Changing patterns of cocaine use: longitudinal observations, consequences, and treatment.

The literature describing contemporary cocaine use from 1970 to 1983 has been reviewed. Short-term studies published on users observed an initial period of social-recreational use supported by the belief that cocaine was safe. By the end of this period, both dosages and chronicity of cocaine use showed an escalation marked by increased adverse reactions. A longitudinal study tracked 99 social-recreational users from 1975 to 1983. By 1983, 41 users had dropped out of the study while eight others had stopped all use. Of the 50 continuing users still in the study in 1983, 25 remained primarily social users with few negative effects and no toxic physical or psychological crises. The remaining 25 users, while engaged in some social use, were more frequently involved in other patterns. Sixteen users frequently escalated to circumstantial-situational patterns marked by some toxic physical effects but no psychological crises. Four users developed intensified (daily) patterns of use with episodes of both physical and psychological crisis reactions. Five users became compulsive users, smoking cocaine free base, and experienced crisis reactions in approximately 10 percent of their intoxications. The majority of users attempted to treat the hyperexcitability and stimulation of excessive cocaine use with multiple drug use or self-initiated strategies of controlled use or short-term abstinence. It is concluded that many of the social users are capable of controlling use with no escalation to more individual-oriented patterns. Others, by escalating patterns of use, increase the risks of dependency and toxicity.