What Is Cocaine Addiction

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KEY TAKEAWAYS

Cocaine addiction is a psychological addiction developed by the continued use of cocaine, either alone or combined with other substances.

Cocaine addiction:

Lowers dopamine receptor availability by 10.7%, increasing dependence [1]
Results in hallucinations in 96% of addicts [2]
Reduces behaviour insight by 25% [3]

Physiological Indicators Of Cocaine Addiction

6% of cocaine consumers who visit the emergency room for chest pain after the use of cocaine experience a myocardial infarction; ischemia and infarction occur in chronic cocaine abusers [4].

47% of daily cocaine addicts experience nasal membrane irritation, such as nasal crusts or scabs, and recurrent nosebleeds [5].

Cocaine abusers with a history of pre-existing seizures have a 200% increased risk of seizure caused by cocaine [6].

6 to 26% of those who take cocaine experience haemoptysis [7].

77 to 85% of those addicted to cocaine who died from cocaine use experienced pulmonary edemas [8].

Coronary stenosis increases by 50% after 6 months of cocaine use [9].

24% of cocaine abusers develop rhabdomyolysis [10].

Psychological Indicators Of Cocaine Addiction

53% of cocaine-dependent people experience cocaine-induced psychosis [11].

96% of cocaine addicts experience hallucinations:

83% experience auditory hallucinations
38% experience visual hallucinations
21% experience tactile hallucinations [2]

Cocaine abusers exhibit a 32.28% impairment in memory and attention compared to individuals who do not use cocaine [12].

68% of cocaine abusers experience paranoia following cocaine use [13].

Chronic cocaine consumers exhibit 39% less empathy compared to non-users, indicating a decline in sociocognitive functioning [14].

The risk of developing OCD is 310% higher in cocaine abusers than in non-users [15].

29% of regular cocaine users report panic attacks [16].

Behavioural Indicators Of Cocaine Addiction

Cocaine use increases aggression by 29% [17].

Cocaine-dependent people have 25% less behaviour insight than non-dependent people, resulting in a lack of social awareness [3].

In a study of rats:

Drug-seeking behaviour in subjects with limited cocaine exposure was reduced by 50% with the use of shock aversives.

After prolonged cocaine exposure, drug-seeking behaviour continued 100% of the time despite shock aversives [18].

73% of regular cocaine consumers report a loss of appetite [16].

Defining Cocaine Addiction By Neurobiological Mechanisms

Neurotransmitter Behaviour

Dopamine receptor availability is 10.7% lower in cocaine addicts than in non-addicts; suppressed dopamine reduces the pleasure experienced from everyday activities and reinforces drug-seeking behaviour [1].

Cocaine blocks serotonin transporters; in a study on mice with insensitive serotonin transporters, researchers found that, after extended use, the mice had a 16.67% higher preference for cocaine compared to the mice with normal serotonin transporters [19].

Changes In Brain Regions

Cocaine addicts have an 18% decrease in amygdala volume compared to non-addicts, predisposing them to cocaine dependence [20].

In a study on mice, repeated exposure to cocaine increased dendritic spine density in the prefrontal cortex by 50% compared to mice who did not consume cocaine; the addicted mice displayed heightened neural responsiveness to the drug, driving repeated drug use [21].

Neurobiological Changes

Cocaine abusers have a 43% decrease in myelin-related gene expression compared to non-addicts, increasing vulnerability to addiction due to disrupted neural communication and structural brain integrity [22].

Prefrontal glutamate concentration decreases by 20.28% when using cocaine, increasing addictive behaviour by forming drug-associated memories and increasing cravings [23].

Cocaine Addiction Vs Addiction To Other Drugs

	Cocaine	Ecstasy
How many users get addicted?	20% [24]	8.5% [25]
Withdrawal symptoms	Agitation and restless behaviour Depressed mood Fatigue Feeling of discomfort Increased appetite Sleep disturbance Slowing of activity	Depression Insomnia Psychomotor agitation
Typical acute withdrawal duration	7 days [26]	7-20 days [27]
Short-term effects	Euphoria Energy bursts that peak within 5 mins Mental alertness	Emotional warmth Altered sensory perception
Long-term effects	Sensitisation, in which less cocaine is needed to produce anxiety, convulsions, or other toxic effects. Risk of stroke or seizures Heart problems Neurological problems: Seizures, Strokes, Memory disturbances, Paroxysmal dystonia	Delayed recall Chronic psychiatric symptoms

	Marijuana	Heroin
How many users get addicted?	1.1% [28]	30.2% [29]
Withdrawal symptoms	Anxiety Disrupted sleep Irritability Anger/ aggression Loss of appetite	Muscle and bone pain Diarrhoea and vomiting Cold flashes with goosebumps
Typical acute withdrawal duration	2-6 days [30]	5 days [31]
Short-term effects	Altered senses Hallucinations Altered mood Delusions	Pain relief Drowsiness
Long-term effects	Breathing problems: Coughing, Sputum production, Wheezing, Dyspnea Cannabinoid Hyperemesis Syndrome (more about synthetic cannabinoids here)	Imbalances in neuronal and hormonal systems Deterioration of the brain's white matter Tolerance and physical dependence

