Tips For Teens – Cocaine

Everything you need to know about cocaine

The Statistics on Cocaine Use in 2019: How Popular Is It?

What is cocaine?

Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America. Although health care providers can use it for valid medical purposes, such as local anesthesia for some surgeries, recreational cocaine use is illegal. As a street drug, cocaine looks like a fine, white, crystal powder. Street dealers often mix it with things like cornstarch, talcum powder, or flour to increase profits. They may also mix it with other drugs such as the stimulant amphetamine, or synthetic opioids, including fentanyl. Adding synthetic opioids to cocaine is especially risky when people using cocaine don’t realize it contains this dangerous additive. Increasing numbers of overdose deaths among cocaine users might be related to this tampered cocaine.

Popular nicknames for cocaine include:

  • Blow
  • Coke
  • Crack
  • Rock
  • Snow

How do people use cocaine?

People snort cocaine powder through the nose, or they rub it into their gums. Others dissolve the powder and inject it into the bloodstream. Some people inject a combination of cocaine and heroin, called a Speedball.

Another popular method of use is to smoke cocaine that has been processed to make a rock crystal (also called “freebase cocaine”). The crystal is heated to produce vapors that are inhaled into the lungs. This form of cocaine is called Crack, which refers to the crackling sound of the rock as it’s heated. Some people also smoke Crack by sprinkling it on marijuana or tobacco, and smoke it like a cigarette.

People who use cocaine often take it in binges—taking the drug repeatedly within a short time, at increasingly higher doses—to maintain their high.

How does cocaine affect the brain?

Image of the brain's reward circuit.Image by NIDAThe brain’s reward circuit, which controls feelings of pleasure

Cocaine increases levels of the natural chemical messenger dopamine in brain circuits related to the control of movement and reward.

Normally, dopamine recycles back into the cell that released it, shutting off the signal between nerve cells. However, cocaine prevents dopamine from being recycled, causing large amounts to build up in the space between two nerve cells, stopping their normal communication. This flood of dopamine in the brain’s reward circuit strongly reinforces drug-taking behaviors, because the reward circuit eventually adapts to the excess of dopamine caused by cocaine, and becomes less sensitive to it. As a result, people take stronger and more frequent doses in an attempt to feel the same high, and to obtain relief from withdrawal.

Short-Term Effects

Short-term health effects of cocaine include:

  • extreme happiness and energy
  • mental alertness
  • hypersensitivity to sight, sound, and touch
  • irritability
  • paranoia—extreme and unreasonable distrust of others

Some people find that cocaine helps them perform simple physical and mental tasks more quickly, although others experience the opposite effect. Large amounts of cocaine can lead to bizarre, unpredictable, and violent behavior.

Cocaine’s effects appear almost immediately and disappear within a few minutes to an hour. How long the effects last and how intense they are depend on the method of use. Injecting or smoking cocaine produces a quicker and stronger but shorter-lasting high than snorting. The high from snorting cocaine may last 15 to 30 minutes. The high from smoking may last 5 to 10 minutes.

What are the other health effects of cocaine use?

Other health effects of cocaine use include:

  • constricted blood vessels
  • dilated pupils
  • nausea
  • raised body temperature and blood pressure
  • fast or irregular heartbeat
  • tremors and muscle twitches
  • restlessness

Long-Term Effects

Some long-term health effects of cocaine depend on the method of use and include the following:

  • snorting: loss of smell, nosebleeds, frequent runny nose, and problems with swallowing
  • smoking: cough, asthma, respiratory distress, and higher risk of infections like pneumonia
  • consuming by mouth: severe bowel decay from reduced blood flow
  • needle injection: higher risk for contracting HIV, hepatitis C, and other bloodborne diseases, skin or soft tissue infections, as well as scarring or collapsed veins

However, even people involved with non-needle cocaine use place themselves at a risk for HIV because cocaine impairs judgment, which can lead to risky sexual behavior with infected partners (see “Cocaine, HIV, and Hepatitis” textbox).

Cocaine, HIV, and Hepatitis

Studies have shown that cocaine use speeds up HIV infection. According to research, cocaine impairs immune cell function and promotes reproduction of the HIV virus. Research also suggests that people who use cocaine and are infected with HIV may be more susceptible to contracting other viruses, such as hepatitis C, a virus that affects the liver. Read more about the connection between cocaine and these diseases in NIDA’s Cocaine Research Report.

Other long-term effects of cocaine use include being malnourished, because cocaine decreases appetite, and movement disorders, including Parkinson’s disease, which may occur after many years of use. In addition, people report irritability and restlessness from cocaine binges, and some also experience severe paranoia, in which they lose touch with reality and have auditory hallucinations—hearing noises that aren’t real.

