Chapter 2
Illicit Use of Cocaine

The spread of cocaine use among Americans during the early twentieth century began to attract the attention of the medical community and national leaders. Government officials decided to investigate the use of cocaine and learned that large numbers of citizens were buying cocaine not in the form of additives to foods, beverages, and medicines intended to treat specific medical conditions, but in its pure form for the pleasurable sensation the drug induced. Evidence that cocaine consumption might have slipped beyond the bounds of medical use caused alarm.

Declared Illegal

As cocaine use rose, hospitals began reporting an alarming increase of illness linked to the drug. In 1912, for example, five thousand deaths were directly or indirectly attributed to cocaine. In 1914 the U.S. government responded by declaring cocaine a controlled substance, making its use illegal except when prescribed by a doctor. As a result, cocaine use dropped dramatically and imports of coca leaves, which in 1914 had been estimated at about 450 tons, fell by two-thirds. Consumption of cocaine continued to decline through the 1930s and 1940s, in part because discretionary income fell sharply during the Great Depression and in part because many men who might have had the opportunity and money to use the drug were fighting World War II. This trend of declining use, however, would not continue indefinitely.

Cocaine During the 1970s

After more than two decades of relative obscurity, cocaine reemerged on the American drug scene in the early 1970s. Deterred by the obvious addictiveness and social stigma of drugs like heroin and the occasional "bad trip" associated with hallucinogens such as LSD, some Americans saw cocaine as a relatively harmless "recreational" drug. Its potential for harm was downplayed, especially since markedly successful individuals in the entertainment industry seemed to use the drug with impunity. As movie stars, rock musicians, and sports heroes openly admitted using cocaine and enjoying its euphoric effects, its popularity and image soared among the general population.

Cocaine quickly occupied a niche in American popular culture. The rock song "Cocaine," recorded by Eric Clapton, Richie Havens, Dave Van Ronk, the Jack Saints, and DRG Compilations, bolstered the drug's cool image. More songs with "cocaine" in the title followed, performed by some of America's most popular singers. Dozens of movies appeared featuring scences that both destigmatized and satirized the use of the drug, depicting cocaine users as fun, successful people. A scene in Woody Allen's film Annie Hall, for example, depicts guests at a party comically sneezing after inhaling the powder. The Albert Brooks film Lost in America includes a scene featuring people laughing with white powder on the tips of their noses. According to a study led by Donald F. Roberts, Thomas More Storke Professor of Communication at Stanford University, who researched the movie industry's pleasurable portrayal of drugs, "Of the movies showing drugs, marijuana appeared most frequently (51 percent), followed by powder cocaine (33 percent)."⁸

Cocaine use among professional athletes was even more common than among musicians or actors. Many athletes believed that cocaine acted as a stimulant that sustained their energy level, allowed them to endure greater pain, and speeded their reaction time on the field. The consequences of cocaine use seemed minor: At the time, even though the drug was illegal, professional sports organizations did not specifically ban the use of cocaine. And law enforcement authorities tended to be reluctant to arrest high-profile players for local basketball and football teams.

The more that sports and popular culture icons glorified cocaine the more the public wanted to experience the same exhilaration, despite a rise in price to over $100 per gram. As more and more Americans tried cocaine, doubts about its alleged harmlessness once again began to grow in the minds of many health professionals. Deaths attributed to cocaine were routinely reported by the press, although they were dismissed by cocaine users as freak accidents or as examples of the consequences of reckless abuse.

Cocaine's Changing Image in the 1980s

Despite growing concerns about its possible dangers, cocaine use in America grew through the early 1980s. In 1985, estimates by various government health agencies placed the number of people who had used it at least once at about 7 million. Of this number, about 5.5 million used it occasionally; about 600,000 were considered habitual users, defined by using it more than 51 times a year.

During this period, evidence pointing to the health risks of cocaine use continued to surface. Stories of death due to cocaine overdoses on college campuses and in affluent neighborhoods began replacing the glittery talk of recreational use by sports and movie stars. For example, the death of college basketball star Len Bias from a cocaine overdose received front-page coverage. Not only were overdoses becoming recognized as a problem, but gradually people began to recognize that once the initial euphoria wore off, cocaine had the insidious quality of inducing a state of depression that triggered a craving for more. Just as ominously, the medical professions began to recognize that many recreational users were showing signs of the ill effects of heavy use.

As it became clear that more and more people were regularly using cocaine, medical researchers began to study the drug's psychological as well as physiological effects. What these scientists discovered was unsettling.

