Brain atrophy and chronic cocaine abuse: background and work in progress.

The crack epidemic, now a decade old, disabused neurologists of the idea that cocaine was a relatively safe drug. Acute neurologic complications of cocaine intoxication such as headaches, delirium, seizures, and strokes have now been amply delineated. Less clear is whether long-term cocaine use, uncomplicated by acute problems, can lead to structural or functional changes in the human brain. Brain atrophy is a potential consequence of alcohol abuse (Cala and Mastaglia 1980; Fox et al. 1976; Harper et al. 1988; Ron et al. 1982), inhalant abuse (Hormes et al. 1986; Rosenberg et al. 1988), and use of nonrecreational substances such as corticosteriods (Bentson et al. 1978; Gordon 1980) and valproic acid (McLachlan 1987). This chapter summarizes some earlier work linking long-term cocaine abuse to brain atrophy, and it describes an ongoing investigation of brain atrophy and dysfunction in chronic cocaine abusers using volumetric brain magnetic resonance imaging (MRI).