime Prevention (2000) World drug report. Oxford University Press, New York
- US Substance Abuse and Mental Health Service Administration (SAMHSA) (1997) National Household Survey on Drug Abuse: main findings 1995. United States Department of Health and Human Services, Rockville, Md.
- US Substance Abuse and Mental Health Service Administration (SAMHSA) (1998) National Household Survey on Drug Abuse: main findings 1996. United States Department of Health and Human Services, Rockville, Md.
- US Substance Abuse and Mental Health Service Administration (SAMHSA) (1999) National Household Survey on Drug Abuse: main findings 1997. United States Department of Health and Human Services, Rockville, Md.
- US Substance Abuse and Mental Health Service Administration (SAMHSA) (2000) National Household Survey on Drug Abuse: main findings 1998. United States Department of Health and Human Services, Rockville, Md.
- Wagner FA, Anthony JC (2002) From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine and alcohol. Neuropsychopharmacology 26:479–499 CrossRef
- Waldorf D, Reinarman C, Murphy S (1991) Cocaine changes. The experience of using and quitting. Temple University Press, Philadelphia
- Ward AS, Haney M, Fischman MW, Foltin RW (1997) Binge cocaine self-administration by humans: smoked cocaine. Behav Pharmacol 8:736–744
- Wu LT, Anthony JC (2000) The use of the case-crossover design in studying illicit drug use. Subst Use Misuse 35:1035–1050
- Epidemiological estimates of risk in the process of becoming dependent upon cocaine: cocaine hydrochloride powder versus crack cocaine
Volume 172, Issue 1 , pp 78-86
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Crack cocaine
- Cocaine-related disorders
- Drug administration routes
- Industry Sectors
- Author Affiliations
- 1. Bloomberg School of Public Health, Johns Hopkins University, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA
- 2. Department of Epidemiology, College of Human Medicine, Michigan State University, B601 West Fee Hall, East Lansing, MI 48824, USA