Barbara E. Kaplan, MHDL

Counseling for Individuals, Couples, Partners, Marriages, Families


For additional information about counseling regarding cocaine issues or counseling in general, please call 704 333-1510.



This article is solely for information purposes.   It is not advice.   It is not intended for minors, and minors are instructed to leave the site.   It is not intended and it does not constitute professional or clinical advice.  The user of this page should not take any steps, or refrain from taking any steps, based on the information in this page, but should instead consult a qualified mental health professional.


For more information on the 2014 SAMHSA survey, please see http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf


According to a Substance Abuse and Mental Health Services Administration (SAMHSA) 2014 National Survey on Drug Use and Health of people 12 years and older, in the United States civilian population (excluding those people institutionalized) in 2014, there were:

  • 1 in 10 people who used an illicit drug in past 30 days of which 7.1 million people had illicit drug use disorder.
  • an estimated 1.5 million people in the  past month were current users of cocaine, and in the past year, about 913,000 people had a cocaine use disorder.  Of people 26 years of age or older, there were about 1 million adults in past month who currently used cocaine, and approximately 702,000 who had a cocaine use disorder in the past year.
  • of the 1.5 million people in the past month who were current users of cocaine, 354,000  were current users of crack.
  • more men using cocaine than women; men were twice as likely to use it than women.

According to SAMSHA, chronic cocaine use can “lead to hospital emergency room visits, prompted by chest pain or palpitations, psychiatric complaints ranging from altered mental states to suicide ideation, and neurological problems including seizures and delirium.” According to the 2011 Drug Abuse Warning Network (DAWN) report, there were 1,252,500 emergency department visits due to illicit drug misuse or abuse.    Of these visits, 505,224 involved cocaine use.  According to the National Center for Health Statistics, CDC Wonder, in the United States, in 2014, there were between 5,000 - 6,000 overdose deaths that involve cocaine use with more male deaths than female.

About Cocaine

Cocaine is a powerful stimulant made from the leaves of the coca plant.  According to the Drug Enforcement Administration, it has a “strong addictive potential.”  It is used for medicinal purposes (e.g., local anesthesia) and as an illegal recreational drug.  As a street substance, cocaine has an appearance of a fine white crystal powder.  To increase profits, this street drug, before sold, is often mixed with other substance(s) such as cornstarch, lactose, glucose, baking soda, amphetamines and other drugs, talcum powder and flour.   However, it may also be mixed with poisonous substances.  Being unaware of what cocaine is mixed with can put the cocaine user at great risk.  For instance, cocaine sold mixed with another drug may increase the effects, resulting in overdose.

Some ways cocaine is administered is by snorting, rubbing on gums, or injection (once dissolved in water).  According to National Institute on Drug Abuse (NIDA), another “popular method of use is to smoke cocaine that has been processed to make rock crystal (also called “freebase cocaine”).  The crystal is heated to produce vapors that are inhaled into the lungs.  This form of cocaine use is called Crack, which refers to the crackling sound of the rock as it’s being heated.   According to the National Institute of Health (NIH):  “Any route of administration can potentially lead to absorption of toxic amounts of cocaine, causing heart attacks, strokes, or seizures – all of which can result in sudden death.”  It is possible that sudden death occurs with initial use!  Cocaine may also be absorbed through the vagina, rectum and penis.

A cocaine user may combine cocaine with other substances in an effort to increase the high and decrease the negative effects (e.g., nervousness).  However, combining cocaine with other substance may result in a serious medical condition(s).  For instance, using cocaine that has been combined with prescription opioids may result in a coma.  Death may even occur when using cocaine that has been mixed with any of the following: heroin, alcohol, prescription opioids, amphetamines.

Some common names for cocaine are: coke, flake, C, pearl, blow, snow, white dust, white lady, candy, nose candy, Charlie, toot. 

Brain Chemistry

The brain consists of trillions of cells and about billions of nerve cells called neurons.  It is these neurons that send and receive messages from other nerve cells via chemical and electrical signals and these nerve cells also process this transmitted information. Dopamine is a natural chemical released by a nerve cell to send signals to other nerve cells.  According to NIH, cocaine increases the level of this chemical messenger “in brain circuits controlling pleasure and movement.  Normally, the brain releases dopamine in these circuits in response to potential rewards, like the smell of good food.  It then recycles back into the cell that released it, shutting off the signal between nerve cells.  Cocaine prevents dopamine from recycling, causing excessive amounts to build up between nerve cells. This flood of dopamine ultimately disrupts normal brain communication and causes cocaine’s high.”  And “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 excess dopamine brought on by the drug.  As a result, people take stronger and more frequent doses to achieve the same high and feel relief from initial withdrawal.”   With this greater use, the negative effects from cocaine use intensify.

Administration and Effects of Cocaine Use

The euphoria from cocaine use is short-lived, the duration being contingent on the route of administration of the drug.  For instance, smoking it results in a quicker high but shorter lasting (5-10 minutes) in contrast to snorting it, which is slow to result in the euphoria but may last 15-30 minutes.   Because the high is short-lived, users often binge (repeatedly using cocaine with increasingly higher dosages in a short period of time) on cocaine.  Once the euphoria dissipates, the user may “crash,” meaning essentially that the euphoria is ultimately replaced by feelings of dysphoria (generalized unhappiness,/dissatisfaction, unease or restlessness) and this state of being may motivate additional cocaine use to replace the misery.  If the cocaine supply is completely depleted, the user may use alcohol or other drugs (e.g., heroin, tranquilizers) in an attempt to obtain relief from the dysphoria.

