The Facts about Cocaine Addiction

Explaining the basics of cocaine dependency and addiction: the signs and symptoms of cocaine use, the different forms and their effects on the body, and the recommended pathways to healing and recovery.
man looking into distance

What is cocaine?

Pure cocaine is a flakey white powder derived from the coca plant of South America. In the 1880s, the U.S. medical community began using the substance as a local anesthetic and, eventually, as a treatment for depression. By the 1960s, people were taking the illicit drug as a "feel-good" stimulant in order to party all night—but not without unpleasant and harmful short- and long-term risks, including addiction and lethal heart attacks, seizures and strokes. In 1970, the U.S. Drug Enforcement Administration categorized cocaine as a Schedule II drug under the Controlled Substances Act due to the high potential for abuse and other dangerous health ramifications. As a Schedule II drug, possession is a felony. 

Common street names/nicknames for cocaine include: 

  • Coke 
  • Blow 
  • Snow 
  • Flake 
  • Nose candy 
  • White dust 
  • Powder 

How is cocaine used? 

There are three forms of cocaine: cocaine hydrochloride (white crystalline powder often mixed or cut with other substances), freebase (a pure form, free of the hydrochloride additive) and crack cocaine (white or pinkish crystals extracted from the powder with baking soda and heat). The hydrochloride powder form is most commonly inhaled or snorted through the nose—although it can be rubbed on the gums, swallowed, or melted and dissolved in liquid, then injected with a needle directly into the vein. Freebase and crack cocaine are usually smoked. 

What’s the difference between crack and cocaine? 

When processed into yellow or pale pink rock crystals, the substance crack cocaine is formed, also referred to simply as crack or "rock." The drug—a cheaper alternative to powder cocaine—vaporizes at smoking temperatures (the substance is called "crack" because of the crackling sound it makes when heated). Crack is typically smoked in a pipe or sprinkled on marijuana or tobacco and smoked like a cigarette. Crack is the most potent and most addictive form of cocaine, according to the Manual of Substance Abuse Treatment. The high comes on fast and produces intense reactions. Long-term effects can be fatal. 

What are the behavioral and physical effects of cocaine?  

Reactions to cocaine use are different for each person. Common physical side effects include: 

  • Sweating 
  • Changes to heart rhythm  
  • Rapid breathing 
  • Feeling very hot or very cold 
  • Nausea 
  • Dizziness  
  • Muscle weakness 

While high on cocaine, some individuals feel energetic, alert and talkative while others feel anxious and on-edge. The high comes on almost immediately and lasts 15 to 30 minutes. When the high fades, a "crash" typically follows. During this time, a person might feel depressed or suicidal, anxious, paranoid or psychotic, and crave more of the drug. After prolonged use, individuals can become tolerant to the effects and "binge"—taking more and more of the substance to keep the high going—for hours or even days. This is the vicious cycle of addiction.  

Is cocaine addictive? 

Yes. Cocaine is a serotonin/norepinephrine/dopamine reuptake inhibitor, which means the substance helps to release "feel-good" chemicals in the brain. Over time, the brain receptors may become desensitized to the manufactured rush of dopamine that cocaine causes. According to the National Institute on Drug Abuse, "As with other drugs, repeated use of cocaine can cause long-term changes in the brain’s reward circuit and other brain systems, which may lead to addiction. The reward circuit eventually adapts to the extra dopamine caused by the drug, becoming steadily less sensitive to it. As a result, people take stronger and more frequent doses to feel the same high they did initially and to obtain relief from withdrawal." 

What are common signs of cocaine abuse or addiction?

Drug paraphernalia—needles, pipes, spoons, small plastic bags and razor blades—indicate cocaine use. Rolled up dollar bills (used to snort lines of powder cocaine) and white residue found on flat surfaces such as hand-held mirrors, magazines or books can be other tell-tale signs. Physical signs include: 

  • White powdery residue around the nose ("sugar spots") 
  • Dilated pupils sensitive to light (it’s not uncommon for an individual using cocaine to wear sunglasses even when it’s not sunny) 
  • Bloodshot or watery eyes 
  • Needle marks on hands, forearms, legs and/or feet 
  • Rapid breathing 
  • Constant runny nose or frequent sniffling 
  • Chronic nosebleeds  
  • Sores in the nose 
  • Frequent sore throats 
  • Shaking hands/restlessness 
  • Decreased appetite 
  • Congestion 
  • Fever 
  • Headaches 
  • Contraction of diseases due to risky sexual encounters (HIV, Hepatitis B or C) 
  • "Coke bloat," when the face—particularly the cheeks—appear aged, bloated and puffy 
  • Irreversible internal nose damage; a loss of blood supply to the septum can cause the bridge of the nose to eventually collapse 

Prolonged cocaine use can negatively affect mental health and psychological well-being. Changes in behavior can include extreme mood swings—from feeling “on-top-of-the-world” and grandiose to hostile and isolated; financial stresses from purchasing the drug or losing work; and mental health symptoms like depression, paranoia or anxiety, even when not under the influence.  

