Drug-producing countries such as the Andean countries of South America where cocaine is manufactured are confronted by special difficulties associated with the widespread availability of drugs. There have been few detailed reports of patterns of use in relation to the type and severity of cocaine dependence problems within those countries. The present study looks at the patterns of cocaine use in relation to severity of dependence among a clinical sample of South American cocaine users. Information about patterns of cocaine use and severity of dependence was collected from a sample of 68 drug users who were receiving treatment for cocaine problems at treatment centres in Bolivia and Peru. Levels of cocaine consumption were extremely high. The mean daily dose was 16.4 grams. The majority of the users (87 per cent) smoked cocaine in the form of pasta, pitillo or basuco. More than half of the sample reported using cocaine at least 20 times a day. Severity-of-dependence scale scores were high and these are consistent with the frequent and compulsive pattern of use reported within the sample. It is suggested that the more severe cocaine problems reported in South America compared to some western countries may be due to the substantial differences in the amounts of cocaine which are typically ingested. In the Bolivian sample most of the users were taking cocaine in amounts which greatly exceed those usually seen in western countries.