into a severe depression from which only the drug can arouse them.
Second, cocaine is problematic as an aphrodisiac, in either its powdered or its base form. Researchers have found considerable differences in sexual responses to the same dosage level of cocaine, depending primarily on the setting of the use and the background experiences of the user. Among male recreational users, cocaine not only helps to prevent premature ejaculation, but at the same time permits prolonged intercourse before orgasm. Among female recreational users, achieving a climax under the influence of cocaine is often quite difficult. For both, however, when an orgasm finally occurs, it is quite intense. Medical accounts generally conclude that because of the disinhibiting effects of cocaine, its use among new users does indeed enhance sexual enjoyment and improve sexual functioning, including more intense orgasms (Grinspoon and Bakalar, 1985; Weiss and Mirin, 1987). These same reports maintain, however, that among long-term addicts, cocaine decreases both sexual desire and sexual performance (MacDonald et al., 1988).
The association between crack and sex appears to be both pharmacological and sociocultural in nature. The pharmacological explanation begins with psychopharmacology: one effect of all forms of cocaine, including crack, is the release of normal inhibitions on behavior, including sexual behavior. The disinhibiting effect of cocaine is markedly stronger than that of depressants such as alcohol, Valium, or heroin. While the latter drugs typically cause a release from worry and an accompanying increase in self-confidence, cocaine typically causes elation and an accompanying gross overestimation of one's capabilities. Moreover, because the effects of cocaine have a rapid onset, so too does the related release of inhibitions.
Often, the association between crack and sex results from the need of female crack addicts to pay for their drugs. This connection has a pharmacological component—crack's rapid onset, extremely short duration of effects, release of inhibitions, and high addiction liability combine to result in compulsive use and in a willingness to obtain the drug through any means. In addition, although overdose is a constant threat, crack use does not pose the kind of physiological limit on the maximum needed (or possible) daily dosage that other drugs do. Whereas the heroin addict typically needs four doses per day, and an alcoholic commonly passes out after reaching a certain stage of intoxication, the heavy crack user typically uses until the supply is gone—be that minutes,