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Cocaine Addiction: Signs, Symptoms, and Treatment

5 min read · 11 sections

Cocaine misuse in the United States is a serious problem that isn’t going away: A 2021 survey found that an estimated 478,000 people aged 12 years or older used cocaine for the first time in that 12-month period.1 Cocaine is considered highly addictive and is associated with numerous mental and physical health problems.2 However, with the right treatment, many people are able to overcome their cocaine addiction.

This page is designed as an overview for understanding cocaine misuse, addiction, and how it can be treated effectively. Cocaine addiction treatment includes inpatient treatment and outpatient options, both of which include education, counseling, and therapies to help guide patients toward long-term recovery and sobriety.

What is Cocaine?

Cocaine is a stimulant drug derived from leaves of the coca plant. It’s usually sold in a white powder or synthesized into crystals or rocks as “crack.” Snorting, smoking, or injecting the drug elicits a brief euphoric, energizing, and exhilarating feeling that lasts a few minutes to an hour, followed by an unpleasant comedown.2

Although cocaine remains legal for medicinal use, its highly addictive potential limits its use as an anesthetic and today, it’s mostly used illicitly. The drug is classified as a Schedule II substance by the U.S. Drug Enforcement Administration (DEA).3 Despite its high potential for misuse, the drug remains popular: In 2021, 1.8 million Americans aged 12 or older reported using cocaine within the past month.1

Cocaine Effects & Adverse Reactions

As a stimulant, cocaine enhances activity in the body’s central and peripheral nervous system.4 The effects of its use appear almost immediately and may include:5

  • Euphoria, or a rush of pleasure or happiness.
  • Mental alertness.
  • Extreme energy.
  • Talkativeness.

The potential adverse effects of cocaine use can include:5

  • Dilated pupils.
  • Irritability and restlessness.
  • Anxiety.
  • Panic and paranoia.
  • Constricted blood vessels.
  • Fast or irregular heartbeat.
  • Nausea.
  • Raised body temperature and blood pressure.
  • Tremors and muscle twitches.

The high and short-term effects are typically short-lived, which may lead to repeat dosing over several hours or even days. Repeat use in this manner is typically followed by a “crash,” which leaves the user feeling fatigued, anxious, and depressed.6

How Is Cocaine Used?

Individuals use cocaine in a variety of ways, including:7

  • Inhaled, as a powder form, through the nostrils (snorted).
  • Taken orally (by swallowing or rubbing it on the gums).
  • Smoked, in a crystalized “crack” or freebase form, wherein the individual inhales the vapor or smoke into the lungs.
  • Dissolved in water and injected into a vein.

Smoking crack or injecting cocaine yields the most rapid and intense high.7

What Is Cocaine Cutting, and What Are Cutting Agents?

Drug dealers often mix cocaine with other products (a process known as “cutting cocaine”) to increase their supply, which also makes the cocaine even more dangerous. The list of cutting agents found mixed with cocaine is long—ranging from pantry items like sugar and starch to other drugs such as amphetamine and heroin.2 In fact, the practice of cutting cocaine with fatal opioids like fentanyl appears to be gaining prevalence, which can lead to overdose and death.8

In fact, in 2021, of the 24,486 overdose deaths involving cocaine, more than 15,000 also involved synthetic opioids (primarily fentanyl).9

Cocaine Overdose

Overdoses involving cocaine can be life-threatening or fatal, often resulting in seizures or cardiovascular emergencies such as heart attack or stroke.5 As previously mentioned, in 2021, 24,486 individuals died of a cocaine-involved overdose.9

Mixing Cocaine with Other Drugs

The risk of overdose is compounded by using other substances with cocaine (polysubstance use). Both alcohol and heroin are commonly used with cocaine.5,10 Some individuals inject a combination of cocaine and heroin—referred to as a “speedball”—a concoction that can be fatal.10

Individuals often take the two substances together because the stimulating effects of the cocaine are offset by the sedating effects of the heroin. However, the effects of cocaine use wear off before the heroin, which may, in turn, cause an individual to take a higher dose of heroin. This can result in fatal slowing of breathing (i.e., respiratory failure) due to an opioid overdose.5

When someone overdoses, it is vital that they get medical treatment as soon as possible. Call 911 immediately and stay with the individual until medical assistance arrives. If available, administer naloxone, which can reverse an opioid overdose but won’t have any effect on the cocaine overdose. As previously mentioned, a growing number of cocaine overdoses also involve opioids, like fentanyl.