Can a person overdose on cocaine?

Yes, a person can overdose on cocaine. An overdose occurs when a person uses enough of a drug to produce serious adverse effects, life-threatening symptoms, or death. An overdose can be intentional or unintentional.

Death from overdose can occur on the first use of cocaine or unexpectedly thereafter. Many people who use cocaine also drink alcohol at the same time, which is particularly risky and can lead to overdose. Others mix cocaine with heroin, another dangerous—and deadly—combination.

Some of the most frequent and severe health consequences of overdose are irregular heart rhythm, heart attacks, seizures, and strokes. Other symptoms of cocaine overdose include difficulty breathing, high blood pressure, high body temperature, hallucinations, and extreme agitation or anxiety.

How can a cocaine overdose be treated?

There is no specific medication that can reverse a cocaine overdose. Management involves supportive care and depends on the symptoms present. For instance, because cocaine overdose often leads to a heart attack, stroke, or seizure, first responders and emergency room doctors try to treat the overdose by treating these conditions, with the intent of:

  • restoring blood flow to the heart (heart attack)
  • restoring oxygen-rich blood supply to the affected part of the brain (stroke)
  • stopping the seizure

How does cocaine use lead to addiction?

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.

Withdrawal symptoms include:

  • depression
  • fatigue
  • increased appetite
  • unpleasant dreams and insomnia
  • slowed thinking

How can people get treatment for cocaine addiction?

Behavioral therapy may be used to treat cocaine addiction. Examples include:

  • cognitive-behavioral therapy
  • contingency management or motivational incentives—providing rewards to patients who remain substance free
  • therapeutic communities—drug-free residences in which people in recovery from substance use disorders help each other to understand and change their behaviors
  • community based recovery groups, such as 12-step programs

While no government-approved medicines are currently available to treat cocaine addiction, researchers are testing some treatments that have been used to treat other disorders, including:

  • disulfiram (used to treat alcoholism)
  • modanifil (used to treat narcolepsy—a disorder characterized by uncontrollable episodes of deep sleep)
  • lorcaserin (used to treat obesity)
  • buprenorphine (used to treat opioid addiction)

Points to Remember

  • Cocaine is a powerfully addictive stimulant drug made from the leaves of the coca plant native to South America.
  • Street dealers often mix it with things like cornstarch, talcum powder, or flour to increase profits.
  • They may also mix it with other drugs such as the stimulant amphetamine or the synthetic opioid fentanyl.
  • People snort cocaine powder through the nose, or rub it into their gums. Others dissolve the powder and inject it into the bloodstream, or inject a combination of cocaine and heroin, called a Speedball. Another popular method of use is to smoke Crack cocaine.
  • Cocaine increases levels of the natural chemical messenger dopamine in brain circuits related to the control of movement and reward.
  • A person can overdose on cocaine, which can lead to death.
  • Behavioral therapy may be used to treat cocaine addiction.
  • While no government-approved medicines are currently available to treat cocaine addiction, researchers are testing some treatments that have been used to treat other disorders.

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What is cocaine?

Cocaine is a powerfully addictive stimulant drug. For thousands of years, people in South America have chewed and ingested coca leaves (Erythroxylon coca), the source of cocaine, for their stimulant effects. The purified chemical, cocaine hydrochloride, was isolated from the plant more than 100 years ago. In the early 1900s, purified cocaine was the main active ingredient in many tonics and elixirs developed to treat a wide variety of illnesses and was even an ingredient in the early formulations of Coca-Cola®. Before the development of synthetic local anesthetic, surgeons used cocaine to block pain. However, research has since shown that cocaine is a powerfully addictive substance that can alter brain structure and function if used repeatedly.

Today, cocaine is a Schedule II drug, which means that it has high potential for abuse but can be administered by a doctor for legitimate medical uses, such as local anesthesia for some eye, ear, and throat surgeries. As a street drug, cocaine appears as a fine, white, crystalline powder and is also known as Coke, C, Snow, Powder, or Blow. Street dealers often dilute (or “cut”) it with non-psychoactive substances such as cornstarch, talcum powder, flour, or baking soda to increase their profits. They may also adulterate cocaine with other drugs like procaine (a chemically related local anesthetic) or amphetamine (another psychoactive stimulant). Some users combine cocaine with heroin—called a Speedball.