Short-Term Psychological Effects

The immediate psychological effect of cocaine ingestion is euphoria. The intensity of this effect depends on how fast the drug reaches the brain; that is, the faster cocaine reaches the brain, the more intense the euphoria. For the first few minutes after inhaling powdered cocaine, or the first few seconds after injecting it, the user experiences the onset of the euphoria, known as a rush. Users describe such feelings as a heightened state of pleasure, a profound sense of mastery over their personal affairs, a sense of cleverness, and an unquestioned confidence in their ability to achieve their goals. Many users claim that the drug helps them perform many physical and intellectual tasks more quickly. As one youth describes it, cocaine made him feel "as if I was going up in a flying machine" or "as if I was a millionaire and could do anything I pleased."⁹ In addition to the sense of euphoria, many users describe being more energetic, talkative, and more acutely aware of the sensations of sound, taste, color, and touch. Officer Gordon James Knowles of the Pearl Harbor Police Narcotics Division questioned a cocaine user and dealer named Carl, whose description of the initial rush also explains its value as an escape from reality:

I feel high like you wouldn't believe. . . . It's hard to explain how you feel. . . . I feel like I'm floating on air. . . . On one hand . . . I feel like an idiot for doing what I'm doing and that is absolutely nothing except getting high, but on the other hand, I love it because I'm getting high as much as I want, when I want . . . and that makes up for everything else. You see people who live on the streets, 99 percent of them snort coke because it's a way for them to forget about life . . . forget about the things you wanted in life . . . this is like a replacement.¹⁰

New pharmacological research supports a widely held theory that cocaine-induced euphoria is tied to a chemical messenger in the brain called dopamine.

Dopamine is a special chemical, called a neurotransmitter, that has the job of transmitting electrical messages from one nerve cell, or neuron, to the next. Researchers, who have identified more than fifty different neurotransmitters, believe that dopamine is the one responsible for interacting, or binding, with the psychoactive chemicals found in cocaine. Dopamine is called the "pleasure neurotransmitter" because the impulses it transmits impart a pleasurable sensation.

Dopamine flows from neurons into the synapses, the tiny spaces between neurons, to form a temporary bridge that carries the signal across the synapse. Normally, after a neuron has transmitted its signal to the next neuron, the dopamine leaves these spaces, returning to the same neuron that released it in a recycling process called re-uptake.

If cocaine is present in the brain while an electrical signal is taking place, scientists believe it blocks the re-uptake process, resulting in a buildup of dopamine in the synapses which creates an abnormally acute sense of pleasure. As the buildup of the dopamine neurotransmitter continues, it causes the euphoria commonly reported as the pleasurable rush.

Exactly why this pleasurable sensation occurs is still largely a mystery. However, Dr. Donald W. Landry, associate professor of medicine at Columbia University, speculates that the answer lies in the limbocortical region deep in the center of the brain. Cocaine, he suspects,

stimulates a neural "reward pathway" that evolved in the ancestors of mammals more than 100 million years ago. This pathway activates the so-called limbocortical region of the brain, which controls the most basic emotions and behaviors . . . [that] undoubtedly conferred a survival advantage. The same structures persist today and provide a physiological basis for our subjective perception of pleasure. When natural brain chemicals known as neurotransmitters stimulate these circuits, a person feels "good."¹¹

When all the cocaine has reacted however, the re-uptake process begins and the dopamine levels drop, causing the euphoria to disappear as fast as it first appeared. The absence of euphoria is experienced as depression. The user also experiences irritability, fatigue, and an intense craving for more of the drug to escape the depression.

It is worth noting that this view of how dopamine causes its pleasurable effects is still theoretical, as Dr. Solomon Snyder of Johns Hopkins University indicates: "Again, we do not know for certain exactly how the brain regulates specific behaviors, but we can formulate some educated guesses and . . . we can use these guesses as the basis for the next important advances in understanding."¹²

For those who have experienced the cocaine cycle of "rush-to-crash" many times, the psychological effects have long-term consequences that become a constant part of the habitual user's life.

Long-Term Psychological Effects

Long-term cocaine use causes clearly visible psychological changes in users. Although doctors cannot say conclusively how long-term cocaine use affects the chemistry of the brain, subtle changes take place that constitute what clinicians call cocaine psychosis. Those who experience cocaine psychosis lose contact with reality and the ability to function normally. The most common manifestations of cocaine psychosis are hallucinations, paranoia, depression, and anxiety.

The user who suffers from cocaine psychosis may experience hallucinations that are highly animated and dramatic sensory distortions, such as seeing objects suddenly change form. One of the most common hallucinations among long-term cocaine users is the sense that insects are crawling on their bodies. So distinctive is this hallucination that the imagined insects are known as "coke bugs." Other hallucinations may take the form of hearing people laughing and talking when no one else is in the room, or smelling the aroma of food when none is present.

