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Cocaine Use Disorder: Signs & Side Effects of Cocaine Use & Addiction

Cocaine is a powerful stimulant drug that causes intense feelings of euphoria and increased energy. Cocaine is derived from coca leaves, which is a plant native to South America. However, before it gets into the hands of users, cocaine is typically cut with other substances, which can be dangerous. Even in its purest form, though, cocaine is a Schedule II drug which means it has a high potential for abuse.

Key Points

  • It is common for cocaine to be “cut” with other substances, some of which can be fatal
  • Cocaine typically comes in 3 different forms and can be detected in the body for up to 90 days
  • Side effects of cocaine can range from mild to severe, including anxiety, hallucinations, aggression, and delusions
  • Using cocaine long-term can have significant impact on internal organs
  • Nearly 1 in 5 deaths as a result of overdose is associated with cocaine
  • Help for cocaine addiction is available

What Are Cocaine?

Cocaine is a drug with intense stimulant effects. The drug comes in a white, crystalline powder that is typically snorted but is sometimes smoked or injected. Cocaine use causes increased energy, alertness, and can produce a sense of euphoria. However, this potent stimulant carries a high risk of mortality, with a recent report stating that nearly 1 in 5 deaths as a result of drug overdose is associated with cocaine.[1]

Why Cocaine is So Addictive

Cocaine affects the brain’s reward system and releases large amounts of dopamine, which is a chemical associated with pleasure and reward. Increased dopamine levels can lead to feelings of euphoria and well-being, reinforcing the desire to repeat the drug use.

Over time, cocaine can cause changes in brain structure and function, making it increasingly difficult for a person to control their drug use and resist the urge to use again.

What are Signs of a Cocaine Addiction?

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), there are several signs that someone has developed a cocaine addiction.[15] Some of thos signs include:

  • Increased Frequency of Use: If an individual begins to use cocaine more frequently, it may be a sign of a cocaine addiction.
  • Tolerance: As cocaine is used more frequently, the body becomes accustomed to the drug, leading to a need for larger doses to achieve the desired effect.
  • Continued Use Regardless Of Consequences: An individual with a cocaine addiction may continue using the drug in spite of relationship problems, financial difficulties, legal troubles, or other consequences.
  • Neglecting Responsibilities: Someone struggling with a cocaine addiction may neglect their responsibilities or avoid situations where cocaine can’t be used.
  • Engaging In Risky Behaviors: Cocaine use can lead to impulsive behavior and high-risk decisions, such as driving under the influence or engaging in unsafe sexual practices.
  • Experiencing Legal Trouble: Obtaining or abusing illegal or illicit substances can lead to emergency medical or law enforcement contacts, which may set in motion damaging legal consequences.

When someone stops using cocaine or reduces their intake, they may also experience withdrawal symptoms such as fatigue, depression, and cravings.

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Cocaine Side Effects

The effects of cocaine can range from mild to severe, and some side effects can be fatal.

Physical Effects

Increased Heart Rate & Blood Pressure

Cocaine affects the nervous system and makes the body more sensitive to certain chemicals. This can cause an increased heart rate and blood pressure, making the heart work harder. At higher doses, cocaine may block certain channels in the heart and cause it to stop working properly[2].

Dilated Pupils

Ingesting cocaine results in more norepinephrine in the body, which triggers the body into “fight or flight” and dilates the pupils. This typically happens within 30 minutes of cocaine use.

Increased Body Temperature

Cocaine can inhibit the body’s ability to regulate temperature, resulting in hyperthermia[9] (body temperature being too hot). Hyperthermia can be extremely deadly and can happen with even a single use of cocaine.

Decreased Appetite

Cocaine is a known appetite suppressant, which is why many users experience drastic and unhealthy weight loss. This weight is sometimes gained back rapidly with cessation of cocaine, which may trigger a relapse.

Irritability & Aggression

As a stimulant, cocaine use not only leads to increased energy but can also trigger fight or flight–and some individuals are more prone to go into “fight” mode. Studies have shown that cocaine use can lead to increased aggression in higher doses[3]

Additionally, when an individual begins to “come down” from a cocaine high and dopamine levels begin to drop, irritability can set in.