People abuse two chemical forms of cocaine: the water-soluble hydrochloride salt and the water-insoluble cocaine base (or freebase). Users inject or snort the hydrochloride salt, which is a powder. The base form of cocaine is created by processing the drug with ammonia or sodium bicarbonate (baking soda) and water, then heating it to remove the hydrochloride to produce a smokable substance. The term crack, which is the street name given to freebase cocaine, refers to the crackling sound heard when the mixture is smoked.

Cocaine Use Disorder

Cocaine is a stimulant drug that is frequently abused. Cocaine makes users feel euphoric, energetic, and mentally alert. Highly addictive, it can cause severe mental and physical problems. Cocaine abuse in the United States peaked in the 1970s and 1980s, but remains a significant problem today. The stimulant directly affects brain function, and long-term addiction leads to extensive physiological and psychological problems.

Pure cocaine was first extracted from the leaf of the Erythroxylon coca bush in the mid-19th century. In the early 1900s, people were lacing tonics and elixirs with the stimulant in hopes of treating a wide range of illnesses. Cocaine quickly became popular as an ingredient in patented medicines (such as throat lozenges and tonics) and other products (such as Coca-Cola, from which it was later removed).

Concern soon mounted due to increased instances of addiction, erratic behavior, convulsion, and death. The Pure Food and Drug Act, passed in 1906, required that dangerous ingredients such as cocaine be listed on product labels. The Harrison Act of 1914 outlawed the use of cocaine altogether in over-the-counter products and made it available only by prescription. Cocaine use dropped dramatically and remained at minimal levels for nearly half a century.

In the 1960s, illicit cocaine use rebounded, and by the late 1970s, the drug had become popular among middle- and upper-middle-class Americans. By the mid-1980s, researchers found widespread evidence of physiological and psychological problems among cocaine users, with increased emergency-room episodes and admissions for treatment.

Today, cocaine is regulated as a Schedule II drug—it has high potential for abuse but can be administered by a doctor for legitimate medical uses, such as a local anesthetic for certain eye, ear, and throat surgeries.

There are two basic forms of cocaine: powdered and freebase. The powdered form is a hydrochloride salt that dissolves in water; freebase is a compound that has not been neutralized by an acid to make hydrochloride salt. The freebase form of cocaine can be smoked, as in “crack” cocaine, processed from cocaine hydrochloride to a freebase for smoking.

The major routes of administration of cocaine are inhaling (or snorting), injecting, and smoking. There is great risk regardless of the method of use, and it is possible to overdose fatally. Compulsive cocaine use may develop even more rapidly if the substance is smoked rather than snorted. Smoking allows extremely high doses of cocaine to reach the brain very quickly and brings an intense and immediate high. The injecting drug user is at risk for acquiring or transmitting HIV/AIDS as well as hepatitis C if needles or other injection equipment are shared.

Cocaine is a strong central nervous system stimulant that interferes with the reabsorption of dopamine, a chemical messenger associated with pleasure and movement. This resulting buildup of dopamine contributes to the high that characterizes cocaine use.

Cocaine’s immediate euphoric effects include a state of hyperstimulation, reduced fatigue, and mental clarity. The duration of the effects depends on the route of administration. The faster the cocaine is absorbed, the more intense the high. However, the faster the absorption, the shorter the duration of action. The high from snorting cocaine may last 15 to 30 minutes, while that from smoking may last 5 to 10 minutes. Increased use can reduce the period of stimulation.

Cocaine’s effects appear almost immediately after a single dose and disappear within a few minutes or hours. Taken in small amounts (up to 100 milligrams), cocaine usually makes the user feel euphoric, energetic, talkative, and mentally alert, especially to the sensations of sight, sound, and touch. It can also temporarily decrease the need for food and sleep. Some users find that the drug helps them to perform simple physical and intellectual tasks more quickly, while others experience the opposite effect.

The short-term physiological effects of cocaine include constricted blood vessels, dilated pupils, and increased temperature, heart rate, and blood pressure. Large amounts of the stimulant (several hundred milligrams or more) intensify the user’s high, but may also lead to bizarre, erratic, or violent behavior. Those using cocaine in such amounts may experience tremors, vertigo, muscle twitches, paranoia, or, with repeated doses, a toxic reaction closely resembling amphetamine poisoning. Some users of cocaine report feelings of restlessness, irritability, and anxiety. In rare instances, sudden death can occur on the first use of cocaine or sometime thereafter. Cocaine-related deaths are often a result of cardiac arrest or seizures followed by respiratory arrest.

Long-term effects of cocaine use include addiction, irritability and mood disturbances, restlessness, paranoia, and auditory hallucinations.

Binge cocaine use, in which the drug is taken repeatedly and at increasingly higher doses, leads to a state of increasing irritability, restlessness, and paranoia. It may result in a full-blown paranoid psychosis in which the individual loses touch with reality and experiences auditory hallucinations.

