Epidemic Cocaine Abuse: America's present, Britain's future?*

Summary Epidemic cocaine abuse has become a major problem in America and may be spreading to England. The paper reviews the historical setting in which cocaine first became a problem in America at the turn of the century and its recent re‐emergence. Possible reasons for this are explained including myths as to its safety, relationship to prior marijuana use, celebrity endorsements and the role of the media, changes in the route of administration and the reinforcing effects of the drug itself. Since heavy cocaine use is now understood to cause a physiologic as well as a psychologic dependence, treatment may need to deal with neurochemical changes possibly involved in the persistent relapses. Pharmacologic approaches to remedy this, especially use of certain tricyclics, are discussed as are a variety of psychological treatments including behavioral, supportive and relapse prevention methods. The paper concludes by listing possible interventions that might lessen the problem if adopted including steps that can be taken in the realms of education, law enforcement, and treatment.