By Edmund Murphy

Last updated: 16 February 2024 & medically reviewed by Hailey Shafir

Cocaine is a powerful, addictive stimulant that is usually snorted or smoked. The symptoms of prolonged cocaine abuse aren’t always obvious and it can be hard to tell if someone has an addiction. This article will provide information about signs and symptoms that may indicate a cocaine use disorder.

Key takeaways:

  • Prolonged cocaine abuse can lead to temperamental mental health such as mood swings; the user often experiencing periods of intense euphoria and grandiose levels of self-confidence before flipping to paranoid thoughts and isolation.

  • In small doses, cocaine causes euphoria, sociability, reduced need for sleep, and increased concentration. However, larger doses cause paranoia, violent behavior, heart attacks, stroke, respiratory problems, and overdose.

  • After prolonged cocaine use, the brain stops naturally producing as much dopamine, meaning the user can often not feel a sense of normality without continued cocaine use, and stopping altogether can cause cocaine withdrawal symptoms.

Warning Signs of Cocaine Abuse

Signs of cocaine abuse

Cocaine is highly addictive and has dangerous side effects on health. Most people will first take cocaine at parties or in social situations and the signs of abuse or addiction may not be apparent before it is too late. 

If left unchecked, prolonged cocaine abuse can lead to extremely damaging consequences for physical health, finances, personal relationships, and mental health. 

Though it may not always be possible to spot the warning signs of cocaine abuse, being mindful of a few key indicators can help identify signs of addiction. 

Common signs of cocaine intoxication include:

Physical signs of cocaine use

  • Dilated pupils

  • Long periods of wakefulness

  • Loss of appetite

  • Runny nose or frequent sniffles

  • White powder around nostrils

  • Congestion

  • Fever

  • Headaches

  • "Coke bloat," when the face, particularly the cheeks, appears aged, bloated and puffy

  • "Coke jaw" Also known as gurning, cocaine causes the user to become incapable of controlling the movement of their jaw 

  • Chronic nose bleeds

Cocaine also has other effects on physical health that may indicate problematic use.

Psychological signs of cocaine use

  • Overconfidence

  • Over-excitement

  • Paranoia

  • Mood swings

  • Irritability

  • Depression

  • Cravings 

  • Impulsive actions

  • Trouble focusing

Behavioral signs of cocaine use

  • Legal issues

  • Drug paraphernalia - Rolled up notes, cocaine residue on surfaces, baggies

  • Absence or tardiness at work

  • Financial troubles

  • Relationship issues

  • Poor decision making

  • Poor work or school attendance

  • Financial stress (cocaine weights like 8 balls are expensive)

  • Neglecting hygiene, health, or other responsibilities

Cocaine abuse symptoms

Powdered cocaine is not only highly addictive but also hazardous to overall health in a myriad of ways. These health risks are both short and long-term, ranging from damage to vital organs and overdose.

When someone takes cocaine, either nasally, intravenously, or inhaling (predominantly with crack cocaine), it causes the blood vessels to constrict, raising blood pressure and putting strain on the heart. Intravenous use increases the risk of blood contamination diseases such as Hepatitis C, inhaling has adverse respiratory effects, and snorting causes damage to the nasal cavity and septum.

Like a lot of stimulant drug abuse, the effects of cocaine usage are relatively short-lived, only lasting between 5-30 minutes.[1] The effects of snorting powder cocaine last longer than smoking it in the form of crack cocaine. Because of its rapid and intense onset, cocaine is considered one of the most addictive drugs.

In small doses, cocaine causes euphoria, sociability, reduced need for sleep, and increased concentration. However, larger doses cause paranoia, violent behavior, heart attacks, stroke, respiratory problems, and death. When a person becomes a frequent or heavy user of cocaine, addiction is more likely to develop and medical treatment may be required.

The common adverse side effects of cocaine abuse include:

  • Headaches

  • High blood pressure

  • Nausea

  • Trouble sleeping

  • Coma

  • Chills

  • Confusion

  • Sweating

  • Seizures

While these negative side effects can be counteracted by stopping cocaine use, some of the long-term side effects are permanent. Prolonged or constant cocaine abuse can cause irreversible damage to the brain, heart, kidneys, lungs, and gastrointestinal system. It can also cause severe psychological and behavioral effects, such as depression and paranoia. 