	Alcohol	Oxycodone
How many users get addicted?	3.5% [32]	1.6% [33]
Withdrawal symptoms	Anxiety or nervousness Irritability Jumpiness or shakiness Not thinking clearly	Watery eyes/runny nose Sneezing/ Yawning Sweating/ Chills Muscle or joint pain Weakness Irritability Anxiety Diarrhoea and vomiting Loss of appetite Fast heartbeat/breathing
Typical acute withdrawal duration	24 hours [34]	24 hours [35]
Short-term effects	Relaxation Impaired coordination	Pain relief Sedation
Long-term effects	Liver disease: Hepatitis, Cirrhosis, Hepatocellular carcinoma, Steatosis, Steatohepatits Cognitive impairment	Liver damage: Hepatic impairment, Cirrhosis Risk of overdose

	Benzodiazepines
How many users get addicted?	5% [36]
Withdrawal symptoms	Anxiety/panic attacks Sleep disorders Cognitive impairment Muscle spasms Perceptual hypersensitivity Depersonalisation Hallucinations Excitability Symptoms of psychosis Convulsions
Typical acute withdrawal duration	10-14 days [37]
Short-term effects	Sedation Relaxation Muscle relaxation
Long-term effects	Risk of dementia Memory problems

When Cocaine Use Becomes Cocaine Addiction

Stage	Behaviours
Initial Use	Initial use is usually preceded by alcohol and cannabis use Use is infrequent, typically in social settings and influenced by peers Initial use enhances social enjoyment Users who sniff cocaine have a 5% risk of developing dependence [38]
Regular Use	Cocaine use becomes more routine Tolerance increases, and more is needed to achieve the same effects Increased in number of friends who also use cocaine
Risky Use/Abuse	Escalation in the quantity and frequency of cocaine use Negative consequences on physical and psychological health, relationships, and responsibilities Denial of the severity of use and secretive behaviours
Dependence	Development of physical and psychological dependence Withdrawal symptoms when not using cocaine Failed attempts to cut down or quit, with a noticeable deterioration in physical health
Addiction/Severe SUD	Compulsive use despite severe negative consequences Anxiety, paranoia, and depression Loss of control over cocaine use, leading to high-risk behaviours
Withdrawal and Relapse	Withdrawal symptoms like depression, fatigue, and intense cravings Risk of relapse due to stress or drug-associated cues or locations

What Factors Change Cocaine Addiction?

Legal And Criminal Justice Protocols

The UK aims to give prisoners the same access to cocaine addiction treatment in prison as in the community.

UK prisoners are referred to support services in the local community when released.

81% of US prisons offer drug and alcohol programs, but only 10% of prisoners receive clinical treatment [39].

In the criminal justice systems of many Asian countries, such as Vietnam, Cambodia, China and Thailand, centre-based compulsory treatment (CCT) is used to resolve illicit drug use problems; this approach has been criticised on human-rights grounds [40].

Historical Patterns Of Cocaine Addiction

In the mid-1880s, cocaine was readily available in commercial and medical products.

In 1980, using cocaine 2 or 3 times a week was thought to cause no serious problems and incapable of causing dependence [41].

The 1980s “crack epidemic” in the USA shifted public perception of cocaine from a harmless party drug to an addictive and dangerous substance [42].

At the beginning of the 1990s, the harmful and addictive qualities of cocaine were well-acknowledged, and it was declared to be the drug of greatest national health concern in the USA [43].

Public Health Initiatives

Aspect	Description	Impact
Harm Reduction Strategies	Educational campaigns on safer practices, advising on: Dosage Hygiene practices Utensil choice Provision of safer ways to consume cocaine	Cocaine addicts consume the drug in safer ways, reducing the overall harm.
Community-Based Interventions	Localised responses with training for addiction service staff, and targeted interventions in heavily impacted areas	Empowers communities to tackle cocaine use.
Outpatient Facilities	Treating individuals without the need for residential services	Improves accessibility and support networks in a confidential manner.
Treatment Funding	Increased funding for drug rehabilitation treatment	More staff to work in drug and alcohol rehabilitation and better access to services for cocaine addicts.
Public Health Surveillance and Data Collection	Conducting extensive surveillance to monitor cocaine use and its health consequences.	Informs public health strategies and ensures responsive, evidence-based interventions.

