Cocaine is the second-most popular illicit drug in the United States. Known for its short, intense high, cocaine is highly addictive and is used for its stimulating and energetic properties. While its use as a recreational drug dates as far back as the early 1900s, cocaine use hit its peak during the 1980s and 90s during the crack epidemic. Cocaine use has been slowly decreasing since then, but supply has remained steady, owing to sophisticated drug smuggling operations in Mexico and South America.

According to the National Survey on Drug Use and Health (NSDUH), cocaine use has remained relatively stable since 2009. In 2016, approximately 2 million people aged 12 and above were reported to be using cocaine, and overdose deaths related to the drug rose nearly 2% between 2016-17.

While cocaine is extremely addictive and damaging to the body, there is hope for recovery. With multiple treatment options available, individuals can restore their health and lead new lives free from addiction.

Before our discussion of the health impacts and methods of treatment for cocaine addiction, let’s begin by exploring what cocaine is, the current prevalence of its use in the U.S., and its historical background.

What Is Cocaine?

Cocaine is a white, powdery stimulant that affects the central nervous system. Derived from the coca plant, cocaine produces intense feelings of energy and euphoria. Like most stimulants, cocaine works on the brain by triggering the production of dopamine —a neurotransmitter that influences feelings of pleasure. The most common way to ingest cocaine is to snort it; however, it can also be smoked (known as “freebasing”) or dissolved in water and injected.

Also known by the street names “blow,” “snow,” or “coke,” cocaine is essentially composed of cocaine hydrochloride, a water-soluble salt that can be ingested by the body. This is the most common form of cocaine, but it is also usually adulterated with other substances, such as baking powder, lactose sugar, flour, amphetamines, or local anesthetics, so that dealers can increase their profits.

When cocaine is smoked or freebased, the hydrochloride base is removed using ammonia. The resultant crystal rocks are made of pure cocaine that can then be smoked through a pipe. However, due to the volatile and explosive risks associated with freebasing, this technique is rarely used anymore. Instead, water and baking soda are used to extract pure cocaine from the base. This is known as “crack” and produces a more intense high.

Cocaine Addiction Statistics

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), roughly 966,000 Americans struggled with cocaine addiction in 2017. That same year, it was reported that 637,000 people aged 12 and above sought treatment for cocaine abuse.

Other statistics include:

  • It is estimated that around 5 million Americans habitually use cocaine.
  • In 2017, 2.2 million Americans used cocaine at least once in the previous month.
  • Cocaine-related overdose deaths increased by 34% between 2016 and 2017.
  • Young adults aged 18 to 25 report the most frequent cocaine use out of all age groups.
  • Cocaine was involved in 1 out of 5 overdose deaths in 2017.
  • The states with the highest cocaine use are California, Colorado, District of Columbia, Delaware, Nevada, New Hampshire, Oregon, Rhode Island, Hawaii, and Vermont.

The Origins of Cocaine

Cocaine is derived from the leaves of the South American coca plant. For centuries, indigenous people in the Andes and the Amazon Rainforest chewed coca leaves to acquire their energetic properties. The ancient Incas, for example, chewed the leaves to increase their heart rate and cope with the thin mountain air. Other tribes also used coca leaves for ceremonial purposes.

In the 1850s, a German chemist named Albert Niemann figured out how to isolate cocaine from coca leaves. This led to an explosion of medicinal uses in Europe; it was even promoted as a cure for depression and sexual impotence by Sigmund Freud. Cocaine’s popularity as a medicinal substance grew into the 1880s, when it was also added to the infamous soft drink, Coca-Cola.

By the early 1900s, cocaine had become a widely used substance, the danger of which started to become evident as people exhibited signs of addiction and ill health. Cocaine was subsequently removed from Coca-Cola in 1903, but recreational use continued, especially among university students and in the entertainment industry.

In the late 1970s, Colombian drug traffickers developed sophisticated networks for the production and distribution of cocaine to the U.S. Since then, cocaine has become one of the most widely used illicit substances in America.

Cocaine Production

Colombia currently produces the largest amount of coca plants, followed closely by Bolivia and Peru. The leaves can be harvested as many as 3 to 8 times per year, depending on the species. To make 1 kg of cocaine base, it takes roughly 450 to 600 kg of fresh leaves, although this depends on the plant, as some species produce more cocaine than others.

While there are several ways to make cocaine, the most popular techniques involve soaking dried coca leaves in lime or other alkaline liquids and then extracting the active ingredient using kerosene. Sulfuric acid and lime are then applied in another extraction process, which leaves behind a coca paste. To filter out impurities, acid and potassium are added, followed by bicarbonate, which causes the base to separate. In a final process, the cocaine paste is filtered through a cloth and then dried.

