Symptoms of Cocaine Addiction, Use, and Abuse

Content Overview


Cocaine, a stimulant, carries a high risk of addiction. Individuals may quickly progress from recreational use to abuse to addiction to cocaine. Each phase along this continuum will involve symptoms. The following are some of the possible physical, psychological, and behavioral symptoms of cocaine abuse:

  • Rapid breathing
  • Loss of appetite
  • Insomnia
  • Unnaturally intense feeling of wellbeing
  • Talkativeness
  • Mood swings
  • Irritability, anxiety, or paranoia
  • Spending a disproportionately large amount of money and resources on cocaine use
  • Skipping important family, work, or social activities to use cocaine
  • Withdrawing from friends, family, coworkers, or classmates
  • Spending time with other people who use cocaine or other drugs
  • Using slang for cocaine such as coke, blow, white lady, lady, sugar, or champagne

Tolerance is a primary physical symptom of cocaine abuse. Due to tolerance, a person will require more cocaine over time to get the familiar high. If cocaine use stops or the amount used is appreciably reduced, withdrawal symptoms will emerge. Withdrawal symptoms can include depression, fatigue, excessive appetite, restlessness and nightmares.

Drug use casts people into the dark in many respects.
Those who use drugs as well as those who are concerned about drug activities can feel as if they are operating in unchartered territory. It can be particularly challenging to identify the phases of drug abuse, such as recreational use versus physical dependence versus addiction. For this reason, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) no longer uses the term physical dependence and addiction. Rather, the DSM-5 instituted use of the concept and term substance use disorder. This classification merges the symptoms of physical dependence and addiction. For any given classification of a drug, there is a substance use disorder for it. For example, cocaine is a stimulant, and therefore comes under stimulant use disorder.

A mental health professional can make a diagnosis of a stimulant use disorder if the qualifying period of time has been met and certain symptoms have emerged (there are 11). Typically, the symptoms must occur over at least a 12-month period, and the drug must be causing some impairment to the person’s functionality in some way. The following is a selection of five paraphrased symptoms of stimulant use disorder:

  • A desire to stop using cocaine but continuing to do so despite any number of troubles it is causing at work, in the home, in relationships, with one’s finances, or with the law
  • Foregoing former activities of interest because most or all of one’s time is being spent using drugs, as well as working on ways to get drugs
  • Continuing to use drugs even when doing so puts one in dangerous situations
  • Building a tolerance: the more individuals use cocaine, the greater the amount needed to achieve the familiar high
  • Going through withdrawal as a result of the body’s dependence on cocaine, (When the volume of intake is decreased or the use stops, withdrawal symptoms emerge.)

Symptoms or side effects can emerge during different phases of cocaine use. A person who has just recently used cocaine may show one set of signs while a chronic user will exhibit another.

People who are concerned about the impact of their cocaine abuse can benefit from an understanding of the different symptoms that can emerge. Individuals who suspect that cocaine use is occurring, but are not sure, may be especially attuned to shifts in the loved one’s physical health, mental state, and behavior.

People who use cocaine will usually have some common experiences. Portrayals of cocaine use persist in movies, and do provide some insight into the experience. The reason cocaine users, like actors in movies, repeatedly snort or bump cocaine is that the drug is fast-acting but short-lived. Some of the immediate experiences associated with cocaine use are:

  • Euphoria: This intense feeling comes from the brain’s reward system. Nature has designed the brain to reward good behavior that perpetuates the species. For example, eating is pleasurable because it promotes survival. But cocaine and other drugs of abuse hijack the brain and cause it to release more neurotransmitters than mundane but critical activities, like eating.
  • A sense of being supremely confident: Sometimes called grandiosity, a person high on cocaine may have such an intense feeling of wellbeing that they have the illusion of being better than everyone else.
  • Being outgoing: Cocaine can make a person feel particularly sociable. During a cocaine high, a person may talk excitedly and jump from one topic to another. For this reason, cocaine use may be especially attractive to individuals who usually experience anxiety or fear in a social setting, as well as those who are depressed.
  • Demonstrating uncharacteristic mood swings: A person on cocaine may shift from being outgoing to being hostile. In this state, the individual may exhibit restlessness, have an angry outburst, or be hyperactive or restless.

Cocaine use is linked to numerous short-term side effects.

