Market Barriers to the Development of Pharmacotherapies for the Treatment of Cocaine Abuse and Addiction: Final Report. Estimate of Cocaine Users in the U.S.


The following paragraph provides a summary of some plausible estimates of cocaine use in the United States. The remainder of this section describes the national surveys on drug abuse from which the estimates of cocaine use are derived.

There are in excess of 2 million addicted or "heavy" cocaine users in the U.S. Of these, about 800,000 to 900,000 enter treatment at least once in a given year. On any given day, there about 250,000 cocaine users enrolled in treatment (i.e., at a residential facility or have been served at an ambulatory treatment center within the previous 30 days). Of these 250,000 currently enrolled users, roughly 150,000 are primary cocaine abusers and 100,000 are secondary cocaine abusers. Thus, of all heavy cocaine users, slightly more than 10 percent are enrolled in treatment on any given day.

While there is no definitive method for estimating the number of cocaine abusers in treatment on any given day, estimates of cocaine users currently enrolled in treatment can best be derived by applying estimates of the proportion of all substance abusers who are cocaine abusers to the NDATUS estimate of 900,000 substance abusers.

Several recent surveys have estimated that up to 17 percent of patients entering specialty substance abuse treatment have primary cocaine abuse (e.g., smoked or other) (Figure 7 below). The State Alcohol and Drug Abuse Profile (SADAP) surveys suggest that the proportion of primary cocaine admits has increased during the 1990s; however, it contains no information on cocaine abuse secondary to other substances. Application of this 17 percent rate yields an estimate of 150,000 daily patients with primary cocaine abuse.

Figure 7: Cocaine Use in Substance Abuse Treatment Study Populations
Selected Major Studies, 1990-1995

(Year of Data)

Clients/ Admits
Cocaine Primary
Cocaine Secondary to
Any Cocaine
(in millions)
Other Drug
(percent of clients, or admits)
TEDS, 1995 1.328 admits 17.1 19 8.3 10.7 36.1
SADAP, 1994 1.826 admits 17.9  -  -  -  -
SADAP, 1993 1.755 admits 15.7  -  -  -  -
SADAP, 1992 1.793 admits 14.8 - - - -
SADAP, 1991 1.976 admits 11.4 - - - -
SADAP, 1990 1.910 admits 11.4 - - - -
DSRS I, 1990 0.720 clients 10.7 - - "with" 18.9 29.6
DSRS II, 1990 1.048 dischs - - - - 38.5


TEDS: Office of Applied Studies, SAMHSA, 1997.

SADAP (all): National Association of State Alcohol & Drug Abuse Directors, various.

DSRS Phase I: Brandeis University, 1993a.

DSRS Phase II: Brandeis University, 1993b.

The Treatment Episode Data Set 1992-1995 (TEDS) survey indicates that an additional 19 percent of substance abuse enrollees are secondary cocaine abusers, i.e., are primarily abusing one or more other substances such as alcohol or heroin. This yields an estimated 170,000 secondary cocaine abusers. However, because cocaine abuse may be the third or fourth drug problem for many of these patients, a more conservative estimate of 100,000 is used. Adding this conservative estimate of 100,000 patients to the SADAP estimate for patients with primary cocaine abuse (150,000) yields a combined estimate of 250,000 primary or secondary cocaine abusers.

The SADAP and TEDS surveys must be used advisedly. First, they draw data exclusively from publicly-reimbursed specialty providers. Second, although such providers have 80 percent of the daily patients (among providers reporting funding sources), there is some uncertainty about how complete and representative these surveys are in their coverage of treatment admissions. TEDS reports on 1.3 million admissions and SADAP on 1.9 million admissions, both of which are purported to be a census of admissions to their provider frames. Other studies have estimated that there are over 3 million admissions to specialty treatment providers per year (Harwood et al., 1994; Denmead et al., 1995; Office of Applied Studies, 1997). Because SADAP and TEDS cover publicly-reimbursed patients only, they may over-represent cocaine abuse relative to the entire population, which may have somewhat lower levels of cocaine abuse relative to all types of drug abuse.

The estimate of the number of cocaine addicts varies somewhat. The Drug Services Research Surveys (DSRS) indicate that by 1990 there were in excess of 200,000 cocaine patients per day (Brandeis University, 1993a, 1993b). In linked studies, DSRS examined drug problems of patients according to the one-day census of treatment (Phase I) and annual discharges from treatment (Phase II). Based on Phase I findings, about 30 percent (i.e., 210,000) of the 720,000 patients enrolled with "drug" or "drug and alcohol" treatment providers (excluding "primary alcohol" providers) had a diagnosable cocaine problem. Although little detail was provided for the estimates, it can be deduced that cocaine was the unambiguous primary problem for about 11 percent (75,000) of all enrollees and that cocaine was accompanied by, and may or may not have been secondary to, alcohol for the other 135,000 enrollees.

In Phase II of DSRS, data on type of substance abuse were available for only 81 percent of the 1.05 million discharged patients. Of these patients, 38.5 percent reported having drug or combined drug and alcohol abuse. Application of proportion to the NDATUS estimate of 620,000 current enrollees in drug or combined drug and alcohol treatment (i.e., 900,000 total substance abusers minus 280,000 alcohol-only abusers; Office of Applied Studies, 1995) yields an estimate of about 240,000 cocaine patients per day.

The estimate of a total of 900,000 cocaine users who are treated at least once in a given year is derived by applying the turnover rate of 3.6 (noted above) to the 250,000 persons with primary or secondary cocaine diagnoses. Figure 8 (below) provides a summary of the general characteristics for cocaine treatment in the U.S.

Figure 8: General Characteristics of the Market for Cocaine Treatment Data for 1992-94
Measure of Cocaine Treatment Market Estimate
Need for cocaine treatment ³ 2 million heavy users
Enrollment in treatment (primary cocaine diagnoses plus 60% of secondary diagnoses) 250,000 patients per day
Specialty providers treating cocaine abusers 11,500 providers
Annual treatment episodes (primary cocaine diagnoses) 800,000 to 1.0 million admissions per year
Individual cocaine abusers treated per year 900,000 persons
Spending on treatment $2.1 billion
Spending on treatment per cocaine patient $23.00 per day enrolled 

$9.00 per day in outpatient

Source: Analysis by The Lewin Group.