Although the person using cocaine may experience euphoria, increased energy and alertness, the use of cocaine may also include the following possible harmful effects aside from those specified above:

  • increased heart rate, blood pressure and body temperature
  • narrowed blood vessels
  • heart rhythm problems
  • inflammation to the heart muscle
  • deterioration of the ability of the heart to contract
  • aortic ruptures
  • worsen Asthma
  • abdominal pain
  • tears and ulcerations of the intestinal tract
  • bleeding within the brain
  • tremors
  • muscle twitches
  • headaches
  • hypersensitivity to sight, sound and touch
  • nosebleeds
  • nasal damage
  • loss of sense of smell
  • nausea
  • lung damage
  • impairs sexual functioning (e.g., erection, orgasm, sex desire)
  • convulsions
  • kidney failure
  • malnourished
  • panic attacks
  • vertigo
  • impaired cognitive functions such as in memory, decision-making, attention, performing motor tasks
  • insomnia
  • restlessness
  • paranoia
  • auditory hallucinations
  • Parkinson's disease
  • speeds up HIV infection
  • psychosis
  • bazaar, erratic, and violent behavior
  • coma
  • infection and death of the bowel tissue from decreased blood flow
  • difficulty swallowing.
  • death

Different routes of administration of the cocaine can result in different adverse effects.  For instance, when snorted, there may be a loss of smell and irritation to the nasal septum resulting in a chronic running nose, problems swallowing.   Asthma may worsen from smoking it and there may be damage to the lungs.

Some Signs and Symptoms of Recent Cocaine Use

  • extremely happy
  • excessive self-confidence
  • feelings of superiority
  • dilated pupils
  • very talkative
  • speaking fast
  • paranoia
  • depression
  • irritability
  • restlessness
  • nosebleeds
  • runny nose all the time like person has a cold
  • shaking or twitches
  • marks on body if injecting cocaine
  • increase in energy
  • repeated requests for money or stealing money
  • not sleeping
  • loss of interest in eating
  • mood swings
  • shaking or twitches


The good news is that Cocaine Use Disorder is a treatable disorder.   There are a number of therapies available for use in the treatment of Cocaine Use Disorder.  One treatment approach is Contingency Management, also referred to as Motivational Incentive, which is utilized in community treatment programs and shown to be effective when used in them.   It uses rewards for patients who abstain from cocaine and other drugs.   Another approach is Cognitive Behavioral Therapy that may be utilized in inpatient and outpatient treatment with individuals and groups.   It assists clients in acquiring skills in an effort to achieve long-term abstinence.   Cognitive Behavioral Therapy (CBT) recognizes that one’s feelings and behavior are largely influenced by one’s thought(s).  It consists of identifying, testing and correcting unhealthy thinking to change the view of self and the world in an effort to decrease psychological disturbance, unwanted, problematic and self-destructive behaviors and improve functioning.  There is a focus on acquiring skills.  These learned skills may be applied during and following counseling to aid in obtaining and maintaining abstinence from cocaine use and throughout life to apply to other issues or problems such as relationship difficulties, stress, anxiety, depression, anger.  According to NIDA, a "central element of CBT is anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies. ...  Research indicates that the skills individuals learn through cognitive-behavioral approaches remain after the completion of treatment."   Also according to the NIDA, former "cocaine users are at high risk for relapse, even following long periods of abstinence. ... Research indicates that during periods of abstinence, the memory of the cocaine experience or exposure to cues associated with drug use can trigger strong cravings, which can lead to relapse."  Cognitive Behavioral Therapy "is an effective approach for relapse prevention.  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 wide range of problems associated with drug use.  This therapy can also be used in conjuntion with other treatments, thereby maximizing the benefits of both."  Currently, there are no medications that are approved by the Food and Drug Administration for the specific treatment of Cocaine Use Disorder.  There is research being conducted on this, and to improve a vaccine to aid in reducing the risk of relapse.

Because cocaine users may also use other drugs, it is important that treatment include any other substance use disorders.  It is also not unusual for people with cocaine use disorders to have other psychiatric disorders such as anxiety or mood disorders.  It is of importance for treatment to focus on these disorders as well.

For more information about Cognitive Behavioral Therapy, please click on the following link:

In addition, treatment may be supplemented by participation in support groups.  However, the effectiveness of Cocaine Anonymous is difficult for researchers to determine due to the anonymity of its participants.  Please be aware that this 12-step group is not confidential!


Something to Consider in Making a Decision to Seek Professional Assistance

People may wonder when to seek help for cocaine use.  Although not an exhaustive list, the following may be considered in making a decision to seek professional assistance:

  • cocaine use as a way to cope with stress
  • repeatedly unable to stop cocaine use when desired
  • driving a vehicle while impaired from cocaine
  • giving up or reducing participation in pursuits that were enjoyable because there is a preference to use cocaine instead or due to recovering from the negative effects of its use
  • cocaine use is repeatedly causing arguments with others or making the arguments or relationship worse
  • receiving complaints or concerns from others about one's cocaine use
  • repeated cravings for cocaine
  • repeatedly can't wait to get off from work to use cocaine
  • cocaine use interferes in caring for family, meeting household or school obligations
  • absences from work or repeatedly going into work late due to cocaine use
  • repeatedly spending a lot of time in cocaine use or recovering from the negative effects of its use
  • stealing or prostituting self to obtain money for cocaine use
  • the same amount/quality of cocaine consumed for some time has less of an effect than it use to have
  • withdrawal symptoms are causing impairment in functioning or are very bothersome
  • morning cocaine use
  • if you think you have a problem with cocaine use
  • repeatedly using more cocaine than on one's mind to use

This article was written some time between January 1, 2016 and January 22, 2019.