Medical Complications of Cocaine Use

There can be severe medical complications associated with cocaine use. Some of the most frequent complications are cardiovascular, including disturbances in heart rhythm and frank heart attacks; respiratory effects such as chest pain and respiratory failure; neurological effects, including strokes, seizures, and headaches; and gastrointestinal complications, including abdominal pain and nausea.

Cocaine use has been linked to many types of heart disease. Cocaine has been found to trigger chaotic heart rhythms called ventricular fibrillation, accelerate heartbeat and breathing, and increase blood pressure and body temperature. Physical symptoms may include chest pain, nausea, blurred vision, fever, muscle spasms, convulsions, coma, and death.

Different routes of cocaine administration can produce different adverse effects. Regularly snorting cocaine, for example, can lead to the loss of the sense of smell, nosebleeds, problems swallowing, hoarseness, and an overall irritation of the nasal septum, which can result in a chronically inflamed, runny nose. Ingested cocaine can cause severe bowel gangrene, due to reduced blood flow. Persons who inject cocaine have puncture marks and “tracks,” most commonly in their forearms. Intravenous cocaine users may also experience allergic reactions, either to the drug or to some additive in street cocaine, which in severe cases can result in death. Because cocaine has a tendency to decrease food intake, many chronic cocaine users lose their appetite and can experience significant weight loss and malnourishment.

Research has revealed a potentially dangerous interaction between cocaine and alcohol. Taken in combination, the two drugs are converted by the body to cocaethylene, which has a prolonged duration of action in the brain and is more toxic than either drug alone. The mixture of cocaine and alcohol is the most common two-drug combination that results in drug-related death.


Cocaine use produces short-term effects and long-term effects. Short-term effects include:

  • Fast heartbeat and breathing
  • Elevation of blood pressure and body temperature
  • Erratic or violent behavior
  • Blurred vision, chest pain, nausea, fever, muscle spasms, convulsions, and death from convulsions, heart failure, or brain failure.

Long-term effects include:

  • Dependence and depression
  • Feelings of restlessness, irritability, mood swings, paranoia, sleeplessness, and weight loss
  • Emotional problems and isolation from family and friends
  • Psychosis, paranoia, depression, anxiety disorders, and delusions
  • Damage to the nose and inflamed nasal passages
  • Increased risk of hepatitis and HIV
  • Severe respiratory infections
  • Heart attacks, chest pain, respiratory failure, strokes, and abdominal pain and nausea

The National Institute of Drug Abuse identifies the warning signs of use:

  • Red, bloodshot eyes
  • A runny nose or frequent sniffing
  • A change in eating or sleeping patterns
  • A change in groups of friends
  • A change in behavior
  • Acting withdrawn, depressed, tired, or careless about personal appearance
  • Losing interest in school, family, or activities previously enjoyed
  • Frequently needing money.

Cocaine abuse falls under the umbrella of stimulant-related disorders. According to DSM-5, the diagnosis of stimulant-related disorders can be made when the pattern of cocaine, amphetamine, or other stimulant use leads to clinically significant impairment or distress, as manifested by at least two of the following during a 12-month period:

  • The stimulant is taken in larger amounts or over a longer period than intended
  • There is a persistent desire or unsuccessful efforts to cut down or control stimulant use
  • A great deal of time is devoted to obtaining the stimulant, using it, or recovering from its effects
  • Craving, or a strong desire to use the stimulant
  • Recurrent stimulant use that interferes with other responsibilities
  • Continued use of the stimulant despite problems caused by or exacerbated by its effects
  • Reduced or discontinued participation in important social, occupational, or recreational activities as a result of stimulant use
  • Recurrent use of stimulant despite physical dangers
  • Continued use despite awareness of physical or psychological problems caused by the stimulant
  • Tolerance, defined by a need for markedly increased amounts of the stimulant to achieve the desired effect or by markedly diminished effect with continued use of the same amount of the stimulant
  • Withdrawal, manifested by either the presence of withdrawal symptoms associated with the stimulant or use of the stimulant or a substitute to relieve or avoid withdrawal symptoms

For more information on symptoms, causes, and treatment of stimulant-related disorders, see our Diagnosis Dictionary.


Cocaine is an “upper” (stimulant) that gives its user a false sense of power and energy. When users come down from the high, they are usually depressed, edgy, and craving more drug. No one can predict whether they will become dependent and addicted, or whether the next dose will be deadly.


