The clinical name “cocaine base” tells little about what its common street name “crack” looks like. Crack is a smokable, rock-like form of cocaine that is highly addictive and dangerous even with short-term use. Of all the ways to use cocaine, smoking crack provides one of the fastest rates of absorption, entering the central nervous system circulation within 6 to 8 seconds.
Cocaine Use Disorder is devastating. According to the 2019 National Survey on Drug Use and Health, which included people aged 12 and older, 5.5 million people reported past year cocaine use [1]. Recognizing the signs may help you identify someone who needs help.
In this article, I describe its physical appearance, the behavioral and physical signs of addiction, and the critical health and social risks involved in its use.
What Crack Looks Like
Crack can often be recognized by its appearance, the paraphernalia around it, and changes in a person’s body, behavior, and health.
Typically, crack looks like small, pebble-sized or larger marble-sized irregular “rocks” or chunks. It often has a rough, jagged appearance, but sometimes is smoother like ceramic pieces. They are off-white, cream, yellowish, or brown in color. Purity and agents cut with it affect the color.
Crack may be crystalline or chalky. The texture is typically brittle, with a hard, crystalline or “waxy” feel and it often crumbles or flakes when handled. Pink, blue, or other vivid colors indicate dangerous adulterants such as stimulants or opioids (e.g., fentanyl).
When exposed to flame, pure crack melts and may numb the tongue when briefly touched to it. It is often sold in tiny, plastic baggies or foil wraps.
Smell, Associated Paraphernalia, and Signs of Use
Crack often gives off a sharp, chemical, or burnt plastic/rubber smell when smoked. This is similar to burning chemicals or gasoline.
Common Paraphernalia
Identifying the tools used to consume crack is often a good way to identify the drug.
- Small Glass Pipes: Often makeshift (from small glass tubes, sometimes with a metal or copper mesh “chore” or brillo pad as a filter).
- Lighters, Matches, or Torches: Used to heat the rock from below.
- Residue: White or brownish powder residue in pipes or on surfaces.
- Small Mirrors or Hard Surfaces: Used to prepare and chop the rock.
- Tiny Plastic Baggies or folded foil packets, often with corners torn off, with white or off‑white residue.
- Broken pens or tubes, near where the person spends time.
Behavioral, Physical, and Psychological Signs of Crack Use
Behavioral and Physical Signs
The immediate effects of smoking crack include [2] [3]:
- Extreme euphoria for a few minutes
- Hyper-alertness
- Rapid, pressured speech
- Erratic or agitated behavior
Common short-term signs include:
- Dilated pupils
- Restlessness
- Muscle twitches or “jitters”
- Excessive sweating
- Rapid breathing or heartbeat
- Elevated temperature
- Loss of appetite
- Insomnia
Longer-term Physical Signs
- Burns on fingers or lips (from pipes)
- Crack lip (sores/blisters)
- Frequent nosebleeds or runny nose (especially if also snorting)
- Chronic cough
- Respiratory distress
- Severe dental problems (“crack mouth”)
- Significant weight loss
- Poor hygiene
- Sores or scabs from scratching due to sensations of bugs crawling on or under the skin (formication, sometimes called “coke bugs”)
Environmental Clues
- Chemical or sweet burning smells
- Hidden stashes of paraphernalia
- Financial problems
- Missing valuables
Crash and Cravings: Psychological Signs
- Initial consumption may be followed by a severe “crash” marked by:
- Depression
- Lethargy
- Irritability
- Intense craving within minutes, leading to a binge cycle
Secretive Behavior: Psychological Signs
- Paranoia
- Defensiveness
- Lying
- Stealing
- Selling belongings
- Legal issues
- Social withdrawal
Neglect of Responsibilities: Psychological Signs
- Decline in performance at work/school
- Neglect of personal hygiene and relationships
Risks and Dangers
Health Risks
- Cardiovascular: Increased blood pressure, heart attack, stroke, arrhythmia—can occur even in first-time users. Sudden death.
- Respiratory: Lung damage, “crack lung”, severe asthma, pulmonary hypertension, swelling, and bleeding.
- Neurological: Seizures, heightened risk of stroke, severe paranoia, and psychosis (tactile hallucinations called “cocaine bugs”), cognitive problems.
- Overdose: High risk due to potency and unknown adulterants, especially synthetic opioids like fentanyl, which can cause fatal respiratory depression.
Social and Legal Consequences
- Rapid development of severe addiction
- Financial ruin, job loss, and homelessness
- Strained or destroyed family and social relationships
- Arrest, incarceration, and a permanent criminal record
What to Do If You Suspect Someone Is Using
- Approach with Compassion, Not Confrontation: Express concern around health and well-being, not accusation.
- Educate Yourself: Understand addiction as a disease. Consult resources from SAMHSA or NIDA.
- Choose the Right Time: Talk when the person is sober and in a private, calm setting.
- Use “I” Statements: Express concern without blame (e.g., “I’ve been worried about you because I’ve noticed…”).
- Offer Support and Resources: Have concrete options ready: the 988 Suicide & Crisis Lifeline, local addiction specialists, treatment centers, or support groups (Narcotics Anonymous).
- Practice Self-Care: Set boundaries. Seek support for yourself through groups like Al-Anon/Nar-Anon.
Seeking Help and the Path to Recovery at Northbound
At Northbound, we have extensive experience helping patients overcome their substance abuse addictions, and with a Christian faith-based track for those wishing to participate.
We offer a wide range of evidence-based therapies, counseling, and trauma-informed support to assist you in your healing. We personalize each treatment plan around the needs of our patients.
The first steps are detoxification and stabilization, under 24-hour medical supervision in our Withdrawal Management center for whatever time you may require.
Our inpatient residential program offers 24/7 live-in treatment for substance abuse. Our outpatient treatment provides a flexible step-down from our residential program, allowing you to live at home and participate for several hours a day.
For more than 30 years, Northbound Treatment Services in California has been at the forefront of providing lifesaving, compassionate residential care and specialized services to help people from all walks of life feel better, discover themselves, and live free from addiction.
We have facilities located throughout California to help guide you on your recovery journey. Reach out to our admissions team now.
Sources
[1] Schwartz, E. et al. (2022). Cocaine Use Disorder (CUD): Current Clinical Perspectives. Substance abuse and rehabilitation, 13, 25–46.
[2] Nestler E. J. (2005). The neurobiology of cocaine addiction. Science & practice perspectives, 3(1), 4–10.
[3] National Institute on Drug Abuse (NIDA). Cocaine.
[4] CAMH. Cocaine and Crack.
Author
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Clinical Director, Clinical Supervisor, EMDR Provider
I am a Licensed Clinical Social Worker and graduated with a degree from the USC School of Social Work in 2015 with an emphasis in mental health. I began my career working with the Orange County Welfare to Work Program providing mental health services to reduce barriers to employment. I have spent the last 5 years working various levels in behavioral health, providing direct service to those struggling with co-occurring disorders.Using an eclectic and integrative approach, I incorporate the AIP model with EMDR, Person-in-Environment (PIE), Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), family systems, interpersonal and solution-focused therapy along with Rogerian positive regard into my practice.
