Yes. Cocaine abusers, especially those who inject, are at increased risk for contracting such infectious diseases as human immunodeficiency virus (HIV/AIDS) and viral hepatitis. In fact, use and abuse of illicit drugs, including crack cocaine, are major risk factors for new cases of HIV. Drug abuse-related spread of HIV can result from direct transmission of the virus through the sharing of contaminated needles and paraphernalia between injecting drug users. It can also result from indirect transmission, such as an HIV-infected mother transmitting the virus perinatally to her child. This is particularly alarming given that 30 percent of all new AIDS cases are among women. Research has also shown that drug use can interfere with judge- ment about risk-taking behavior, and can potentially lead to reduced precautions regarding sexual behaviors, the sharing of needles and injection paraphernalia, and the trading of sex for drugs, by both men and women.

Additionally, hepatitis C (HCV) has spread rapidly among injection drug users; Centers for Disease Control and Prevention (CDC) estimates indicate infection rates of 50 to 80 percent in this population. While currently available treatment is not effective for everyone and can have significant side effects, medical followup is essential for all those who are infected. At present, there is no vaccine for the hepatitis C virus. The virus is highly transmissible via injection, and HCV testing is recommended for any individual who has ever injected drugs.

The full extent of the effects of prenatal drug exposure on a child is not completely known, but many scientific studies have documented that babies born to mothers who abuse cocaine during pregnancy are often prematurely delivered, have low birth weights and smaller head circumferences, and are often shorter in length.

Estimating the full extent of the consequences of maternal drug abuse is difficult, and determining the specific hazard of a particular drug to the unborn child is problematic for many reasons. Multiple factors—such as the amount and number of all drugs abused; extent of prenatal care; possible neglect or abuse of the child; exposure to violence in the environment; socioeconomic conditions; maternal nutrition; other health conditions; and exposure to sexually-transmitted diseases—can contribute to the difficulty in determining direct impact of prenatal cocaine use on maternal, fetal, and child outcomes.

Many recall that “crack babies,” or babies born to mothers who used crack cocaine while pregnant, were at one time written off by many as a lost generation. They were predicted to suffer from severe, irreversible damage, including reduced intelligence and social skills. It was later found that this was a gross exaggeration. However, the fact that most of these children appear normal should not be overinterpreted as indicating that there is no cause for concern. Using sophisticated technologies, scientists are now finding that exposure to cocaine during fetal development may lead to subtle, yet significant, later deficits in some children, including deficits in some aspects of cognitive performance, information-processing, and attention to tasks—abilities that are important for success in school.

There was an enormous increase in the number of people seeking treatment for cocaine addiction during the 1980s and 1990s. Treatment providers in most areas of the country, except in the West and Southwest, report that cocaine is the most commonly cited drug of abuse among their clients. The majority of individuals seeking treatment smoke crack, and are likely to be polydrug users, or users of more than one substance. The widespread abuse of cocaine has stimulated extensive efforts to develop treatment programs for this type of drug abuse. Cocaine abuse and addiction is a complex problem involving biological changes in the brain as well as a myriad of social, familial, and environmental factors. Therefore, treatment of cocaine addiction is complex, and must address a variety of problems. Like any good treatment plan, cocaine treatment strategies need to assess the psychobiological, social, and pharmacological aspects of the patient's drug abuse.

Pharmacological Approaches

There are no medications currently available to treat cocaine addiction specifically. Consequently, NIDA is aggressively pursuing the identification and testing of new cocaine treatment medications. Several newly emerging compounds are being investigated to assess their safety and efficacy in treating cocaine addiction. Topiramate and modafanil, two marketed medications, have shown promising signals as potential cocaine treatment agents. Additionally, baclofen, a GABA-B agonist, showed promise in a subgroup of cocaine addicts with heavy use patterns. Because of mood changes experienced during the early stages of cocaine abstinence, antidepressant drugs have been shown to be of some benefit. In addition to the problems of treating addiction, cocaine overdose results in many deaths every year, and medical treatments are being developed to deal with the acute emergencies resulting from excessive cocaine abuse.

Behavioral Interventions

Many behavioral treatments have been found to be effective for cocaine addiction, including both residential and outpatient approaches. Indeed, behavioral therapies are often the only available, effective treatment approaches to many drug problems, including cocaine addiction, for which there is, as yet, no viable medication. However, integration of both types of treatments may ultimately prove to be the most effective approach for treating addiction. Disulfiram (a medication that has been used to treat alcoholism), in combination with behavioral treatment, has been shown, in clinical studies, to be effective in reducing cocaine abuse. It is important that patients receive services that match all of their treatment needs. For example, if a patient is un-employed, it may be helpful to provide vocational rehabilitation or career counseling. Similarly, if a patient has marital problems, it may be important to offer couples counseling. A behavioral therapy component that is showing positive results in many cocaine-addicted populations is contingency management. Contingency management may be particularly useful for helping patients achieve initial abstinence from cocaine. Some contingency management programs use a voucher-based system to give positive rewards for staying in treatment and remaining cocaine free. Based on drug-free urine tests, the patients earn points, which can be exchanged for items that encourage healthy living, such as joining a gym, or going to a movie and dinner.

Cognitive-behavioral therapy, or “Relapse Prevention,” is another approach. Cognitive-behavioral treatment, for example, is a focused approach to helping cocaine-addicted individuals abstain—and remain abstinent—from cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of cocaine abuse and dependence. The same learning processes can be employed to help individuals reduce drug use and successfully cope with relapse. This approach attempts to help patients recognize, avoid, and cope; i.e., recognize the situations in which they are most likely to use cocaine, avoid these situations when appropriate, and cope more effectively with a range of problems and problematic behaviors associated with drug abuse. This therapy is also noteworthy because of its compatibility with a range of other treatments patients may receive, such as pharmacotherapy.

Therapeutic communities (TCs), or residential programs with planned lengths of stay of 6 to 12 months, offer another alternative to those in need of treatment for cocaine addiction. TCs focus on resocialization of the individual to society, and can include on-site vocational rehabilitation and other supportive services. Of course, there is variation in the types of therapeutic processes offered in TCs.