Cocaine and other substance abuse disorders are complex, involving biological systems as well as myriad social, familial, and environmental factors. Therefore, treatment of cocaine and stimulant abuse can be complex. As with any disorder, treatment strategies need to assess the psychobiological, social, and pharmacological aspects of the individual’s drug abuse.

Behavioral Interventions

Many behavioral treatments have been found effective for stimulant abuse, including in both residential and outpatient situations. Behavioral therapies are often the only available effective treatment for many drug use problems, including cocaine use,

Cognitive-behavioral treatment is a focused approach to helping cocaine abusers cut d own or abstain— and remain abstinent—from abusing cocaine and other substances. The underlying assumption is that learning processes play an important role in the development and continuation of substance abuse. The same learning processes can be employed to help individuals reduce drug use and successfully cope with relapse. Cognitive-behavioral therapy aims to help patients recognize the situations in which they are most likely to use cocaine, avoid the situations when appropriate, and cope more effectively with a range of problems associated with drug abuse. CBT is also compatible with a range of other treatments, including pharmacotherapy.

Another approach to treatment is harm reduction, whereby psychotherapeutic strategies are aimed at reducing the negative consequences associated with substance abuse without requiring the individual to commit to abstinence. Such an approach may eventually lead users to abstinence, and data shows that it often does, but its primary goal is to improve users’ quality of life whether or not they are immediately willing to aim for abstinence.

A behavioral therapy component that may be particularly useful for helping patients achieve initial abstinence from cocaine is contingency management. Some contingency management programs use a voucher-based system to give positive rewards for staying in treatment and remaining cocaine-free.

Pharmacological Approaches

There are no medications currently available to treat cocaine abuse specifically. Consequently, the National Institute on Drug Abuse (NIDA) is aggressively pursuing the identification and testing of new cocaine treatment medications. Several emerging compounds are being investigated to assess their safety and efficacy. Two medicines currently marketed for other conditions, topiramate and modafanil, have shown promise. Additionally, baclofen, a GABA-B agonist, has shown promise in a subgroup of cocaine addicts with heavy use patterns. Antidepressant drugs are of some benefit with regard to mood changes experienced during the early stages of cocaine abuse. Medical treatments are also being developed to deal with acute emergencies resulting from excessive cocaine abuse.

Medications are sometimes used in combination with behavioral therapy. Disulfiram (a medication that has been used to treat alcohol abuse), in combination with behavioral treatment, has been successful in reducing cocaine abuse.

It is important that patients undergoing treatment for substance use receive services that match all of their treatment needs. For example, if a patient is unemployed, it may be helpful to provide vocational rehabilitation or career counseling. Similarly, if a patient has marital problems, it may be important to offer couples counseling.

Therapeutic communities (TCs) or residential programs with stays of several months are also on offer for treatment for those who abuse cocaine. TCs focus on resocialization of the individual and can include on-site vocational rehabilitation and an array of other supportive services.

How is cocaine addiction treated?

In 2013, cocaine accounted for almost 6 percent of all admissions to drug abuse treatment programs. The majority of individuals (68 percent in 2013) who seek treatment for cocaine use smoke crack and are likely to be polydrug users, meaning they use more than one substance. Those who provide treatment for cocaine use should recognize that drug addiction is a complex disease involving changes in the brain as well as a wide range of social, familial, and other environmental factors; therefore, treatment of cocaine addiction must address this broad context as well as any other co-occurring mental disorders that require additional behavioral or pharmacological interventions.

Pharmacological Approaches

Presently, there are no medications approved by the U.S. Food and Drug Administration to treat cocaine addiction, though researchers are exploring a variety of neurobiological targets. Past research has primarily focused on dopamine, but scientists have also found that cocaine use induces changes in the brain related to other neurotransmitters—including serotonin, gamma-aminobutyric acid (GABA), norepinephrine, and glutamate. Researchers are currently testing medications that act at the dopamine D3 receptor, a subtype of dopamine receptor that is abundant in the emotion and reward centers of the brain. Other research is testing compounds (e.g., N-acetylcysteine) that restore the balance between excitatory (glutamate) and inhibitory (GABA) neurotransmission, which is disrupted by long-term cocaine use. Research in animals is also looking at medications (e.g., lorcaserin) that act at serotonin receptors.

Several medications marketed for other diseases show promise in reducing cocaine use within controlled clinical trials. Among these, disulfiram, which is used to treat alcoholism, has shown the most promise. Scientists do not yet know exactly how disulfiram reduces cocaine use, though its effects may be related to its ability to inhibit an enzyme that converts dopamine to norepinephrine. However, disulfiram does not work for everyone. Pharmacogenetic studies are revealing variants in the gene that encodes the DBH enzyme and seems to influence disulfiram effectiveness in reducing cocaine use. Knowing a patient’s DBH genotype could help predict whether disulfiram would be an effective pharmacotherapy for cocaine dependence in that person.

