How Does Cocaine Affect the Brain?

Cocaine is a stimulant drug that about 4.8 million people 12 and older used in the United States in 2021. The National Institute on Drug Abuse calls cocaine a powerfully addictive drug that can alter brain function and structure if used repeatedly.

What Does Cocaine Do to the Brain?

Cocaine is a powerful stimulant, which means it speeds up the transmission of messages in the body. More specifically, it acts upon a set of interconnected regions in the brain called the limbic system. 

It prevents a neurotransmitter key to the body’s reward system called dopamine to not get recycled as it normally would, which causes a buildup of the neurotransmitter. This is the primary way in which cocaine causes a user to experience a euphoric high. 

Short-Term vs. Long-Term Impact

Cocaine’s damages can be split into two categories. Some changes are short-lived, and others are persistent.

Short-term mental health effects of cocaine include the following:

• Erratic or violent behavior
• Restlessness
• Irritability
• Anxiety
• Panic
• Paranoia

Long-term mental health effects of cocaine include the following:

• Changes in brain pathways that respond to stress, making people more likely to use drugs when under pressure
• Decreases of functioning in the orbitofrontal cortex, which can lead to poor decision-making and a lack of self-insight
• Changes in how much glutamate the brain releases, which experts hope might lead to a target for addiction treatment in the future

How Does Cocaine Affect Mood & Emotions?

Cocaine is typically used for its ability to cause a powerful high that can make a person feel energetic, happy, and excited. However, repeated or heavy use can also make a person more likely to experience other negative emotions connected to the manic feelings cocaine can cause, including making some users feel angrier, irrationally nervous, or even fearful and paranoid about things that don’t make logical sense. 

Cognitive Ability & Cocaine

In 2013, researchers demonstrated that 30% of regular cocaine users and 12% of recreational users had clinically significant cognitive impairment when compared to non-drug users.

Cocaine can cause deficits in the following measurements of cognitive ability:

• Attention
• Working memory
• Social cognition
• Emotional empathy
• Perspective-taking
• Social decision making

In 2014, researchers demonstrated that some of these problems are reversible in people who quit. Even decreasing cocaine use can mean small cognitive improvements after about a year. Those results might encourage people to take quitting seriously by enrolling in an appropriate treatment program.

Can Cocaine Cause Physical Changes to the Brain?

Cocaine can affect a variety of important areas of the brain with repeated use. An animal study showed that tiny protrusions from brain cells called dendritic spines, which are an important part of the memory formation process, are produced at a substantially higher rate in animals injected with cocaine compared to a control group injected with water. After only two hours from receiving their first dose, a significant difference was noticed, meaning cocaine use seems to create strongly reinforced memories related to the euphoric high it causes.

It’s been found that a part of the basal ganglia (and part of the brain involved in motor control and planning) called the caudate nucleus is enlarged in individuals with a history of long-term cocaine use. It’s also been found that there is less gray matter in the frontal cortex of regular cocaine users, an area of the brain responsible for a variety of important functions, including impulse control and decision making. 

Additionally, cocaine use has been shown in brain scans to decrease the amount of dopamine 2 (D2) receptors in the brain, which may make a person less sensitive to behavior humans would normally find rewarding.

Does Cocaine ‘Age’ the Brain?

A study involving brain imaging of habitual cocaine users found younger and middle-aged people with cocaine use disorder had brains that looked typical of much older adults. 

Users in their 30s and 40s showed signs in their scans more closely associated with adults over 60 years old. Middle-aged cocaine users had a variety of health risks more closely associated with that age group too, showing a much higher rate of memory loss, increased susceptibility to infection, and higher rates of cardiovascular disease than is typical of a non-drug user of the same age. 

People who are addicted to cocaine likewise tend to perform worse in tasks involving the prefrontal cortex, issues which elderly adults often also develop.

This study produced some important findings, although it doesn’t have all the answers. Researchers involved in the project also want to study more casual cocaine use — associated with people who use cocaine but aren’t addicted to the drug. They also want to track users for longer periods to more closely map how cocaine use changes the brain of a single individual over time.

Can the Brain Recover From Cocaine Use?

It can be tough to recover from changes to the brain that are the result of chronic drug use, although at least some level of recovery is generally possible with abstinence (and drug abstinence is also important for making sure issues don’t worsen). 

A small 2018 study found male military veterans who had used cocaine and then had recovered and remained abstinent from cocaine use saw recovery in neural systems related to reward, craving, and controlling inhibitions, but less significant recovery in neural systems related to decision-making.

In animal studies, it’s been found that stimulating the orbitofrontal cortex can help to restore some adaptive learning capabilities that can be lost with heavy cocaine use. In the future, it’s possible that  strengthening OFC activity in humans will be used as part of recovery treatment to help users better improve their insight and awareness of the consequences of drug use, internalizing the issues drugs can cause and resisting their use more effectively.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More