Cocaine Addiction Symptoms: Signs to Watch For

Cocaine addiction symptoms include using more than you meant to, failing to cut back, craving it between uses, spending money you don’t have on it and keeping on even as it damages your health, work or relationships. Physical signs of use, like dilated pupils, a runny nose, nosebleeds, fast talking and little sleep, often show up first. When the drug wears off, a crash of exhaustion and low mood follows. Cocaine has a reputation as a party drug that people can take or leave. Plenty of people find out they can’t.

Is Cocaine Addictive?

Yes. The National Institute on Drug Abuse (NIDA) calls cocaine an addictive stimulant. It sends dopamine surging through the brain’s reward circuits, and the brain wants to repeat whatever caused that. With repeated use, NIDA explains, the reward system becomes less sensitive to natural pleasures, while stress circuits become more sensitive. Life without cocaine starts to feel gray and irritable, and the drug becomes the fix for a problem it created. In the U.S., cocaine is a Schedule II drug: it has a limited medical use as a local anesthetic and a high potential for misuse.

Physical Signs of Cocaine Use

Someone who is high on cocaine may show:

• Dilated pupils
• A runny nose, frequent sniffing or nosebleeds
• Fast speech and jumping between topics
• Unusual energy, confidence or excitability
• Restlessness, jaw clenching or fidgeting
• Little interest in food, and staying up all night
• Sweating or seeming overheated

Over time, you may notice weight loss, a constantly irritated nose, a loss of sense of smell, burn marks on fingers or lips from smoking crack, or track marks from injecting. For the full picture of the damage, see the effects of cocaine on the body.

Behavioral and Emotional Signs

The changes in behavior often say more than the physical ones. Watch for:

• Mood swings, from euphoric and chatty to irritable, anxious or paranoid
• Unexplained money problems, borrowing or missing valuables
• Frequent trips to the bathroom at gatherings
• Disappearing for nights or weekends
• New friends, or old friends who’ve quietly dropped away
• Secretiveness, defensiveness or lying about where they’ve been
• Sleeping for long stretches after a binge

NIDA notes that large amounts can lead to erratic or violent behavior. Paranoia during or after a binge is common too.

Signs of Cocaine Use Disorder

Clinicians use a set of criteria to diagnose cocaine use disorder. You don’t need to be a doctor to recognize them in yourself or someone else:

• Using more cocaine, or for longer, than intended
• Wanting to cut down and not being able to
• Spending a lot of time getting, using or recovering from cocaine
• Strong cravings
• Falling behind at work, school or home
• Continuing even as it causes fights or damages relationships
• Giving up activities you used to care about
• Using in risky situations, like before driving
• Continuing despite physical or mental health problems
• Needing more to get the same effect (tolerance)
• Feeling withdrawal when you stop

Two or three of these point to a mild problem. Six or more suggests a severe one. Even a mild problem tends to grow.

Cocaine Withdrawal Symptoms

Cocaine withdrawal doesn’t usually look as dramatic as alcohol or heroin withdrawal, and MedlinePlus notes there are often no visible physical signs. It’s still hard. The crash starts almost right away after a binge. MedlinePlus lists these symptoms:

• Agitation and restlessness
• Depressed mood
• Fatigue
• A general feeling of discomfort
• Increased appetite
• Vivid, unpleasant dreams
• Slowed movement and thinking

Cravings and depression can last for months after long-term heavy use stops. Some people have suicidal thoughts during withdrawal. If that happens, call or text 988, or call 911, and don’t leave someone alone who is at risk.

Who Is at Higher Risk?

Anyone can become addicted to cocaine, and some people develop a problem after only a handful of uses. Risk runs higher for people with depression, anxiety or another mental health condition, people with another addiction (especially alcohol, which often goes hand in hand with cocaine; see cocaine vs. alcohol), and people with a family history of addiction.

If Someone You Love Is Showing These Signs

Pick a calm, sober moment. Name specific things you’ve seen (“you’ve been gone three weekends in a row, and money is missing from the account”) instead of labels. Expect denial. Let them know you’ll help them find treatment when they’re ready, and mean it. If you’re finding that their use is running your life too, support groups for families can help you hold steady. Be aware that much of the cocaine supply is now contaminated with fentanyl, according to NIDA. If someone using cocaine becomes hard to wake or is breathing slowly, call 911 and give naloxone if you have it.

How Cocaine Addiction Is Treated

NIDA says there are currently no FDA-approved medications for cocaine use disorder. Behavioral therapies are the core of treatment, and they work: cognitive behavioral therapy, contingency management (rewards for staying drug-free) and therapeutic communities among them. The right setting depends on the person. MedlinePlus notes that outpatient care works about as well as inpatient care for many people, while severe cases may need a live-in program. Our levels of care range from residential treatment to intensive outpatient, and an assessment helps match the setting to the need.

Cocaine Addiction Treatment at Covenant Hills

Covenant Hills is a Christian-based treatment center in Orange County, California. Our cocaine addiction program uses individual and group therapy to get at the roots of the addiction, not just the habit, and clients can choose a faith-based or traditional track. If you recognize these cocaine addiction symptoms in yourself or someone you love, call 800-662-2873 for a free, confidential assessment.

Frequently Asked Questions

What are the first signs of cocaine addiction?

Using more often or in larger amounts than planned, craving it between uses, spending more money on it and feeling low or irritable when it wears off.

How can you tell if someone is on cocaine?

Look for dilated pupils, sniffing or nosebleeds, rapid speech, unusual energy, restlessness and little appetite or sleep, followed by a crash.

What are cocaine withdrawal symptoms?

Depression, fatigue, agitation, increased appetite, vivid unpleasant dreams and slowed thinking and movement. Cravings and low mood can last months.

Is there medication for cocaine addiction?

Not yet. NIDA says no medications are FDA-approved for cocaine use disorder, but behavioral therapies like CBT and contingency management are effective.