Finally, researchers have developed and conducted early tests on a cocaine vaccine that could help reduce the risk of relapse. The vaccine stimulates the immune system to create cocaine-specific antibodies that bind to cocaine, preventing it from getting into the brain. In addition to showing the vaccine’s safety, a clinical trial found that patients who attained high antibody levels significantly reduced cocaine use. However, only 38 percent of the vaccinated subjects attained sufficient antibody levels and for only 2 months.

Researchers are working to improve the cocaine vaccine by enhancing the strength of binding to cocaine and its ability to elicit antibodies. New vaccine technologies, including gene transfer to boost the specificity and level of antibodies produced or enhance the metabolism of cocaine, may also improve the effectiveness of this treatment. A pharmacogenetics study with a small number of patients suggests that individuals with a particular genotype respond well to the cocaine vaccine—an intriguing finding that requires more research.

In addition to treatments for addiction, researchers are developing medical interventions to address the acute emergencies that result from cocaine overdose. One approach being explored is the use of genetically engineered human enzymes involved in the breakdown of cocaine, which would counter the behavioral and toxic effects of a cocaine overdose. Currently, researchers are testing and refining these enzymes in animal research, with the ultimate goal of moving to clinical trials.

Behavioral Interventions

Many behavioral treatments for cocaine addiction have proven to be effective in both residential and outpatient settings. Indeed, behavioral therapies are often the only available and effective treatments for many drug problems, including stimulant addictions. However, the integration of behavioral and pharmacological treatments may ultimately prove to be the most effective approach.

One form of behavioral therapy that is showing positive results in people with cocaine use disorders is contingency management (CM), also called motivational incentives. Programs use a voucher or prize-based system that rewards patients who abstain from cocaine and other drugs. On the basis of drug-free urine tests, the patients earn points, or chips, which can be exchanged for items that encourage healthy living, such as a gym membership, movie tickets, or dinner at a local restaurant. CM may be particularly useful for helping patients achieve initial abstinence from cocaine and stay in treatment. This approach has recently been shown to be practical and effective in community treatment programs.

Research indicates that CM benefits diverse populations of cocaine users. For example, studies show that cocaine-dependent pregnant women and women with young children who participated in a CM program as an adjunct to other substance use disorder treatment were able to stay abstinent longer than those who received an equivalent amount of vouchers with no behavioral requirements. Patients participating in CM treatment for cocaine use who also experienced psychiatric symptoms—such as depression, emotional distress, and hostility—showed a significant reduction in these problems, probably related to reductions in cocaine use.

Cognitive-behavioral therapy (CBT) is an effective approach for preventing relapse. This approach helps patients develop critical skills that support long-term abstinence—including the ability to recognize the situations in which they are most likely to use cocaine, avoid these situations, and cope more effectively with a range of problems associated with drug use. This therapy can also be used in conjunction with other treatments, thereby maximizing the benefits of both.

Recently, researchers developed a computerized form of CBT (CBT4CBT) that patients use in a private room of a clinic. This interactive multimedia program closely follows the key lessons and skill-development activities of in-person CBT in a series of modules. Movies present examples and information that support the development of coping skills; quizzes, games, and homework assignments reinforce the lessons and provide opportunities to practice skills. Studies have shown that adding CBT4CBT to weekly counseling boosted abstinence and increased treatment success rates up to 6 months after treatment.

Therapeutic communities (TCs)—drug-free residences in which people in recovery from substance use disorders help each other to understand and change their behaviors—can be an effective treatment for people who use drugs, including cocaine. TCs may require a 6- to 12-month stay and can include onsite vocational rehabilitation and other supportive services that focus on successful reintegration of the individual into society. TCs can also provide support in other important areas—improving legal, employment, and mental health outcomes.

Regardless of the specific type of substance use disorder treatment, it is important that patients receive services that match all of their treatment needs. For example, an unemployed patient would benefit from vocational rehabilitation or career counseling along with addiction treatment. Patients with marital problems may need couples counseling. Once inpatient treatment ends, ongoing support—also called aftercare—can help people avoid relapse. Research indicates that people who are committed to abstinence, engage in self-help behaviors, and believe that they have the ability to refrain from using cocaine (self-efficacy) are more likely to abstain. Aftercare serves to reinforce these traits and address problems that may increase vulnerability to relapse, including depression and declining self-efficacy.

