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Signs & Symptoms of Cocaine Abuse & Addiction

Cocaine is an illicit drug that is used by around 5.2 million people in the U.S.1 For many people who use cocaine, it can become addictive. In fact, over 1 million people meet the criteria for a cocaine use disorder (CUD) in the last 12 months.1 Cocaine can also be deadly, with nearly 20,000 people dying of a cocaine-related overdose in 2020.1

If you or your loved one have a problem with cocaine use and need help, this page can help you better understand what cocaine is, the signs of cocaine use, the paraphernalia people utilize in taking cocaine, and how to get help.

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What Is Cocaine?

Cocaine is a drug made from the leaves of the coca plant, which is found in South America. It is classified as a stimulant. While it can be used in a few legitimate medical situations, such as local anesthesia for certain eye, ear, and throat surgeries, it is primarily an illicit, recreational drug.

Cocaine looks like a white, crystal-like, fine powder; crack cocaine (sometimes called “freebase” cocaine) looks like a white or off-white rock crystal. Cocaine is often cut or combined with such substances as cornstarch and talcum powder to increase dealers’ profits.2 Sometimes it is mixed with other drugs like amphetamine or synthetic opioids like fentanyl. This can make it particularly risky, since users often don’t know it is combined with these potentially dangerous additives. For example, nearly three-quarters of those who died from cocaine-related overdose in 2020 also had synthetic opioids like fentanyl in their system.3

When people use cocaine, they typically snort the powder or dissolve the powder in water and inject it intravenously. Others may rub it on their gums.2 When people inject cocaine, they may mix it with other drugs, such as heroin, in what is known as a speedball.2 People may smoke crack cocaine, and this is sometimes also called “freebasing.” Other people mix cocaine with substances such as marijuana and inhale cocaine and cannabis vapors simultaneously.2

Repeated use of cocaine can cause long-term changes and adaptations in the brain that can lead to addiction. For example, people who use cocaine can quickly become tolerant to its effects and may increase their dose, use more frequently, or both in an effort to get the same high as before.2 Regular use of cocaine can also lead to dependence, where a person experiences uncomfortable withdrawal symptoms after stopping or significantly reducing their cocaine use. Avoiding these withdrawal symptoms by continuing to take cocaine can also contribute to cocaine addiction.2

Effects of  Use

When a person uses cocaine, they may feel a short-lived burst of energy and feel happy and alert.1 Sometimes after using cocaine, people can also get irritable and even paranoid.1

Other physical symptoms are subjective and may not be observed by others, such as:4

  • Headaches.
  • Nausea.
  • Tremors.
  • Vertigo.
  • Restlessness.

When a person uses cocaine, they can become dependent upon it. When a person becomes dependent on cocaine, they will find themselves experiencing symptoms of withdrawal when their use ceases or they significantly reduce their use of cocaine.5 These withdrawal symptoms may include:2

  • Depression.
  • Fatigue.
  • Increased appetite.
  • Restlessness.
  • Vivid or scary dreams.
  • Thinking slower than usual or feeling “foggy” in your head.

In addition, when a person uses cocaine long-term, using cocaine can contribute to the development of serious long-term health effects, which may include:5

  • Intestinal disorders from swallowing cocaine.
  • Loss of smell from snorting cocaine.
  • Asthma and lung diseases from smoking cocaine.
  • HIV and hepatitis from injecting cocaine.
  • Poor nutrition and weight loss.

Signs of Cocaine Addiction

Over time and with continued cocaine abuse, a person may develop an addiction to cocaine, which can result in negative consequences and the inability to stop using cocaine despite a strong desire to do so.6

There are signs that indicate a person’s cocaine use has become problematic. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which is used by psychiatrists and other physicians to diagnose mental health issues, outlines signs of a substance use disorder (SUD).

