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Signs of Cocaine Use & Abuse

Signs of cocaine use and abuse include euphoria, irritability, anxiety, excitability, paranoia, and shakiness.

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Cocaine is a powerfully addictive stimulant drug sold as a sniffable powder or smokable glass (crack cocaine). People abuse cocaine because of its energizing effects and intense rush of pleasure. However, the high wears off quickly, which is why people often use cocaine in a binging pattern in order to keep the high going.

Nearly 5 million people reported abusing cocaine in 2021. That’s equivalent to about 1.7% of people aged 12 or older.[1]

While opioid painkillers tend to dominate news stories about overdoses, cocaine poses many dangers as well. People can and do die due to cocaine abuse, and it can even lead to sudden death, no matter how many or few times a person has used it.

Cocaine & Your Brain: Why It’s So Addictive

The brain’s reward pathway is known as the mesolimbic dopamine system, and one of the main reward areas is known as the nucleus accumbens. [2]

Normally, this system is stimulated by natural pleasures like sex and food. However, cocaine stimulates this pathway much more intensely than natural rewards by causing a rush of dopamine—a neurotransmitter associated with feelings of pleasure—and then blocking the dopamine from being removed from the synaptic space. This means that dopamine builds up to produce an intense high or feeling of euphoria. [2]

This same brain system is also associated with memory and motivation. Using cocaine and experiencing an intense high teaches the brain that this is a preferred activity and is necessary for survival (since natural rewards are pro-survival behaviors). This can lead to cocaine cravings and continued and compulsive use, especially over previously enjoyed hobbies or activities. [2]

Short-Term Risks

Cocaine users often binge on the drug. They take doses repeatedly, and each hit is bigger than the last. During a binge, people feel:[3],[5]

  • Irritable
  • Panicked
  • Paranoid 
  • Psychotic 
  • Restless

You could hurt yourself or someone else during an episode like this. You could also get arrested due to erratic or dangerous behavior. 

Other short-term risks of cocaine abuse include:[5]

  • Rapid heart rate
  • Increased blood pressure
  • Chest pain
  • Irregular heartbeat
  • Sweating and chills
  • Vomiting
  • Rapid, purposeless movements
  • Muscular weakness
  • Seizures
  • Confusion
  • Muscle twitching
  • Coma

Cocaine Use Can Cause Sudden Death

The biggest risk of cocaine use, even in the short term, is the risk of sudden cardiovascular death. This can happen among people who were previously healthy or have no pre-existing conditions or risk factors. [4]

One study examining young adults who had died of sudden cardiovascular death found that recent cocaine use was a significant risk factor. Compared to the general population, the rate of recent cocaine abuse was 13-58 times higher among those who had experienced sudden cardiovascular death. [4]

Long-Term Consequences

Cocaine is a blood vessel constrictor. Use it regularly, and your vital organs will be deprived of oxygen and nutrients. You could experience the following:[5]

  • Heart attacks 
  • Stomach ulcers 
  • Strokes 
  • Weight loss 

Cells inside your brain can also die due to a lack of oxygen and nutrients. You could struggle to remember critical information, and some people with a long-term habit develop impulse control and inhibition issues. If the part of your brain controlling motor function is damaged, you could develop shaking in your hands and feet. 

Addiction is a risk with long-term use. If you use crack cocaine, for example, you could become addicted to the drug in just two or three weeks of regular use. 

Long-Term Risks of Snorting, Injecting, and Smoking Cocaine

Some risks of chronic cocaine abuse depend on how a person is abusing cocaine. For example, long-term risks of injecting cocaine include:[5]

  • Track lines
  • Collapsed veins
  • Abscesses
  • Cellulitis
  • HIV
  • Hepatitis
  • Infection of the heart lining
  • Tuberculosis

Meanwhile, if someone snorts cocaine, they may experience the following consequences:[5]

  • Chronic sinusitis
  • Nosebleeds
  • Nasal damage
  • Perforation of the nasal septum

Lastly, smoking crack cocaine can cause:[5]

  • Lung infections
  • Bronchitis
  • Chronic cough
  • Pneumonitis

Signs of Cocaine Use

Many of the signs of cocaine abuse are similar to the short-term and long-term risks.

Physical Signs

Many of the physical signs of cocaine abuse depend on the method of administration. If the person is injecting cocaine, look for track lines or needle marks on their arms. If they primarily snort cocaine, look for nosebleeds or chronic nasal congestion. Smoking crack cocaine may cause a cough that doesn’t go away or severe issues like bronchitis.

Some other physical signs include:[5]

  • Unexplained weight loss
  • Complaints of chest pain 
  • Coughing
  • Recurrent infections
  • Scratching at skin 
  • Sniffling 
  • Coordination problems
  • Convulsions
  • Profound sweating
  • Increased energy followed by a crash

People who use cocaine need paraphernalia like needles, lighters, and straws. If you spot these tools, a cocaine habit may be present. 

