Cocaine Use and Addiction: Signs, Risks, and Getting Help

Cocaine is a stimulant drug with addictive potential that people purchase illegally and use recreationally for its energy-enhancing and euphoric effects.¹

Cocaine use can have several negative health effects, and repeated use may lead to physiological dependence and addiction.² According to the 2021 National Survey on Drug Use and Health (NSDUH), 4.7 million people aged 12 or older used cocaine in the past year, and 1.3 million people aged 12 or older had a cocaine use disorder in the past year.³

If you or someone you care about is struggling with cocaine use or addiction, knowing the signs, risks, and how to find appropriate treatment can help you make an informed decision about your health. This page will help you learn more about cocaine use and addiction, including:

• The addictive nature of cocaine.
• Signs of cocaine addiction.
• Risks of cocaine misuse and addiction.
• Treatment options.

What Is Cocaine?

Cocaine is a powerful stimulant drug made from the leaves of the coca plant.¹

Stimulants are a broad class of drugs that also includes caffeine, prescription amphetamines like Adderall, and illegal drugs like crystal methamphetamine.⁴ Stimulants increase the activity of norepinephrine and other neurotransmitters in the brain, with more potent stimulants like cocaine and amphetamine also increasing the activity of dopamine.⁴

Cocaine is sold as a street drug as a fine, white powder that people can dissolve and inject into the bloodstream, snort through the nose, or rub onto their gums.¹ Cocaine is also sold and smoked in rock form, known as crack cocaine.^{1, 2}

In smaller amounts, cocaine can make a person feel energetic, euphoric, and mentally alert.¹ In larger amounts, the effects of cocaine are heightened, and a person may be more likely to experience erratic, aggressive, or violent behavior.¹

Repeated cocaine use stimulates the brain’s mesolimbic dopamine system, which regulates emotions, motivation, and reward.¹ At the same time, repeated cocaine use affects circuits involved in stress, which can lead to signs of withdrawal, such as increased displeasure and negative mood. The combined effects of repeat exposure desensitize a person’s reward pathway to natural reinforcers. This makes it more likely for a person to seek cocaine as a source of reward and in response to stress, instead of looking for other sources of pleasure, such as food or relationships.¹

Because it has a high potential for misuse and addiction, cocaine is classified as a Schedule II drug by the U.S. Drug Enforcement Administration.¹

Signs of Cocaine Addiction

The repeated use of cocaine may lead to addiction.¹ A person who is addicted to cocaine continues to seek out and use the drug despite experiencing significant negative consequences at home, school, or work, or within relationships.^{1, 5}

Cocaine addiction is diagnosed as a stimulant use disorder by qualified mental health and medical professionals using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).⁵ To receive this diagnosis, a person must display at least 2 of these cocaine addiction signs within a 12-month period.⁵

• Using stimulants in larger amounts or over a longer period than was intended.
• Experiencing a persistent desire or unsuccessful efforts to cut down or control stimulant use.
• A great deal of time is spent obtaining, using, or recovering from the effects of stimulants.
• Experiencing cravings, strong desires, or urges to use stimulants.
• Failing to fulfill major obligations at home, school, or work due to stimulant use.
• Continuing to use stimulants despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of stimulant use.
• Giving up or reducing important social, occupational, or recreational activities because of stimulant use.
• Using stimulants in situations in which it is physically hazardous, such as driving.
• Continuing to use stimulants despite having a persistent physical or psychological problem caused or exacerbated by the stimulant.
• Developing a tolerance, which means either a need for markedly increased amounts of stimulants to achieve the desired effect or a markedly diminished effect with continued use of the same amount of stimulants.
• Experiencing withdrawal, as manifested by a characteristic withdrawal syndrome, or using stimulants to relieve or avoid withdrawal symptoms.

Risks of Cocaine Misuse and Addiction

Cocaine misuse and addiction expose users to several negative health effects, some of which can be life-threatening. The potential risks of cocaine include, but are not limited to:^{1, 6, 7}

• Cardiovascular effects, including irregular heartbeat and heart attack.
• Gastrointestinal effects, including abdominal pain and nausea.
• Neurological effects, including seizure, stroke, and impaired cognitive functioning over time.
• Respiratory effects, including asthma, lung damage, loss of smell, nasal damage, nosebleeds, trouble swallowing, and pneumonia.
• Mental health effects, include anxiety, panic attacks, paranoia, and psychosis.

Although rare, sudden death can occur the first time a person uses cocaine or unexpectedly after.¹

The route of administration (e.g., injecting, snorting, smoking) can influence the risks of cocaine use. For example, people who inject cocaine can have a higher risk of contracting hepatitis C, HIV, and other bloodborne diseases, while snorting powder cocaine increases the risk of damage to the inside of the nose and sinuses, and oral use of cocaine can increase the risk of severe bowel decay.^{1, 2}

Cocaine use can also result in a life-threatening overdose.¹ A person can overdose on cocaine alone, which usually results in chest pain and cardiovascular complications, however, the risk of a fatal overdose increases with instances of polysubstance use, which is the use of multiple substances simultaneously or within a short time. (e.g., cocaine and alcohol or cocaine and heroin).⁸ People often mix cocaine with alcohol or cocaine with heroin (e.g., “speedball”), which are dangerous combinations that can greatly increase overdose and other health risks.² Combining cocaine and alcohol poses additional risks and can result in the production of cocaethylene in the body, which increases cocaine toxicity.¹

With chronic cocaine use, a person may become physiologically dependent on the drug. With physiological dependence, cocaine withdrawal symptoms can emerge when a person abruptly cuts back or stops using cocaine altogether.^{1, 2} As a result, a person may continue to use cocaine to avoid unpleasant withdrawal symptoms.² While cocaine withdrawal is not typically life-threatening, it can cause pose several risks, including dysphoria, a danger of stimulant withdrawal that involves a state of dissatisfaction and low mood, which can lead to suicidal behavior and ideation.⁹

Getting Help

If you or someone you care about is struggling with cocaine misuse or addiction, help is available. Treatment can help you stop using cocaine and start the path to recovery.

Recovery looks different for everyone but may start with detox to help patients stop using cocaine as comfortably and safely as possible. Cocaine withdrawal is often considered “mild,” (when compared to withdrawal from other substances like alcohol and opioids) however, patients may still benefit from the safety and comfort detox as there can be a risk of dysphoria.⁹

Following detox, entering ongoing treatment can help patients work toward long-term recovery. Treatment can take place in an inpatient or outpatient setting and may include a combination of:¹⁰

• Behavioral counseling and therapy.
• Evaluation and treatment for co-occurring disorders (e.g., anxiety, depression).
• Long-term continuing care focused on relapse prevention.

While there are currently no FDA-approved medications for the treatment of cocaine withdrawal or cocaine use disorder, treatment may include other medications to manage co-occurring disorders or distressing symptoms such as hallucinations, paranoia, or psychosis.^{1, 9} Treatment may focus on behavioral therapies, such as cognitive-behavioral therapy (CBT) to help patients identify and modify negative or unhelpful behaviors and thoughts associated with addiction.⁹ Patients may also participate in community-based recovery groups, such as Cocaine Anonymous (CA), which can help offer support to help patients sustain recovery.¹

If you are ready to learn more, American Addiction Centers (AAC) is ready to help. You can contact AAC by to learn more about cocaine addiction treatment options. You can also easily verify your insurance online.

Frequently Asked Questions