What Is Cocaine Addiction?

How to Spot the Signs and Find Treatment

Cocaine addiction accounts for roughly 6% of all drug rehab admissions in the United States. This addiction can be difficult to treat, and the majority of those seeking treatment for cocaine addiction are polydrug users (use more than one drug recreationally).

Cocaine addiction is not considered a behavioral problem—it is classified as a substance use disorder in which biological, psychological, environmental, and genetic factors are thought to predispose a user to addiction. By recognizing the signs of addiction, those who are addicted can identify the problem, seek professional treatment, and experience lasting recovery.

Verywell / Laura Porter

Why Cocaine Is So Addictive

Cocaine, also known as coke, is a powerful stimulant derived from the coca plant. It is a highly addictive drug. It is abused by several methods, including snorting it through the nose, smoking it, and injecting it intravenously. Globally, it is the second most frequently used illicit drug.

Cocaine acts on the reward centers of the brain by increasing the effects of naturally occurring neurotransmitters (such as serotonin and dopamine) that make a person feel good. The drug blocks reuptake of these neurotransmitters.

Reuptake is a process that normally modulates the action of the neurotransmitters by decreasing their concentration in the brain. When cocaine excessively increases the concentration of “feel good” neurotransmitters in the brain, the drug prolongs and amplifies the effects of these chemicals.

When snorted, smoked, or injected, cocaine induces intense feelings of euphoria. Over time, however, the body alters its own natural patterns in terms of production and reuptake of the neurotransmitters. Tolerance to the drug develops and more and more cocaine is needed to achieve the desired effect.

As an individual develops tolerance to cocaine, they also become physically dependent on it. If the drug is discontinued, withdrawal symptoms, with physical effects, can occur. A strong craving for cocaine is the most prominent effect of withdrawal, but other symptoms usually occur as well.

Cocaine withdrawal symptoms include:

  • Depression and apathy
  • Anxiety
  • Trouble concentrating
  • Feeling overwhelmingly physically and mentally exhausted
  • Restlessness or agitation
  • Physical discomfort, including aches, pain, or feeling hot or cold
  • Appetite changes
  • Vivid dreams

Cocaine addiction can develop quickly, often within a month. When a person is addicted to cocaine, they may begin to use it with methods that produce a more intense effect—such as smoking or injecting the drug instead of snorting it. Sometimes an intense effect is achieved by using more powerful forms of the drug, such as crack, or using other drugs in addition to cocaine.

Crack Cocaine

According to the National Institute on Drug Abuse, around 68% of people seeking cocaine treatment regularly use crack cocaine.


Signs and Symptoms

The euphoric effects of cocaine use are accompanied by physical effects, including a rapid heart rate, sweating, and pupil dilation (widening of the pupils). Cocaine can also cause other adverse effects, such as anxiety, crawling sensations on the skin, hallucinations, and paranoia. Some of these feelings can persist, or might even increase, during the comedown (“crash”) as the euphoria is wearing off.

The signs of cocaine addiction extend beyond the physical symptoms and also involve emotional and behavioral changes.

Signs of cocaine addiction can include

  • Teeth grinding
  • Dry mouth
  • Dilated pupils
  • Persistent runny nose or nosebleeds (without a reason like allergies or a sinus infection)
  • Hyperactivity, excessive or unusually rapid speech
  • Overconfidence
  • Reckless behavior
  • Mood or behavioral changes
  • The presence of visible white powder or burn marks on the mouth, nose, or hands
  • Appetite changes and weight loss
  • New, erratic, or unusual sleeping patterns
  • Avoiding others, being secretive, or hiding drug use
  • Decreased interest in and participation in activities that had been previously enjoyable—such as socializing, work, or leisure activities
  • Unexplained spending or financial problems
  • Neglecting personal appearance or hygiene

Having drug paraphernalia, or other items for using cocaine in your home or apartment can be a sign of addiction too.

Symptoms of Crack Use

Side effects that can develop as a result of smoking crack include coughing up blood, hoarseness, persistent sore throat, and shortness of breath.



There are a number of complications of cocaine addiction, and they can differ depending on your method of using the drug.

You may develop thinning or deterioration of the septum nasi (the septal cartilage in your nose) if you snort the drug. Injecting the drug can increase your risk of a serious skin infection, such as a bacterial staphylococcus infection. Cellulitis (a severe type of skin infection) and necrotizing fasciitis (destruction of the infected tissue), and a systemic infection can develop as well. Sharing needles can increase the risk of HIV and hepatitis B.

Cocaine use can also contribute to kidney injury and has been implicated in certain rheumatologic conditions.

The main complication of cocaine addiction is overdose, which results in cocaine toxicity. While cocaine can adversely affect every organ in the body, its most dangerous and life-threatening effects are on the
cardiovascular system.

Tachycardia (rapid heart rate), arrhythmia (irregular heart rate or rhythm), and malignant hypertension (severely high blood pressure) can lead to a heart attack, stroke, or death. Acute kidney failure (rather than slowly deteriorating kidney function) is a life-threatening emergency that’s also common with cocaine overdose.

When to Call 911

Signs of cocaine overdose include:

  • Tremulousness
  • Nausea, vomiting
  • Tachycardia
  • Chest pain
  • Hyperthermia (high body temperature)

Seek emergency care if you experience any of the above symptoms. Cocaine toxicity can lead to death within a few hours.


Some people are more vulnerable to cocaine addiction than others. There is no way to predict who will develop cocaine addiction. With that said, studies have suggested that some groups are at the highest risk. These include people who also abuse alcohol and cannabis, as well as individuals who have depression.