Scientists have found promising results from telephone-based counseling as a low-cost method to deliver aftercare. For example, people who misused stimulants who participated in seven sessions of telephone counseling showed decreasing drug use during the first 3 months, whereas those who did not receive calls increased their use. Voucher incentives can boost patients’ willingness to participate in telephone aftercare, doubling the number of sessions received according to one study.

Community-based recovery groups—such as Cocaine Anonymous—that use a 12-step program can also be helpful in maintaining abstinence. Participants may benefit from the supportive fellowship and from sharing with those experiencing common problems and issues.

Cocaine Effects and Abuse

Any use of cocaine is considered abuse because it is an illegal substance. Cocaine is a central nervous system stimulant that affects the brain by stimulating high levels of dopamine, a brain chemical associated with pleasure and reward. Over time, Cocaine negatively effects every part of the body with potential for severe long-term effects. It can cause changes to genetics in brain cells, nerve cells and proteins, among other permanent effects.

Other effects of using cocaine include:

  • Talkativeness
  • Excitement
  • Alertness
  • Anxiety
  • Overconfidence

How people use cocaine also alters the potency and duration of the effects. The effects of snorting it are short-lived, lasting approximately 15-30 minutes. Smoking or injecting cocaine is more intense but lasts for an even shorter period, about 5 to 10 minutes. Most cocaine users will dose frequently in order to maintain the desired effects. Injecting the drug poses a higher risk of overdose than snorting.

Cocaine abuse is particularly dangerous because continued use can cause strain on the heart. The most common cause of death in frequent cocaine users is stroke or cardiac arrest. If you or someone you know is abusing cocaine, get help now.

Addiction to Cocaine

Cocaine is a highly addictive drug, but it may be hard to recognize an addiction to it. Craving cocaine and ignoring the consequences that come with it are signs of an addiction.

The psychological addiction is often the hardest part to overcome, although there are undeniable physical symptoms of addiction as well. Someone who uses cocaine frequently will develop a dependence on it, meaning they need to have it in order to feel normal. Once a dependence has developed, a tolerance will develop and withdrawal symptoms will occur when stopping use.

Once someone becomes addicted to cocaine, it can be very hard to stop. This is because cocaine abnormally increases the level of dopamine in the brain, eventually reprogramming the brain reward system.

Although some people are able to quit on their own, many require therapy or rehab.

Cocaine and Other Drugs

Many people who experiment with cocaine usually do so in environments where other substances are being used. For this reason, many people with a cocaine addiction may also have a dependence on other substances, such as alcohol or marijuana. This is known as poly-drug use and is especially dangerous, as it increases the risk of fatal overdose.

Cocaine and alcohol are frequently used together, to the point where alcohol can be a trigger for recovering cocaine users. For this reason, it is important to abstain from all drugs during recovery. Using heroin and cocaine together (known as a “speedball”) is arguably the most dangerous of all drug combinations that include cocaine.