In addition to having negative medical and psychological effects on people, cocaine use also tends to lead to problems and consequences in a person’s life. In fact, continuing to use after experiencing problems is considered a telltale warning sign of addiction. Some of the negative impacts of cocaine use may include:

  • Conflicts in an important relationship related to cocaine use

  • Problems or impairments at work or losing one’s job because of cocaine use

  • Legal charges or problems related to possession or use of cocaine

  • Financial strain resulting from cocaine use

  • Emotional problems, irritability, or mood swings

Related: How much does cocaine cost?

Recognizing cocaine addiction

Cocaine abuse can often lead to someone developing an addiction, though they are not the same thing. Cocaine abuse will often cause negative side effects to the user, but this does not mean they are unable to quit on their own. Cocaine addiction is more complicated and often requires help to overcome.

Like most forms of addiction, a person with a cocaine use disorder will be diagnosed by a licensed professional using these 11 criteria, outlined by the DSM-5:[12]

  1. Hazardous use: You have used the substance in ways that are dangerous to yourself and/or others, i.e., overdosed, driven while under the influence, or blacked out.

  2. Social or interpersonal problems related to use: Substance use has caused relationship problems or conflicts with others.

  3. Neglected major roles to use: You have failed to meet your responsibilities at work, school, or home because of substance use.

  4. Withdrawal: When you stop using the substance, you experience cocaine withdrawal symptoms.

  5. Tolerance: You have built up a tolerance to the substance so that you have to use more to get the same effect.

  6. Used larger amounts/longer: You have started to use larger amounts or use the substance for longer amounts of time.

  7. Repeated attempts to control use or quit: You've tried to cut back or quit entirely, but haven't been successful.

  8. Much time spent using: You spend a lot of your time using the substance.

  9. Physical or psychological problems related to use: Your substance use has led to physical health problems, such as liver damage or lung cancer, or psychological issues, such as depression or anxiety.

  10. Activities given up to use: You have skipped activities or stopped doing activities you once enjoyed in order to use the substance.

  11. Craving: You have experienced an intense craving for the substance.

These criteria are measured by the negative impact the substance has on a person's life; including physical, psychological, and behavioral measures, and are classified as mild, moderate, and severe. The criteria are measured against the previous 12 months of substance use and a score of 2-3 is considered mild, 3-5 moderate, and 6 or more severe.[12] Even severe cocaine addictions can be treated and overcome.

Intervention for a cocaine use disorder

It can be very difficult to convince a cocaine user to seek help. Often, those suffering from the signs of cocaine addiction will try to avoid the problem or insist they will seek help on their own, even if they never do. Sometimes, it is possible to share your concern for the person with the addiction, but staging an intervention may not be advised (especially without a licensed addiction specialist present). find out more about staging an intervention here. 

Being overly confrontational often leads people with an addiction to shut down, become defensive, and close themselves off even more. It’s ok to tell a person you care about that you are worried about them and want them to get help, but usually they will need to choose to engage in treatment on their own. 

Often, it will take a person more than one attempt to get clean and sober, so it’s important to have realistic expectations when a person does decide to get help. Most people who develop addictions do eventually stop using, so there is always a reason to be hopeful and optimistic.[5] Still, a person with an addiction needs to make the decision to stop and make a change in order to be successful.

Cocaine withdrawal and treatment

Cocaine releases high amounts of dopamine in the brain, the biochemical that is responsible for producing pleasure and reward. After prolonged cocaine use, the brain stops naturally producing as much dopamine, meaning the user can often not feel a sense of normality without continued cocaine use, and stopping altogether can cause cocaine withdrawal symptoms. 

Cocaine addiction does not require a medical detox to overcome, but treatment improves the chances of successfully recovering. Even attending a 12-step group or outpatient program can be helpful to people working to overcome cocaine addiction. These programs can help people learn how to cope with withdrawal, manage any cocaine cravings, and set themselves up for a drug-free life. Find treatment for cocaine addiction today.