Author Affiliation: Dr Hyman is Director, National Institute of Mental Health, Bethesda, Md.
Clinical Crossroads Section Editor: Margaret
A. Winker, MD, Deputy Editor.
DR REYNOLDS: Mr R is a healthy 28-year-old
man with a 4-year history of cocaine addiction. He lives in Boston with his
girlfriend. He has Massachusetts free care insurance coverage and sees his
primary care physician, Dr B, at Beth Israel Deaconess Medical Center.
About 4 years ago at a party, Mr R first tried cocaine intranasally.
Although he did not seek out more cocaine, about 6 months later, he smoked
some cocaine. He has been pursuing smoked cocaine, or crack, ever since. He
began using crack several times a day, subsequently losing jobs, apartments,
and relationships. He stole a car from his family and money from his friends.
Hyman SE. A 28-Year-Old Man Addicted to Cocaine. JAMA. 2001;286(20):2586-2594. doi:10.1001/jama.286.20.2586