Communication Disorders Quarterly

The street drug cocaine, including its permutations crack cocaine and methamphetamine cocaine, is a widely used substance of abuse and has long been associated with a variety of neurologic complications, such as those catego-rized as dystonic extrapyramidal reactions (Choy-Kwong & Lipton, 1989). According to the Office of National Drug Control, 5.7 million individuals in the United States use cocaine regularly, and its use has become increasingly prev-alent in the past decade (Office of National Drug Control Policy, 2008). As more individuals experiment with or chronically abuse this drug, the full spectrum of its poten-tial for causing neurological deficits is becoming appreci-ated (Catalano & Catalano, 1997). In 1990, Choy-Kwong and Lipton reported that cocaine has been “associated with a nearly 3-fold increase risk ” of extrapyramidal motor dys-function (p. 863). In addition, Cardoso and Jankovic (1993) suggest that the presence of extrapyramidal movement dis-orders associated with cocaine use is very likely more com-mon than currently recognized, given the “notorious tendency of drug abusers to deny drug exposure ” (p. 177). The increased popularity of certain forms of administration, notably the crack form, has further expanded the number of individuals presenting with cocaine-related neurological deficits (Catalano & Catalano, 1997). Any drug, whether prescribed or illegal, affecting the delicate equilibrium of the neurotransmitters dopamine and acetylcholine can be implicated as a cause of acute or delayed-onset extrapyramidal motor dysfunctions, such a