Cocaine distribution is highly complex and organized. Once the cocaine is harvested by coca farmers, it is then shipped off to labs for processing. This is sent to trafficking agents and distributors, who direct it to other organizations for shipment, where it is then smuggled through Mexico. It is estimated that about 90% of the cocaine in the U.S. comes through the U.S.-Mexico border, mostly via Texas.

The Effects of Cocaine

Cocaine activates the dopamine system in the brain, the build-up of which produces strong feelings of alertness and euphoria. Snorting is the most popular method of taking cocaine; however, the high only lasts for about 15 to 30 minutes, which encourages frequent use. If cocaine is smoked, the high is more immediate and intense, but the effects only last for 5 to 15 minutes. The short duration of the high and its intensity can lead to cycles of binging and addiction.

Like many drugs, long-term cocaine use results in tolerance. Individuals require higher doses to reach the desired effects, which puts them at risk of an overdose. Below are some of the most common effects of cocaine use. The longer the drug is used, the more it damages the brain and central nervous system, which is why the effects change over time.

Short-Term Effects

  • Hallucinations, hyperexcitability, irritability
  • Intense euphoria
  • Extreme tactile, hearing, and visual sensitivity
  • Increased body temperature
  • Anger/irritability
  • Decreased appetite
  • Anxiety and paranoia

Long-Term Effects

  • Permanent damage to blood vessels in the heart and brain
  • High blood pressure
  • Headaches
  • Convulsions and seizures
  • Heart disease, heart attack, and stroke
  • Mood problems
  • HIV or hepatitis (through injecting)
  • Bowel decay (through swallowing)
  • Loss of smell, nosebleeds, destruction of tissues (through snorting)
  • Liver, kidney, and lung damage
  • Malnutrition, weight loss
  • Tooth decay
  • Auditory and tactile hallucinations
  • Sexual problems and infertility (for men and women)
  • Disorientation, apathy, confused exhaustion
  • Increased risky behavior
  • Delirium or psychosis
  • Severe depression
  • Tolerance and addiction (even after just one use)

Common Cocaine Combinations

While cocaine is often cut with other substances, people also combine it with other drugs to get a more intense high. These combinations can be dangerous and lead to more serious complications.


Alcohol is frequently combined with cocaine to reduce its stimulating side-effects, which include anxiety, tension, clenching, or twitching. However, like other stimulants, cocaine can mask the effects of alcohol, causing someone to drink more than they normally would. Conversely, alcohol can mask the stimulating effects of cocaine, potentially leading to an overdose.

Another dangerous consequence of mixing alcohol and cocaine is the production of cocaethylene in the liver when these drugs are metabolized simultaneously. A build-up of cocaethylene can lead to major stress on the organs, particularly the cardiovascular system and the liver. Cocaethylene also temporarily enhances the high produced from alcohol and cocaine; however, that euphoria effect can lead to increased blood pressure, aggression, and poor judgment.


Opioids, like heroin, are regularly combined with cocaine to produce what is known as a “speedball.” This dangerous combination produces a more intense high than can be achieved by using each drug individually. While speedballs create a unique high of their own, these drugs are antagonistic, and create opposing effects in the body. As one is a stimulant and the other a depressant, they cancel each other out, which can lead to overdoses when an individual mistakenly thinks they are more sober than they actually are. Another dangerous consequence is that heroin is longer lasting, and can cause respiratory failure when the cocaine wears off.


Ecstasy and cocaine are another common combination. These two stimulants create a more intense rush together than they would if they were used on their own. However, this combination also increases a person’s heart rate, increasing the risk of heart attack or stroke. These dangerous side-effects apply to other stimulants, including prescription drugs, such as Adderall.

Signs & Symptoms of Cocaine Addiction

The signs and symptoms of cocaine addiction vary from person to person, depending on the method and how long they’ve used it. However, there are physical, psychological, behavioral, and social signs to watch out for.

Physical Signs

Cocaine is a stimulant, so the physical signs of addiction are synonymous with substances that cause alertness, euphoria, and excessive movement. People who use cocaine regularly may exhibit some of these symptoms even when the drug has worn off, which is a clear sign of addiction.

  • Increased heart rate and body temperature
  • Excitability
  • Dilated pupils
  • High energy
  • Restlessness
  • Insomnia
  • Dilated pupils
  • Runny nose and persistent nosebleeds
  • Hypertension (high blood pressure)
  • Excessive sweating
  • Diminished appetite and weight loss
  • “Blacking out” from taking cocaine
  • Physical tolerance and withdrawal

Psychological Signs

Individuals who regularly abuse cocaine will exhibit psychological signs of dependence, as well as intense emotional changes once the drug has worn off. Because of the severe highs and lows that are caused by stimulants, individuals often experience issues such as:

  • Agitation
  • Mood changes
  • Irritability
  • Restlessness
  • Brief states of euphoria
  • Excessive confidence
  • Impaired ability to focus or concentrate
  • Impaired decision-making abilities
  • Loss of interest (or deterioration in) personal hygiene and physical appearance
  • Depression
  • Psychosis
  • Exacerbation of existing mental health conditions
  • Taking cocaine to relieve stress or tension