Psychological Effects


Cocaine is a stimulant and is associated with increased energy levels, leading to restlessness. This can intensify as the dosage is increased.

Anxiety & Paranoia

Using cocaine can result in heightened anxiety and paranoia and has even shown to induce panic attacks[11]. Those with pre-existing anxiety disorders may experience more intense anxiety symptoms when using cocaine.

Hallucinations & Delusions

It is possible for cocaine to cause hallucinations and other delusions, which include homicidal and suicidal thinking. Studies have shown that the “crack” form of cocaine is associated with more intense symptoms and increased instances of violence[6].

Long-Term Effects of Cocaine

Repeated use of cocaine over time can lead to severe effects, damaging multiple organs including:

Lungs: Cocaine causes the veins, arteries, and capillaries in the vascular system to narrow, which can cause hardening of the cellular walls of organs such as the lungs. This can be fatal.
Cocaine smoking can also cause hemorrhages, pulmonary edema, and an increased risk of developing pulmonary diseases such as pneumonia, bronchitis, and emphysema.

Heart: Repeated cocaine use can lead to thickening of the heart muscle, heart failure, and an increased risk of heart attacks. Cocaine use may also cause arrhythmias, as well as weakened heart muscle, aortic tears, and infections in the heart valves.

Nose: Cocaine can damage the nose and nasal passages with long-term use. Cocaine constricts blood vessels and reduces blood flow, which leads to inflammation, irritation, and tissue damage. Repeated use can also cause a hole in the septum and symptoms such as chronic congestion, runny nose, nosebleeds, and even a loss of the sense of smell.

Eyes: Serious eye problems such as retinal detachment, glaucoma, and even blindness are risks of long-term cocaine use. Cocaine can also cause a condition called ischemic optic neuropathy that can lead to sudden vision loss[13].

Liver: Cocaine use harms the liver by causing cell damage, blood clots, and fat buildup, which can lead to hepatitis, liver failure, liver disease and an increased risk of liver cancer.

Kidneys: Cocaine use can cause kidney damage by reducing blood flow, promoting cell death as well as inflammation and scarring. This can eventually lead to kidney failure, which can be fatal.

Statistics on Cocaine Use, Misuse, and Addiction

Cocaine use presents a significant challenge to the American people. Over the previous decade, pre-pandemic era, cocaine production and use was on a trajectory of steady increase.[8]

While some numbers dropped during the recent pandemic, in 2021, more than 4.8 million people over the age of 12 reported using cocaine over the course of the previous year. According to the National Center for Drug Abuse Statistics, cocaine is still recorded as one of the top two most frequently used substances in the United States, just behind cannabis.[9][10]

Approximately 1.4 million of those same respondents also suffered from cocaine use disorder. Perhaps the most troubling data are the numbers that show over 24,000 overdose deaths in 2021 were associated with cocaine use.[11]

However, in the same year, only 89,000 people sought treatment for substance, drug, or alcohol use disorder, despite the average number of new users being introduced to cocaine being over 847,000 in a given year. [12][13]

These numbers are a commentary on the tragic and alarming state of U.S. cocaine use and the critical importance of addiction treatment.

A mound of white powder in a petri dish on a dark background.

Where Cocaine Comes From

Cocaine is derived from coca leaves, which is a plant native to South America. The majority of cocaine that comes into the United States is sourced from countries Colombia, Peru, and Bolivia, where coca is grown and harvested illegally.

What is Cocaine Cut With?

The vast majority of cocaine will be “cut” with other substances, meaning other substances have been added to pure cocaine. Drug dealers cut cocaine to increase the quantity of the drug so that there is more to sell.

Cocaine is commonly cut with the following substances:

  • Baking soda
  • Boric acid
  • Benzocaine
  • Creatine
  • Caffeine
  • Cornstarch
  • Flour
  • Laxatives
  • Laundry detergent
  • Methamphetamine
  • Sugar
  • Worming agent (such as levamisole)

Pure cocaine comes in a crystalline form, which is then processed and turned into a powder. These additional substances all come in a white powder form so it is nearly impossible to determine whether or not the cocaine has been cut.