Additionally, many people misuse alcohol and cocaine at the same time. Perhaps because the high from mixing alcohol and cocaine is more intense than the highs either substance produces on its own. Alcohol may also mitigate the discomfort of “coming down” from cocaine, while cocaine offsets the impairing effects of alcohol misuse. However, the two substances react to produce cocaethylene, which may increase the toxic effects of cocaine and alcohol on the heart.5

Is Cocaine Addictive?

Cocaine is considered to be highly addictive, largely because its use results in a surge of dopamine activity—the neurochemical associated with reward, motivation, and emotion. These increased levels of active dopamine in the brain serve to reinforce the drug-use behavior.10

With time, the brain’s reward circuitry may adapt to being artificially stimulated by cocaine, wherein the brain and body become so used to having cocaine present in the system, it needs it to function normally. Thus, if cocaine use suddenly stops or is drastically reduced, withdrawal symptoms will likely surface.10

Symptoms of Cocaine Addiction

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), addiction to cocaine is clinically referred to as a stimulant use disorder.11 Clinicians may evaluate individuals for meeting certain criteria when formally diagnosing stimulant use disorders. This criteria includes: 11

  • Using larger amounts of cocaine or for a longer period of time than originally intended.
  • Trying to cut back on or stop cocaine use altogether and being unsuccessful.
  • Spending a lot of time trying to get, use, or recover from the effects of cocaine use.
  • Experiencing cravings, urges, or desires to use cocaine when use is stopped.
  • Using cocaine despite falling behind on your responsibilities at school, work, or home.
  • Using cocaine despite having interpersonal problems with loved ones that are caused or worsened by drug use.
  • Giving up important social activities, occupational tasks, or other activities once enjoyed because of cocaine use.
  • Continuing to use cocaine in situations that are physically dangerous.
  • Continuing to use cocaine despite knowing that it is causing or worsening a physical or mental health problem.
  • Developing a tolerance for cocaine, meaning that either an individual needs significantly more cocaine to produce the same desired effect or “high” or that the effect has been significantly lessened with the same amount of cocaine.
  • Experiencing withdrawal symptoms when cocaine use suddenly stops or is drastically reduced.

If you recognize some of the above criteria in your own drug-related behaviors or those of a loved one, you might want to reach out for additional evaluation.

Cocaine Withdrawal

As mentioned above, chronic cocaine use can result in physiological dependence, which can cause withdrawal symptoms when cocaine use stops or is significantly reduced. Cocaine withdrawal symptoms can start within a few hours of last use or may begin within the first several days.11 These symptoms can cause unpleasant physiological and cognitive effects, including:10-12

  • Fatigue.
  • Vivid or unpleasant dreams.
  • Sleep disturbance, such as insomnia (inability to fall or stay asleep) or hypersomnia (excessive sleepiness, or sleeping too much).
  • Increased appetite.
  • Psychomotor retardation (physically moving very slowly) or agitation (moving very quickly or in an unsettled way).
  • Depression.
  • Slowed thinking processes.
  • Paranoia.
  • Cravings.

While it rarely presents immediate physical risks, cocaine withdrawal symptoms can be dangerous if, for instance, the depression is profound and accompanied by suicidal thoughts or attempts.12

Other medical complications associated with cocaine withdrawal—though rare—may include cardiac problems, seizures, and brain hemorrhaging.12

Thus, if you or a loved one are concerned about withdrawal symptoms from cocaine use, contact a healthcare professional for guidance.

Dangers of Long-Term Cocaine Use

Continued cocaine use carries many dire health risks and adverse long-term effects to practically every major function in the body—especially the cardiovascular system. Cardiac complications include disturbances in heart rhythm and heart attacks, as well as inflammation of the heart muscle, deterioration of the ability of the heart to contract, and aortic ruptures.13

People who misuse cocaine may also be malnourished. Individuals who chronically use cocaine sometimes neglect healthy eating habits when on a binge, and the drug reduces blood flow in the gastrointestinal tract, causing ulcers and tears.14 Cocaine misuse also harms the liver and kidneys and can even cause renal failure in extreme cases.15 Other serious health risks associated with long-term cocaine use include:14

  • Impaired cognitive function, including problems with attention, impulse inhibition, memory, making decisions involving rewards or punishments, and performing motor tasks.
  • Dangerously high blood pressure.
  • Acute coronary syndrome.
  • Stroke.
  • Seizure.
  • Hyperthermia, or abnormally high body temperature.