Many who struggle with cocaine addiction benefit from integrated treatment for co-occurring substance and mental health disorders. For some individuals, seeking the next high becomes all-consuming, even at the expense of family or work responsibilities. Some people become unreliable and dishonest, and resort to stealing to fund their substance use. 

Behavioral warning signs to watch for include: 

Overly talkative/chatty/excitable for no apparent reason 

  • Excessive fidgeting 
  • Panic attacks 
  • Paranoia 
  • Hallucinations 
  • Delusions 
  • Irritability 
  • Violent or aggressive behavior 
  • Increased libido 
  • Mood swings 

How do cocaine and crack affect the body? 

Both crack cocaine and cocaine can be extremely dangerous, whether used once or more frequently. 

In a study presented to the American Heart Association, Australian researchers described cocaine as "the perfect heart attack drug." The effects are so immediate, even a healthy first-time cocaine user can have a heart attack. Cocaine taxes the cardiovascular system when blood vessels thicken, reducing the flow of oxygen to the heart. In turn, the heart muscle works harder. Cocaine is a vasoconstrictor, which makes the heart pump faster while narrowing the blood vessels.  

Some additional effects to the body: 

  • Long-term use can lead to atherosclerosis and coronary artery disease, or hardening of the arteries or capillaries—the leading cause of death for both men and women in the U.S. 
  • When powder cocaine is snorted, blood vessels in the lining of the nose shrink and then widen, resulting in a red, runny, stuffed-up nose. After repeated use, the blood vessels can become permanently damaged, affecting the cocaine user's sense of smell. 
  • Snorting the drug can also cause a loss of blood supply to the septum (the thin dividing wall between the nostrils that supports the bridge of the nose), causing the wall to disintegrate. When the septum becomes weakened, the bridge of the nose can actually collapse. 
  • Smoking crack can cause "crack lung," with potentially fatal symptoms including severe chest pains, high body temperatures and issues breathing. 
  • Injecting the drug can cause infections and increased risk of hepatitis or HIV through sharing needles. 

Is it safe to use cocaine with alcohol? 

Absolutely not. Mixing the two substances can create cocaethylene, which has a toxic effect on the liver and heart, dangerously affects heart rate and rhythm, and increases the risk of heart attack or stroke. 

What happens when you mix cocaine and heroin?

The combination of cocaine, a central nervous system stimulant, with heroin, an opioid depressant, is commonly referred to as a "speedball." Some mistakenly believe the stimulant will produce an immediate high followed by a sense of relaxation from the depressant—with the "upper" and "downer" combination canceling out any negative side effects. In reality, the stimulant causes the body to use more oxygen, while the depressant reduces the rate of breathing. This "push-pull" reaction can lead to stroke, aneurysm, uncoordinated motor skills and fatal consequences, like respiratory failure. 

Why is fentanyl added to cocaine, and what are the potential consequences?  

In recent years, a growing number of dealers and traffickers have started mixing fentanyl, a synthetic opioid pain reliever, with cocaine and other drugs. According to the Centers for Disease Control and Prevention, "Fentanyl is 50 times more potent than heroin and 100 times more potent than morphine." People who don't realize they're taking fentanyl-laced cocaine are at an increased risk of overdose, according to the National Institute on Drug Abuse. If cocaine is contaminated with fentanyl, overdose can result in cardiac arrest or permanent brain damage—and there's no way to tell if the drug is laced. 

What are the signs of cocaine overdose? 

Overdose signs include everything from unpleasant or uncomfortable physical symptoms to lethal heart attack or stroke. Here are the most common signs: 

  • An elevated heart rate or irregular heart rhythm 
  • High blood pressure 
  • Feeling shaky 
  • Difficulty breathing 
  • Blurred vision 
  • Extreme anxiety 
  • Feeling disoriented or confused 
  • Hallucinations 
  • Heart attacks 
  • Seizures 
  • Strokes 

In the event of an overdose, medical professionals try to restore blood flow to the heart, stop the seizure or restore blood supply to the brain. Some overdose patients respond favorably to the drug naloxone. 

If you suspect an overdose, call 911 immediately.  

What is the most effective treatment for cocaine abuse or addiction? 

The physical treatment starts with clearing the toxic effects of cocaine from the body, known as detoxification or "detox." In order to successfully manage cocaine withdrawal symptoms, supervised medical detox is recommended. Cocaine withdrawal can range from a few days to months. The risk of returning to use increases during this time as the body attempts to rebalance. Attending drug rehab provides support and resources during the recovery process.

What are the most common cocaine withdrawal symptoms?

  • Strong cravings for the drug typically come when cocaine use stops, with withdrawal symptoms occurring in phases, starting a day or two after last use and lasting up to 10 weeks. These phases can include: 
  • Cocaine cravings 
  • Intense hunger 
  • Depression 
  • Anxiety 
  • Restless sleep 
  • Extreme tiredness/exhaustion 
  • Angry outbursts/overall agitation 
  • Inability to experience pleasure