Behavioral Signs

Many of the behavioral signs of cocaine addiction are similar to other drug dependencies. Any sudden changes in behavior or signs of withdrawal can be clear indicators of a problem. These include:

  • Neglecting relationships and responsibilities
  • Poor attendance and performance at work
  • Social isolation and withdrawal from family and friends
  • Increased impulsivity or urgency
  • Reckless, risky behaviors
  • Talking excessively
  • Continuing to use cocaine, despite its negative side-effects
  • Spending a great deal of time using, obtaining, or recovering from cocaine use
  • Only associating with people who use cocaine
  • Being secretive or lying about their whereabouts
  • Losing interest in activities and hobbies
  • Using other drugs alongside cocaine

Other Signs

Aside from the numerous symptoms above, there is a cluster of key signs of cocaine addiction that are noticeable during periods of withdrawal, or when the drug has temporarily worn off.

Extreme Mood Swings

In the early stages of cocaine use, an individual is likely to be chatty and vibrant. But when the effects wear off, they can become withdrawn and depressed. If someone was previously sociable and easygoing, but is suddenly hostile and doesn’t want to engage in conversation, this could be a sign of addiction.

Financial Problems

Unlike cheaper stimulants like meth, cocaine is expensive. Also, frequent cocaine use can make it difficult to sustain steady employment, leading to ongoing financial difficulties.

Physical Changes

People who use cocaine for a long period will start to show noticeable physical changes. One of the most prominent is the “crash phase,” when the body is deprived of dopamine. This leads to extreme exhaustion, and is characterized by intense cravings, depression, and long periods of sleep. The crash phase also occurs during the withdrawal period when an individual is detoxing.

Mental Health Changes

Cocaine is known for causing paranoia and anxiety, especially when the drug wears off. If you notice someone is emotionally flat and is experiencing new (or worsened) anxiety and depression, it may signal an addiction.


During periods when the person isn’t taking cocaine, or the effects have worn off, they can start to exhibit largely psychological withdrawal symptoms. This includes irritability, insomnia, fatigue, cravings, and depression.

Long-Term Health Consequences

Long-term cocaine use can have lasting and damaging effects on a person’s health, which can vary depending on the method of taking the drug. For instance, someone who regularly snorts cocaine will likely suffer damage to the nose passages and tissues, while a person who smokes it will experience respiratory and breathing issues. Injecting cocaine, on the other hand, can lead to other complications, such as ruptured blood vessels and infectious diseases.

In general, cocaine causes damage to the blood vessels, organs, and the brain, so it’s important to seek help before it’s too late.

The physical consequences of long-term cocaine use include, but are not limited to:

  • Reduced immunity
  • HIV infection
  • Hepatitis
  • Mood disorders
  • Cardiovascular disease
  • Respiratory illness
  • Gastrointestinal disease
  • High blood pressure
  • Stroke
  • Seizures
  • Altered sleep patterns
  • Memory loss
  • Slow reaction time
  • Short attention span
  • Shrinking brain size
  • Nose collapse

The long-term psychological consequences of cocaine use include:

  • Violent, erratic, or paranoid behavior
  • Delusions
  • Confusion, anxiety, and depression
  • Hallucinations (“coke bugs” – a sensation of bugs under the skin)
  • Loss of interest in food or sex
  • Psychosis

Another important thing to look out for is a potential cocaine overdose. Every individual is at risk, even if they are experienced at taking the drug. Key signs and symptoms include:

  • Delirium
  • Dangerously high body temperature
  • Rapid heartbeat
  • Elevated blood pressure
  • Breathing problems
  • Kidney failure
  • Stroke

Cocaine Addiction Resources

At, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.

We provide our readers with factual, evidence-based content concerning the causes and nature of addiction, as well as available treatment options. However, this informative content is intended for educational purposes only. It is by no means a substitute for professional medical advice, diagnosis, or treatment. With regard to any addiction-related health concerns, you should always seek the guidance of a qualified, registered physician who is licensed to practice medicine in your particular jurisdiction. You should never avoid or delay seeking professional health care advice or services based on information obtained from our website. Our authors, editors, medical reviewers, website developers, and parent company do not assume any liability, obligation, or responsibility for any loss, damage, or adverse consequences alleged to have happened directly or indirectly as a result of the material presented on

About the Author

Jenn Tomomitsu, PhD

Jenn is a Canadian writer and poet with a background in psychology, sociology, and natural health. She is the founder of The Master in You, a mental wellness site that provides information about the role that thoughts and emotions play in our physical and emotional health. Jenn is passionate about inner growth and the power of the mind-body connection, and this informs her writing and research on addiction treatment. On Rehabaid, Jenn aims to write accessible, informative content and provide resources that can help people make empowered and informed decisions about their recovery.

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