Cocaine abuse and dependence: the scope of the problem

The dramatic increase in cocaine use over the past 20 years has been of epidemic proportions. Cocaine is an extremely attractive and captivating drug that is a powerful reinforcer, induces strong psychological dependence and produces marked adverse behavioral changes. These characteristics, for planning purposes, would seem to suggest that the problem will continue to expand in scope. What we still do not know is the extent to which this increased use translates into a need for treatment. If as few as 10% of the users become problem users, as occurs with alcohol, we may be faced with a tremendous surge in demand for services such as occurred in the late sixties and for which we are similarly unprepared. We need to launch a major national effort to gain much more basic epidemiologic data, monitor the course of the epidemic, and support the development of new preventive and treatment approaches specifically tailored to cocaine, based on its particular advantages and disadvantages and the characteristics of its user population.