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Psychological effects

Crack cocaine is a substance that affects the brain chemistry of the user: causing euphoria,[6] supreme confidence,[7] loss of appetite,[6] insomnia,[6] alertness,[6] increased energy,[6] a craving for more cocaine,[7] and potential paranoia (ending after use).[6][8] Its initial effect is to release a large amount of dopamine,[2] a brain chemical inducing feelings of euphoria. The high usually lasts from 5–10 minutes,[2][6] after which time dopamine levels in the brain plummet, leaving the user feeling depressed and low.[2] When cocaine is dissolved and injected, the absorption into the bloodstream is at least as rapid as the absorption of the drug which occurs when crack cocaine is smoked,[6] and similar euphoria may be experienced.

A typical response among users is to have another hit of the drug; however, the levels of dopamine in the brain take a long time to replenish themselves, and each hit taken in rapid succession leads to increasingly less intense highs.[2] However, a person might binge for 3 or more days without sleep, while partying with hits from the pipe.[8]

Use of cocaine in a binge, during which the drug is taken repeatedly and at increasingly high doses, leads to a state of increasing irritability, restlessness, and paranoia.[6] This may result in a full-blown paranoid psychosis, in which the individual loses touch with reality and experiences auditory hallucinations.[6]

Stimulant drug abuse (particularly amphetamine and cocaine) can lead to delusional parasitosis (aka Ekbom's Syndrome: a mistaken belief they are infested with parasites).[9] For example, excessive cocaine use can lead to formication, nicknamed "cocaine bugs" or "coke bugs," where the affected people believe they have, or feel, parasites crawling under their skin.[9] These delusions are also associated with high fevers or extreme alcohol withdrawal, often together with visual hallucinations about insects.[9]

People experiencing these hallucinations might scratch themselves to the extent of serious skin damage and bleeding, especially when they are delirious.