50 Interesting Cocaine Facts


  • Scotland has the highest cocaine use of any other country in the world. One in 40 Scots use the drug, or about 2.4% of the population.
  • Being in love and being high on cocaine activates the same portions of the brain.
  • Karl Koller (1857-1944), an Austrian ophthalmologist, experimented with the anesthetic qualities of cocaine by infamously applying the drug to his own eye and then pricking it with needles.
  • Some users mix cocaine and heroine, which is known as a speedball.
  • Cocaine is the most powerful central nervous stimulant found in nature. Cocaine creates feelings of alertness, energy, self-confidence, and even power.
  • The name “crack” cocaine comes from the “crackling” sound that is created when impure cocaine is heated.
  • In 1885, a U.S. manufacturer sold cocaine with the promise that cocaine would “make the coward brave, the silent eloquent, and render the sufferer insensitive to pain.” They even include a syringe in the packaging.
  • Inca civilization in the Andes Mountains believed the cocaine was a gift from the gods.
  • In the early 1900s, white business owners would encourage their African-American employees to cocaine to boost their performance.
  • Pure cocaine was first extracted from the leaves of the coca plant in 1859 and was marketed in a fortified wine (known as coca wine) in France as early as 1863.
  • Cocaine was first used in the U.S. in the 1880s, where it was applied as an anesthetic in eye, nose, and throat operations.
  • In the United States, cocaine is about $150 per pure gram.
  • Both Ernest Shackleton and Captain Scott took cocaine tablets on their South Pole expeditions.
  • Cocaine hydrochloride, the purified chemical from the leaves of the coca plant, was the main active ingredient in several tonics and elixirs produced for a variety of illnesses in the early 1900s. One product, Tucker’s Asthma Specific, contained 420 milligrams of cocaine per ounce.
  • Chronic cocaine use can cause a condition called “bruxism,” which is involuntary teeth grinding.
  • Coca-Cola originally contained an estimated nine milligrams of cocaine per serving. While cocaine was officially removed from the drink’s ingredients in 1903, a cocaine-free version of the coca leaf is still used as a flavor additive in the soda.
  • Chronic cocaine use can destroy the cartilage separating a person’s nostrils.
  • Because cocaine can cause dehydration and a dry mouth, users may have less saliva in their mouth, which can lead to tooth decay.
  • Psychoanalyst Sigmund Freud famously advocated cocaine for treating depression, alcoholism, and morphine addiction.
  • The famous nineteenth-century literary character Sherlock Holmes frequently used cocaine, especially when he didn’t have any stimulating cases to excite his mind.
  • Common street names for cocaine include coke, blow, C, marching powder, and nose candy, among dozens of others that signify cocaine and cocaine mixtures with other recreational drugs.
  • More than 400,000 babies are born addicted to cocaine each year in the U.S.
  • Men are more likely to use cocaine than women because the drug is associated with living dangerously and wildly, but the gender gap is beginning to decrease.
  • The direct pharmacological effects of the drug itself causes only one third of the deaths associated with cocaine use. The vast majority of deaths related to cocaine are caused by homicide, suicide, and motor vehicle collisions as a result of the drug’s mind-altering properties.
  • Because cocaine is popular among middle to upper-class communities, it is known as the “rich man’s drug.”
  • Men tend to feel the effects of cocaine faster than women and report more episodes of euphoria and dysphoria (intense bad feelings) related to the drug than women do.
  • Ingesting both cocaine and alcohol causes more deaths than any other drug combination.
  • Cocaine overdose is the most common reason for drug-related visits to the emergency department in the U.S., causing 31% of such visits. In 1978, cocaine accounted for only 1% of drug-related emergency room visits.
  • Approximately 10% of people who begin using cocaine will immediately progress to serious, heavy use of the drug.
  • After marijuana, cocaine is the second most commonly used illicit drug in the United States.
  • According to one study, trace amounts of cocaine can be found on four out of every five dollar bills in circulation. However, because cocaine is a fine powder and is easily spread around, presence of the drug does not necessarily mean the bill was used as a snorting straw.
  • Cocaine users tend to have higher rates of antisocial personality disorder, depression, anxiety, and multi-substance abuse than the general population. These traits are also more common among their immediate-family relatives.
  • Every day, 2,500 Americans try cocaine for the first time.
  • Globally, over 200 million people use illegal drugs, of which 21 million use cocaine.
  • High-sugar and processed foods are just as addictive or more so than cocaine.
  • Cocaine has been described as the “perfect heart attack drug” because it increases blood pressure, stiffens arteries, and thickens heart muscle walls. These abnormalities persist long after the effects of cocaine have worn off, even in recreational users.
  • The most addictive form of cocaine is crack cocaine.
  • Cocaine is derived from the leaves of the coca plant. Three countries, Colombia, Peru, and Bolivia account for all the coca harvested in the world.
  • The United States consumes approximately 37% of the world’s cocaine, although they only make up less than 5% of the world’s population. Europe and South America round out the top three cocaine consumers.
  • Aerosmith frontman, Steven Tyler admitted that he spent over $5 million on cocaine in the 1970s and 1980s.
  • Cocaine that is sold on the streets is often mixed with sugar, quinine, cornstarch, or local anesthetics.
  • Some people will use tampon applicators to insufflate or “snort” cocaine. Such devices are often called “tooters.
  • Sharing straws to snort cocaine can spread several blood diseases, including hepatitis C.
  • Injecting cocaine (also known as mainlining) is the quickest way to get high. Some users ears’ ring after an injection, a condition which is known as a “bell ringer.”
  • In 1884, William Stewart Halsted, a famous American physician, performed the first surgery using cocaine as an anesthetic. Halsted would later become the first cocaine-addicted physician on record.
  • The illegal market for cocaine is between $100 and $500 billion each year globally.
  • Hitler was addicted to cocaine, among many other drugs, which helped fuel his ranting paranoia.
  • The most common way of consuming cocaine is sniffing or snorting it.
  • A British father accidentally sent a Tupperware full of cocaine with his son to preschool. He was in a hurry to get his son to Smarty Pants Preschool and thought the Tupperware was the boy’s lunch.
  • One woman tried to smuggle cocaine in her breast implants. Airport officials grew suspicious when they noticed bandages and gauze under one of her breasts.


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