Some common signs of cocaine addiction include:

  • Taking more cocaine than was originally intended.
  • Unsuccessful attempts to cut back or stop using cocaine.
  • Using a good deal of time and resources to get cocaine, use it, or recover from using cocaine.
  • Having cravings, a strong desire or urge to use cocaine.
  • Neglecting responsibilities at work, school, or home.
  • Continued use of cocaine, despite experiencing negative consequences from using cocaine.
  • Foregoing hobbies and other activities that were once important to the person.
  • Using cocaine in situations where it is dangerous and high-risk.
  • Taking cocaine even though it causes psychological or medical issues or makes existing issues worse.
  • Tolerance, which is using more and more cocaine to keep getting the same effects as before.
  • Having signs of withdrawal, such as insomnia or restlessness, after stopping use or significantly reducing use of cocaine.

To meet the criteria for a cocaine use disorder, an individual must display at least two of the criteria above within a 12-month period:7

There are also other signs of cocaine abuse, as well as substance abuse in general. These are not included in the DSM-V criteria, but sometimes substance misuse can also manifest itself as:8

  • Poor hygiene and/or a decline in personal appearance.
  • Abrupt changes in mood and behavior.
  • Sudden changes in peer groups and activities.
  • Secretiveness and lying.


Oftentimes when someone uses cocaine, certain drug paraphernalia can be found in their possession, perhaps in their room, car, or bag. Some common types of cocaine paraphernalia include: 9

  • Rolled up tubes of paper or short straws.
  • Lighters.
  • Mirrors.
  • Small spoons.
  • Razor blades.

What to Do if Someone Is Showing Signs of Cocaine Abuse

When your loved one is using cocaine or showing signs of cocaine addiction, it may be time to reach out for help. Seeking treatment can help a person to recover from the negative consequences associated with cocaine use. . The first step is to find a drug rehab center and encourage your loved one to seek treatment. Cocaine addiction treatment uses many types of evidence-based treatment approaches, which can include:10-12

  • Cognitive-behavioral therapy (CBT). CBT is used in many treatment programs. This form of therapy aims to help you change your thinking patterns and find alternative ways to cope with stress that don’t involve using cocaine or other drugs. CBT also helps you manage your triggers that could lead to a relapse in cocaine use after treatment.
  • Contingency management is a treatment approach in which numerous forms of incentives or rewards are given when a person achieves various treatment goals. Examples of incentives include entertainment or leisure items such as movie tickets, or practical items such as baby diapers.
  • Motivational enhancement therapy, or motivational interviewing (MI). This approach to treatment focuses on enhancing motivation and getting people to commit to treatment.

These treatment approaches can be used in either inpatient or outpatient settings. Inpatient programs are 24/7 rehabs where a person can get help under close supervision while they live at the facility. Similarly, there are residential options for care where people can live in a supportive, drug-free environment. Some of these programs are short-term while others may last several months.13

Outpatient care is delivered at various levels of intensity. These include:14


  1. National Institute on Drug Abuse. (2022). What is the scope of cocaine use in the United States?
  2. National Institute on Drug Abuse. (2021). Cocaine DrugFacts.
  3. National Institute on Drug Abuse. (2022). Overdose Death Rates.
  4. National Institute on Drug Abuse. (2019). Cocaine research report. What are the short-term effects of cocaine use?
  5. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Is there a difference between physical dependence and addiction?
  6. National Institute on Drug Abuse. (n.d.). Signs of cocaine use.
  7. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  8. Tennessee Department of Mental Health and Substance Abuse. (n.d.). Warning signs of drug abuse.
  9. Drug Enforcement Agency. (2022). How to identify drug paraphernalia.
  10. National Institute on Drug Abuse. (2020). Cognitive-behavioral therapy.
  11. National Institute on Drug Abuse. (2020). Contingency management interventions/motivation incentives
  12. National Institute on Drug Abuse. (2020). Motivational enhancement therapy.
  13. National Institute on Drug Abuse. (2019). DrugFacts: Treatment approaches for drug addiction.
  14. American Society of Addiction Medicine. (2015). What are the ASAM levels of care?

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