Some cocaine additives can be highly dangerous and lead to overdose, poisoning, and death.

Cutting cocaine for the purpose of increasing the quantity of the drug is not the only reason that adulterants are added to pure cocaine. Other substances, like fentanyl, are added to cocaine to intensify or enhance its effects.

Although “cut” cocaine can lead to overdose, poisoning, and death, it is important to recognize that “pure” cocaine also has the potential to be deadly.

What Forms Does Cocaine Come In?

Cocaine typically comes in three forms: powder, crack cocaine, and freebase cocaine:

Cocaine Powder

Cocaine most commonly comes in the form of a white, crystalline powder which is snorted, smoked, or dissolved and then injected intravenously.

Crack Cocaine

Cocaine may also come in the form of crack cocaine, which is a rock-like substance that is consumed by smoking.

This substance is made by combining and heating cocaine with baking soda or another alkaline substance. The mixture of cocaine and baking soda is heated until it forms a solid substance that can be broken into small pieces, which are commonly known as “crack rocks” which are typically smoked, but are sometimes snorted.

Freebase Cocaine

Freebase cocaine is created by using a chemical process to remove impurities from the cocaine powder and then smoked. There is no form of cocaine that is “safer” than the others, but crack cocaine is thought to be most addictive.

How Long Does Cocaine Stay in the Body?

How long cocaine stays in the body depends on several factors, including frequency of use, dosage, method of ingestion, and individual body composition and metabolism. Whether or not you have consumed alcohol while taking cocaine can also impact detection time, as alcohol can cause cocaine to stay in the body for a longer period of time.

Average cocaine detection times include:

Test Detection Time
Urine Up to 4 days
Blood Up to 2 days
Saliva Up to 2 days
Hair Up to 90 days

Why Do People Use Cocaine?

Those who use cocaine may do so for a range of reasons, from curiosity to job performance. People often use cocaine for the following reasons:

Pleasurable Effects

Cocaine can produce feelings of euphoria and excitement, and may decrease stress and anxiety. Many people who use cocaine do so as a way to self-medicate and cope with difficult emotions or situations.

Increased Alertness

Cocaine use is associated with increased energy, alertness, and focus, as well as a general sense of and confidence. Many cocaine users turn to the drug as a way to improve work performance, although this is counterintuitive.

Social Pressure & Curiosity

Some people may use cocaine due to pressure from peers or for the sake of experimentation. This is more common in younger age groups, such as those of high school and college age demographics. However, many young people who begin to use cocaine socially develop an addiction that can last for years.

Can You Overdose on Cocaine?

Cocaine overdose is possible in both new cocaine users and users who have developed a tolerance. A cocaine overdose can be deadly, and the risk for overdose increases if a person takes a large dose of the drug or the drug is cut with other substances such as opioids.

Symptoms of a cocaine overdose include:[14]

  • Hypertension
  • Altered state of consciousness and confusion
  • Seizure
  • Chest pain
  • Reduced blood flow
  • Headache
  • Paranoia and excited delirium
  • Hyperthermia
  • Severe agitation and restlessness
  • Blurred vision or vision loss
  • Diarrhea, vomiting, and abdominal pain

In some cases, those experiencing a cocaine overdose may go into a coma.
If you or someone you know is exhibiting signs of a cocaine overdose, call 911 immediately.

What are Cocaine Withdrawal Symptoms?

Cocaine withdrawal can vary from person to person, depending on frequency of use, dosages, and individual factors such as overall health. Some of the most common cocaine withdrawal symptoms include:

  • Intense cravings for the drug
  • Anxiety, depression, and mood swings
  • Fatigue
  • Restlessness
  • Increased appetite
  • Weight gain
  • Vivid dreams or nightmares
  • Difficulty concentrating
  • Muscle aches, chills, and sweating

For some individuals, especially longtime users or those that use larger amounts of the drug, cocaine withdrawal symptoms may seem unbearable. In some cases, severe depression or suicidal ideations may occur.