Aspect	Examples of Public Health Initiatives
Harm Reduction Strategies	Health service leaflets Government-sponsored websites Safe Inhalation Pipe Provision kits
Community-Based Interventions	Prize-based systems that reward cocaine abstinence Cocaine Anonymous meetings
Outpatient Facilities	Outpatient rehab facilities
Treatment Funding	£267 million boost to drug and alcohol treatment in the UK €500,000 funding for cocaine services in Ireland
Public Health Surveillance and Data Collection	National Drug Treatment Reporting System in Ireland The National Drug and Alcohol Treatment Monitoring System in the UK

References

[1] Volkow, N. D., et al. “Decreased Striatal Dopaminergic Responsiveness in Detoxified Cocaine-Dependent Subjects.” Nature, vol. 386, no. 6627, Apr. 1997, pp. 830–33. “Addicts showed reduced dopamine release in the striatum, the brain region where the nucleus accumbens is located, and also had a reduced ‘high’ relative to controls. In contrast, addicts showed an increased response to methylphenidate in the thalamus (a region that conveys sensory input to the cortex). This thalamic response was associated with cocaine craving and was not seen in control subjects. Thus, our findings challenge the notion that addiction involves an enhanced striatal dopamine response to cocaine and/or an enhanced induction of euphoria.”
[2] Brady, K. T., et al. “Cocaine-Induced Psychosis.” The Journal of Clinical Psychiatry, vol. 52, no. 12, Dec. 1991, pp. 509–12. “Ninety-six percent (28/29) of the subjects experienced hallucinations: 83% (24/29), auditory hallucinations; 38% (11/29), visual hallucinations; and 21% (6/29), tactile hallucinations.”
[3] Moeller, Scott J., et al. “Impaired Insight in Cocaine Addiction: Laboratory Evidence and Effects on Cocaine-Seeking Behaviour.” Brain, vol. 133, no. 5, Apr. 2010, pp. 1484–93. Accessed 6 Aug. 2020.
[4] Karila, L., et al. “Diagnosis and Consequences of Cocaine Addiction.” Current Medicinal Chemistry, vol. 19, no. 33, Nov. 2012, pp. 5612–18. “Six percent of the patients with chest pain proceed to infarction... Ischaemia and infarction usually occur in chronic abusers.”
[5] Schwartz, R. H., et al. “Nasal Symptoms Associated with Cocaine Abuse during Adolescence.” Archives of Otolaryngology - Head and Neck Surgery, vol. 115, no. 1, Jan. 1989, pp. 63–64. “47% of those who used the drug daily, recalled that they had nasal membrane irritation with nasal crusts or scabs, recurrent nosebleeds, or both.”
[6] Karila, L., et al. “Diagnosis and Consequences of Cocaine Addiction.” Current Medicinal Chemistry, vol. 19, no. 33, Nov. 2012, pp. 5612–18."There is a 2-fold increased risk of seizure in cocaine abusers with a history of seizures."
[7] Karila, L., et al. “Diagnosis and Consequences of Cocaine Addiction.” Current Medicinal Chemistry, vol. 19, no. 33, Nov. 2012, pp. 5612–18. "Haemoptysis occurs in 6 to 26% of cocaine users."
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[24] Karila, L., et al. “Diagnosis and Consequences of Cocaine Addiction.” Current Medicinal Chemistry, vol. 19, no. 33, Nov. 2012, pp. 5612–18. Accessed 21 Jan. 2020. “20% of these will become long-term cocaine-dependent patients.”
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[39] Widra, Emily. “Addicted to Punishment: Jails and Prisons Punish Drug Use Far More than They Treat It.” Prison Policy Initiative, 30 Jan. 2024. “Most state and federal prisons (81%) offered some ‘drug or alcohol dependency, counseling, or awareness programs’ in 2019, but among people in state prisons with a substance use disorder, only 10% had received clinical treatment in the form of a residential treatment program, professional counseling, detoxification unit, or MAT.”
[40] Vuong, Thu, et al. “The Political and Scientific Challenges in Evaluating Compulsory Drug Treatment Centers in Southeast Asia.” Harm Reduction Journal, vol. 14, no. 1, Jan. 2017. Accessed 10 Aug. 2020. “In Vietnam, like many countries in Southeast Asia, the commonly used approach of center-based compulsory drug treatment (CCT) has been criticized on human rights ground.”
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[42] Miech, Richard. “The Formation of a Socioeconomic Health Disparity: The Case of Cocaine Use during the 1980s and 1990s.” Journal of Health and Social Behavior, vol. 49, no. 3, Sept. 2008, pp. 352–66. “The disparity in cocaine use formed at a time when the reputation of cocaine changed from glamorous to unsavory. It can be somewhat difficult in today’s environment—in which cocaine and the cocaine trade are associated with violence, blighted neighborhoods, and desperation—to view cocaine through the lens of the 1970s and early 1980s, when it was perceived by many as an innovative, recreational drug.”
[43] Gawin, F. “Cocaine Addiction: Psychology and Neurophysiology.” Science, vol. 251, no. 5001, Mar. 1991, pp. 1580–86. “Cocaine was considered incapable of producing dependence in 1980 but was recently proclaimed the drug of greatest national health concern.”

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: October 27, 2025