According to the Foundation for a Drug-Free World, the following are some of the reported short-term effects:

  • A loss of appetite
  • Rapid breathing
  • Cravings to use cocaine again
  • Dilated pupils
  • Increased blood pressure, body temperature, and heart rate
  • Nausea
  • Contracted blood vessels
  • Convulsions or seizures
  • Trouble sleeping
In the long-term, cocaine use can have several physical side effects. The following is a sample of the possibilities:

  • Irreversible damage to the heart, brain, and blood vessels
  • High blood pressure, which can lead to stroke, heart attack, and death
  • Damage to the kidneys, liver, and lungs
  • Serious tooth decay
  • Weight loss and malnutrition
  • Damage to the reproductive capacity of males and females
  • If sniffed, damage to nasal cavity tissues
  • If smoked, lung damage
  • Development of a substance use disorder
  • If injected, risk of abscesses and infectious disease, as well as track marks

Cocaine use can also result in a fatal overdose. According to the National Institute on Drug Abuse, from 2001 to 2014, there was a 42 percent rise in the number of cocaine-involved deaths. In 2006, the number of cocaine overdoses showed a high of over 7,000 deaths. The low for this period was in 2010, when the rate was just above 4,000 fatal overdoses. In 2014, there were more the 5,000 cocaine overdose deaths.

Different mental health symptoms can emerge at different points during cocaine addiction and even after recovery. There is a host of possibilities, ranging from rare to common. The following are some of the known mental health side effects that can emerge immediately after cocaine use or as a result of chronic use:

  • Depression or serious depression
  • Cocaine-induced psychosis
  • Anxiety and paranoia
  • Visual hallucinations
  • Vivid, frightening dreams
  • Tactile hallucinations, such as the sensation of bugs being under the skin
  • Delirium
  • Disorientation or confusion
  • A feeling of apathy or lack of ability to experience pleasure

Mental health symptoms arise from the sudden impact of cocaine on the brain, but over time, they can owe to structural changes in the brain. For example, chronic use of cocaine can cause long-term damage to the brain and lead to deficits in cognitive functioning. This happens because ongoing use of cocaine causes an imbalance in dopamine levels. In addition, there can be a decrease in the prefrontal cortex, the area that is responsible for attention, processing complex data, and logic. To illuminate this point further, consider that individuals who have a diagnosis of attention deficit hyperactivity disorder often have deficiencies in the prefrontal cortex area.

Behavioral Symptoms of Cocaine Use

woman depressed and on drugsWhen a person progresses from recreational use of cocaine to a stimulant use disorder, there will likely be noticeable changes in temperament, appearance, and behavior.
Some of these changes will relate to using the drug (i.e., physical and mental health changes) while others will be a direct outgrowth of actions taken to get the drug (can include stealing or selling possessions of varying value). Still other behaviors may involve the administration of the drug (for instance, if it’s smoked, the related apparatus may be found in the person’s living area).

The following are some additional behavioral changes that may accompany cocaine use or a cocaine use disorder:

  • Experiencing problems in life: this may involve trouble with performance or meeting responsibilities at home, at work, or in school.
  • A neglected appearance: As the cocaine use takes hold, there may subsequently be less of an interest in grooming, appearance, and clothing.
  • An increase in efforts to be secretive: For instance, individuals may prohibit others from entering private spaces, such as their car, bedroom, or school locker.
  • Draining resources: There may be a sudden uptick in spending, use of credit cards, requests to borrow money, inability to meet bills, and liquidation of assets.
It can also help to know the paraphernalia that is associated with cocaine use. Paraphernalia varies depending on the specific way this stimulant drug is used. Snorting is a common method of administration. Paraphernalia involved in snorting includes straws, pens with the contents emptied out, a rolled-up dollar bill, a mirror or other surface (that may have cocaine residue on it), and sharp-edged objects like credit cards (that may have cocaine residue at the edge). If a person is injecting cocaine, syringes, spoons (likely with burn residue), lighters, and a belt or hose (to help the person find a vein) may be discovered. It may be alarming to find cocaine paraphernalia, so it’s important to keep in mind that stimulant use disorder is a treatable condition. Recovery can reverse much, if not all, of the damage associated with a cocaine use disorder.
By the time behavioral changes are apparent, there are also likely to be other symptoms. Individuals who are concerned about a loved one’s suspected cocaine use may feel uncertain as to how to parse through the symptoms they are witnessing. The key isn’t to focus on classifying the symptoms; one doesn’t have to know why they’re happening – just that they are, and that they relate to cocaine use. It’s important to compare the person’s familiar behaviors to current ones, as well as consider any hard evidence, such as finding cocaine or cocaine paraphernalia.

Next steps can include having an informal talk with the person. If that would not likely be helpful or doesn’t seem sufficient, it is possible to stage an intervention with the help of an interventionist or an addiction specialist. In view of the negative side effects associated with cocaine use, it’s helpful to act as early as possible.

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