Drugs Used in Cocaine Withdrawal Management

Despite many years of study, no viable drugs have emerged as an acceptable solution for cocaine withdrawal management. In some extreme cases, beta blockers may prove beneficial but this is not standard practice.[16]

Can You Quit Cocaine on Your Own?

While it is possible for an individual to quit using cocaine on their own, it can be extremely difficult. Withdrawal symptoms can be intense both physically and emotionally.

If you are trying to stop using cocaine, there are detox and drug rehab programs available that can help manage symptoms and help you avoid relapsing. A treatment center can help you address any underlying causes that are contributing to cocaine use and help you develop healthy coping skills so that you have the best chance at long term recovery.

Can You Recover From a Cocaine Addiction?

Recovery from a cocaine addiction is possible, no matter how long an individual has taken the drug. Although some of the long-term physical effects of cocaine may be long lasting or permanent, it is possible for those who have abused cocaine long-term to see a significant reduction in symptoms.

There is not a “cure” for cocaine addiction. Continual re-commitment to staying clean from cocaine is key to preventing relapse.

What to Expect During Cocaine Addiction Treatment

While everyone’s experience with cocaine addiction recovery is unique, there are some general stages and treatments that you can expect.

Here’s what you can expect during the cocaine addiction recovery process:


The first step in getting help from a treatment center is detox, which involves eliminating the drug from your body. Medical supervision is often necessary during this stage to help manage uncomfortable symptoms and intense stress associated with withdrawal.

The majority of rehab centers will require an individual to be clean and clear of substances before entering treatment so that energy and focus can be put into healing rather than withdrawal symptoms.


Post detox, you will be admitted into your program. Depending on the severity of the addiction, the risk of relapse, and other individual factors, either inpatient or outpatient treatment will be recommended. During your admissions process, your treatment team will create an individualized plan for you that is created around your unique circumstances.

Individual Therapy

Therapy will help you address underlying issues that contribute to addiction, such as trauma, stress and anxiety, low-self worth, or mental health diagnosis. Individual therapy sessions may include cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), acceptance and commitment therapy (ACT), motivational interviewing (MI), and other modalities.

Group Therapy

Connection and support are key in recovery. Group therapy sessions offer a structured, supported environment where those with similar experiences can receive support and learn valuable communication and interpersonal skills. Group therapy may be talk therapies or holistic interventions such as art therapy, music therapy, yoga therapy, and other types of therapy that address the whole person.


Attending treatment is only part of a lifelong recovery process. Aftercare is a crucial part of preventing relapse, and may involve ongoing therapy, recovery support groups, and other resources that can help you maintain sobriety.

Cocaine addiction treatment is multifaceted and recovery is not always linear. There may be setbacks and struggles that feel insurmountable, but with the right treatment plan, support systems, and coping skills, overcoming a cocaine addiction is possible.

Get Treatment for a Cocaine Addiction

We understand you have questions and concerns about seeking recovery treatment. Call now to discuss your options with our admissions team and we’ll be happy to answer all of your questions

Frequently Asked Questions About Cocaine

More questions about cocaine or cocaine addiction? We’ve answered some of the most commonly asked questions below.

Can Cocaine Make You Angry?

Cocaine has been associated with feelings of anger, increased aggression, and in some cases, violent behavior. This is exacerbated when cocaine is taken at high doses or with long-term use.

How Many People Use Cocaine?

According to a recent National Survey on Drug Use and Health, an estimated 4.8 million people aged 12 or older in the United States used cocaine in 2022. Cocaine use was highest in the 18-25 age group (1.2 million people).[17]

Does Cocaine Keep You Awake?

Cocaine is a powerful stimulant that affects the central nervous system and increases levels of norepinephrine in the body, which can keep you awake. However, cocaine use can lead to sleep disturbances and insomnia.

How Do You Come Down From Cocaine Fast?

There is no fast way to come down from cocaine. If you or someone you know has taken cocaine and is experiencing severe adverse effects or signs of an overdose, seek medical attention right away.

How Can You Get Cocaine Out of Your Body?

Cocaine is metabolized by the liver and excreted through urine. Drinking plenty of water and staying hydrated can help aid in excretion of these metabolites out of the body, however, there is no quick way to get cocaine out of your system.


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