Psychological Signs

Some people who abuse cocaine know they shouldn’t, and they can seem repentant and guilty the day after a binge. They might say they’ll never use it again, and they might promise to stay sober. 

A cocaine comedown can also lead to depression, and some people may cry or shut themselves away until they feel better. 

Psychological signs that someone is high on cocaine may include noticeable behavioral changes or mental status changes, such as:[5]

  • Hypervigilance
  • Interpersonal sensitivity
  • Euphoria
  • Blunted emotions
  • Inappropriate anger
  • Excessive anxiety
  • Repetitive actions with no purpose
  • Impaired judgment
  • Talkativeness
  • Excitability

As the drug wears off, look for depression, sadness, and anxiety. The person might leave your company for a minute and return high again. You might notice wide swings in mood and energy levels.

Symptoms and Signs of Cocaine Addiction

About 1.3 million people have a cocaine use disorder.[8] Someone like this has lost control over when, how much, and how they use cocaine. Someone who has a cocaine addiction presents with at least two of the following symptoms:[5]

  • They use higher or more frequent amounts of cocaine than intended.
  • They experience a strong desire to quit or control cocaine use.
  • They spent a lot of time obtaining and using cocaine as well as recovering from the comedown.
  • They experience strong cravings to use cocaine.
  • They are unable to meet responsibilities at home, school, or work due to cocaine use.
  • They continue to use cocaine despite interpersonal issues caused or worsened by use.
  • They neglect previously enjoyed activities or hobbies due to cocaine use.
  • They regularly use cocaine in dangerous situations.
  • They continue to abuse cocaine despite mental health or medical issues caused or worsened by use.
  • They develop tolerance and need more cocaine to get high.
  • They experience cocaine withdrawal symptoms when they abruptly stop using.

3 Reasons Cocaine is So Dangerous

You’re tempted to use cocaine for the very first time. What should stop you? And why should you step in to help someone with a problem? Here are three good reasons. 

1. Mixing Cocaine Can Be Unpredictable

People often use cocaine in party situations, and they blend the drug with other substances. Cocaine is known to react with these substances:

  • Alcohol: Both substances can impact the cardiovascular system. Mixing them can lead to a heart attack. 
  • Opioids: One is a stimulant, and the other is a depressant. Mixing them leads to confusing signals in your body. You could develop breathing difficulties and heart problems. 
  • MDMA: Both are stimulant drugs, and taking them together puts immense strain on your heart. 
  • Antidepressants: Both work on brain cells. A combination of these substances can lead to seizures. 

2. Cocaine is Rarely Pure

You can’t get cocaine from a pharmacy, doctor, or friend. Dealers make and sell drugs, and they rarely produce a product that contains 100% cocaine.

Almost all cocaine is cut with other drugs, including amphetamines and opioids like fentanyl. Your next dose could be stronger than you expected, and it could easily lead to problems.

3. Cocaine Overdose is Possible

Cocaine was involved in almost 23% of drug overdose fatalities in 2021.[10] That same year, nearly 25,000 people died from a cocaine-related overdose.[1] Taking too much is very easy, especially if you’re in the middle of a binge episode. Being aware of cocaine overdose symptoms could potentially save a life. 

Immediate Steps to Take in Case of Cocaine Overdose

2. Add a section titled ‘Immediate Steps to Take in Case of Cocaine Overdose’ with actionable advice for urgent situations, providing life-saving information.

What to Do Next

If you suspect that someone you love has a cocaine abuse problem, it’s time to speak up. People with an addiction may struggle to quit without help. 

But in a treatment program, they can get the medication management and counseling they need to kick the habit for good. The conversation you have now could save your friend’s life.

A treatment center can help you learn how to start this conversation. Don’t be afraid to reach out for help today.

Profile image for Dr. Alison Tarlow
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

Updated January 24, 2024
Resources
  1. What is the scope of cocaine use in the United States? National Institute on Drug Abuse. (2016).
  2. Mind Matters: The Body's Response to Cocaine. National Institute on Drug Abuse.
  3. What Are the Long-Term Effects of Cocaine Use? (May 2016). National Institute on Drug Abuse.
  4. Recent cocaine use is a significant risk factor for sudden cardiovascular death in 15-49-year-old subjects: a forensic case-control study Morentin B, Ballesteros J, Callado LF, Meana JJ. Addiction. 2014;109(12):2071-2078.
  5. Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. (2013).
  6. Cocaine. National Institute on Drug Abuse.
  7. Facts You Should Know About Crack. Illinois Department of Human Services.
  8. What Is the Scope of Cocaine Use in the United States? (May 2016). National Institute on Drug Abuse.
  9. Cocaine DrugFacts. (April 2021). National Institute on Drug Abuse.
  10. Stimulant Overdose. (2023). Centers for Disease Control and Prevention.
  11. Global Cocaine Intoxication Research Trends During 1975–2015: A Bibliometric Analysis of Web of Science Publications. (February 2017). Substance Abuse Treatment, Prevention, and Policy.
  12. Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association. (2013).
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