Pregnant individuals who use cocaine also risk harming the fetus. Cocaine decreases blood flow to the uterus, robbing the fetus of oxygen, resulting in raised heart rate and blood pressure. Babies born from individuals who misused cocaine during pregnancy have an increased risk of heart defects, problems with the central nervous system (CNS), and death.16 Despite the dire risks, there are about 750,000 cocaine-exposed pregnancies each year.17

Additionally, each of the methods of cocaine administration have specific adverse effects associated with long-term use. Repeatedly snorting cocaine damages the nasal cavity, causing nosebleeds, chronic runny nose, and a loss of the sense of smell.14

Smoking crack cocaine can cause lung damage and worsen asthma over time.14

Individuals who inject cocaine increase their risk of contracting infectious diseases like HIV and hepatitis C and overdose, particularly if the cocaine is mixed with additional substances.14

Cocaine Addiction Treatment Process and Therapies

About 5% of all admissions to drug use treatment programs in 2020 were a result of cocaine use.19 Substance use disorder, the clinical term for addiction, is complex and the most effective treatment approach is one specifically designed to serve an individual’s needs. Many programs implement a combination of several proven methods.

Although potential pharmaceutical treatments for cocaine dependence are ongoing, there are currently no medications approved by the U.S. Food and Drug Administration (FDA) available for either cocaine detoxification or longer-term treatment of cocaine use disorders.  Symptoms of stimulant withdrawal are often treated supportively with rest, exercise, and a healthy diet. In severe cases of agitation, sleep disturbance, or depression, physicians may enlist supportive medications.

Formalized treatment includes rehabilitation in an inpatient or outpatient facility. The primary treatment for cocaine misuse comes in the form of behavioral interventions. However, medications may be prescribed to help with cravings or withdrawal symptoms. One of the most important aspects of successful treatment is that patients remain in the program for the entire duration of treatment.20 

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends the following methods of rehabilitation therapy when treating stimulant misuse:21

  • Motivational interviewing: Usually the first step in therapy when a patient begins treatment, motivational interviewing helps patients recognize the ways addiction comes between them and their goals and strains their relationships. The approach is designed to help patients overcome apathy and feel motivated and optimistic about their recovery.
  • Contingency management: Stimulants are highly addictive because they hijack the brain’s reward circuits—contingency management works to repair these faulty patterns by rewarding positive behaviors. For example, attending meetings, taking prescribed medication, and passing drug toxicity exams are all met with reward.
  • Community reinforcement: This method emphasizes the positive behaviors identified in contingency management by building a supportive social network around the patient. This may include relationship counseling, job skills training, recreational activities, etc.
  • Cognitive-behavioral therapy: With cognitive-behavioral therapy, patients learn to avoid the obstacles that threaten their sobriety and overcome unhealthy thought patterns. This form of therapy is also crucial for patients that have any co-occurring mental health issues.

Cocaine addiction is a serious problem that causes many adverse mental and physical effects. In addition to the risks associated with cocaine use, people with substance use disorder also suffer from the social stigma associated with addiction. However, addiction is not a choice nor a sign of weakness—it is a complex medical disease that can be treated successfully. With the right treatment, many people live healthy, fulfilling lives in recovery.

Cocaine Addiction Treatment and Levels of Care

If you or a loved one is suffering from cocaine addiction or another substance use disorder, it’s not too late to seek treatment. At American Addiction Centers (AAC), we will guide you through each level of treatment and what services are offered at each facility. Cocaine addiction treatment may include a combination of inpatient treatment, behavioral therapies, and more.

Cocaine rehab treatment levels at our facilities may include:

  • Residential treatment: Clients that enter residential treatment centers enjoy the stability and security of a facility that is monitored 24/7 by medical staff.
  • Partial hospitalization: Here, clients are given more independence than residential treatment programs. Partial hospitalization programs may be ideal for patients who are highly motivated to recover and/or have completed more intensive programs.
  • Intensive outpatient programs: These programs are designed so that patients visit a facility to receive treatment during the day and return home or to a sober living environment at night. It’s a good fit for patients that have demonstrated they do not need 24-hour monitoring.
  • Transitional living/sober housing programs: After completing an inpatient or outpatient program, many people benefit from staying in a sober environment, supported by peers and staff that provide medical services, job opportunities, and other resources as they reintegrate.
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