In addition to hallucinations, addicts may experience periods of paranoia; that is, they may think that people with hostile or harmful intentions are plotting against them. The most common example of paranoid thinking among cocaine users is falsely believing that the police are tapping their telephones.

Depression, a dulled mood and loss of energy and enthusiasm for normal activities, also often accompanies the paranoia and hallucinations. Excessive cocaine use commonly leads to a disinterest in friends, school, or usual family activities. Adding to the misery of a cocaine psychosis sufferer is the anxiety that goes with constant uncertainty over finding the next fix of cocaine.

Antisocial Behavior

Although not all long-term cocaine users experience cocaine psychosis, those who do are unable to function in society. Thus, cocaine psychosis is likely to affect those personally and professionally connected to the user as well as the user himself.

Those suffering from cocaine psychosis display a variety of anti-social behaviors, such as deception, violence, and isolation.

This deception often begins with lying to friends and family about the cost and frequency of cocaine use; experts in addictive behavior note that self-deception in the form of blaming others for the user's addiction is also common. If this pattern continues unchecked, many regular cocaine users escalate their deception to nonviolent forms of criminal behavior such as shoplifting, burglary, and forgery to pay for their cocaine habits.

Coke Bugs

One of the most common manifestations of cocaine psychosis is a sensory hallucination experienced by many long-term users who feel bugs crawling all over their bodies and in their mouths. This hallucination is so common that it has become known as "coke bugs." Eugene Richards, in his book Cocaine True, Cocaine Blue, interviews a cocaine addict who tells this story about coke bugs:

I knew this guy, every time he got high, he thought he felt these little bugs, and he would pick at his skin and bleed. He had holes all over, he'd swear he'd see them moving, try to get them with clippers and scissors and razors. Try to dig them out. Finally, he just got a thing of Black Flag, the roach spray, and sprayed his whole body, and wound up dying. But cocaine is not supposed to do that. It does that when you do too much.

If nonviolent criminal behavior fails to generate enough money to meet the addict's cocaine needs, violence is often the next step. Violent behavior can range from verbal assaults to the extremes of physical assault, murder, and suicide. Such antisocial behavior often results from inability to resolve their distress through conflict resolution techniques such as negotiation and compromise. The association between prolonged use of cocaine and violent behavior is well documented. One criminologist, James Lardner, held conversations with inmates in New York's Rikers Island prison and reported that

interviews with criminals, accused criminals, former criminals, and street-savvy kids in Phoenix, New York City, and Newark, N.J., highlighted another important development: a new awareness of the harm done by hard drugs, and especially by cocaine and crack cocaine, associated with some of the worst violence of the past decade.¹³

Often, however, it is the addict who is the victim of the violence. The National Institute on Drug Abuse (NIDA), for example, reports:

Dr. Kenneth Tardiff of Cornell University Medical College in New York City headed a team of researchers that studied the 4,298 homicides that occurred in New York City during 1990 and 1991. Cocaine was found in the bodies of 31 percent of the victims. Homicide victims may have provoked violence through irritability, paranoid thinking, or verbal or physical aggression, which are known to be pharmacological effects of cocaine.¹⁴

Cocaine and Crime

Many cocaine and crack addicts support their habits through criminal activities. Eugene Richards, author of Cocaine True, Cocaine Blue, interviews Sally, a teenage cocaine addict with an already long history of crime:

I got shot selling drugs. ... The guy pulled up a .22 from the side of the car. That was years ago because I'm sixteen this year. I just got out [of jail] in January, armed theft and robbery. But I had no gun. I had some money and a lady's pocket book and then I got caught in a stolen car. Now I live with my parents, though my favorite thing is still going downtown with other girls. I hop on the trolley downtown to see if I can steal something. Easiest stuff is pants, silk shirt, socks. I go in there and try on the pants and put my jeans on top of it, then walk out the door. Sometimes I take leather pants and get thirty, forty dollars back up here.

My mom's around here somewhere. I don't really do tricks [prostitution], but sometimes I sell drugs, making four hundred to five hundred dollars a week. If you add it all up, though, I blow a lot of it smoking turbos [crack mixed with marijuana] and drinking beer.

The deceptions and antisocial behavior that the cocaine abuser inevitably relies on to support his or her habit frequently alienate both friends and family. The resulting isolation tends to reinforce the user's paranoia and depression, creating a vicious cycle that is destructive not just for the addict but for all those who deal with him or her.