A review of specialist crack cocaine treatment approaches in England. The evidence base for engagement, and lessons for current practice.
Crack cocaine remains one of the most persistent challenges in England’s treatment system, yet services are still largely built around opioid dependence rather than stimulant use. In 2024–25, 32,399 adults entering treatment in England reported crack cocaine problems.
Crack presents differently from opioid dependence: binge-and-crash patterns, rapid destabilisation, paranoia, and a narrow window of motivation. The central challenge has rarely been what treatment is offered, it is whether people can be engaged quickly and credibly enough to stay with it at all.