While the reasons for the development of cocaine addiction are complex and not fully understood, cocaine addiction is associated with DeltaFosB, a protein that regulates the reward center of the brain. Chronic cocaine use impacts genes responsible for the expression of this substance.

As DeltaFosB levels continue to build, permanent changes in the brain affect the following structures :

  • Nucleus accumbens: A region in the brain that serves as a reward center, where behaviors are reinforced.
  • The prefrontal cortex: An area of the brain where decisions and impulse control are regulated.

The impairment of these cognitive centers can lead to the compulsive use of cocaine—with little to no regard for the consequences. The impairment of judgment and loss of impulse control further promotes high-risk behaviors, sometimes increasing the risk of accidents or exposure to infections like HIV and hepatitis C.


The National Survey on Drug Use and Health reports that there are around 1.5 million current users of cocaine in the United States.


Cocaine addiction is one of the different stimulant use disorders. Stimulant use disorders are a subcategory of substance use disorder. The criteria is outlined in the Diagnostic and Statistical Manual of Mental Disorders, Edition 5 (DSM-5), a guide used by psychiatrists and other mental health professionals for the diagnosis and treatment of mental health conditions.

Substance Use Disorder

Substance use disorder occurs when an individual continues to use a substance despite clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.

For a person to be diagnosed with stimulant use disorder, they must be more than just a user. For this diagnosis, a person must meet at least two of 11 criteria outlined in the DSM-5 within the previous 12 months.

The DSM-5 criteria for substance abuse disorder include the following:

  1. Using more of the substance or taking it for a longer duration than prescribed or intended
  2. Being unable to reduce or stop taking the substance, despite wanting or trying to
  3. Devoting excessive time, money, or resources to obtaining, using, or recovering from use
  4. Craving the substance
  5. Neglecting or having difficulty carrying out responsibilities at work, school, or home because of the substance use
  6. Persisting in using the substance despite its effect on relationships
  7. Missing out on activities (social, recreational, school, work) because of the substance use
  8. Using the substance in a dangerous or harmful way
  9. Using the substance despite adverse emotional or physical effects  
  10. Developing a tolerance to the substance
  11. Experiencing withdrawal symptoms when the substance is reduced or stopped

The severity of the disorder can be classified as “mild” if two to three criteria are met, “moderate” if four to five are met, and “severe” if six or more are met. These classifications may help direct the most appropriate course of treatment.

Detox and Treatment

Unlike heroin and opioid drugs, there are no medications used to treat cocaine addiction. The treatment is focused on detoxification (also referred to as detox) and behavioral therapies. You might receive treatment with a pharmaceutical drug if you have a co-addiction that can be treated pharmacologically, such as an addiction to alcohol or opioids.

Treatment may be delivered on an outpatient basis, but treatment for cocaine addiction often requires a period of inpatient care in a treatment center, particularly since withdrawal symptoms can lead to depression and a variety of serious psychiatric symptoms.


Coming off cocaine is a process that may take several weeks. Some people who are trying to stop using cocaine may experience better outcomes from inpatient rehabilitation, especially because cocaine cravings can be intense during withdrawal, and relapse is common.

If you seek an inpatient program, you would be in a supervised setting where you are not able to obtain or use the drug. When you stop taking cocaine, you can experience severe withdrawal symptoms that need to be managed.

For example, you may need medication for the treatment of abrupt or severe changes in your blood pressure. You might need counseling, supervision, and medication if you develop depression and suicidal ideation.

Behavioral Interventions

Behavioral treatment includes psychotherapy and other psychosocial interventions. These approaches help to maintain abstinence from cocaine after detox. Often, behavioral therapy is initiated right when you begin detox, or even before you stop using the drug. And you might need to continue your behavioral treatment for months or even years after you stop using cocaine.

The goal of behavioral therapy is to avoid relapse or abusing or becoming addicted to another drug in the future and learning how to live a healthy and sober life. Different types of behavioral interventions that may be used in the treatment of cocaine addiction include:

  • Cognitive behavioral therapy (CBT): This type of therapy would be focused on learning how to control your thoughts and behaviors by changing your unhealthy thinking processes.
  • Contingency management (CM): This is a process in which you and your therapist would create incentives to help you avoid drug use.
  • Dialectal behavioral therapy (DBT): This is a process in which you would learn a variety of emotional management strategies.
  • Rational emotive behavioral therapy (REBT): This type of counseling involves replacing irrational or untrue beliefs (such as a belief that you are flawed) with accurate and rational thoughts. 

Following initial treatment, some people are transferred to a drug-free therapeutic community (TC) for six to 18 months to reinforce coping skills in a community atmosphere. Thereafter, many rely on 12-step programs to maintain sobriety.

Future Therapies

Emerging treatments that are being investigated may show promise in the treatment of cocaine addiction:

  • Dopamine D3 receptor antagonists: These substances might be able to reduce some addictive behaviors associated with drug use.
  • Antabuse (disulfiram): Currently used an anti-alcohol medication, this treatment produces an unpleasant effect in response to alcohol. There is some evidence that it might help in the treatment of cocaine addiction as well.
  • Cocaine vaccine: There is research examining whether a possible cocaine vaccine might neutralize some of the effects of cocaine.

How to Find Help

If you or someone you know is struggling with substance abuse or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357. SAMHSA also provides an online treatment center location.

If you are having suicidal thoughts, dial 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or a loved one are in immediate danger, call 911.

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By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.