Rehab 4 Addiction

How cocaine use negatively affects mental health

In this article we will look at how cocaine can impact mental health both from a short term and longer-term use perspective.

Cocaine is a concentrate of the drug found in the South American coca bush, whose leaves are chewed by people in the Andes to help with altitude sickness and to give a gentle lift like coffee.

Cocaine hydrochloride powder has far more powerful effects than chewing coca leaves and can lead to enduring psychiatric and physical problems that can in both cases kill the user.

Cocaine can also cause lasting social problems for the user that affects their mental health independently from the chemical’s effect on the nervous system.

How Cocaine Is Taken

Until the drug was banned in countries around the world, cocaine was most commonly consumed in Coca Cola’s soft drink! Now it is consumed illegally in four different ways:

  • It can be eaten
  • Cocaine can be snorted as one of the quickest ways of getting a hit
  • It can be injected after being treated with vinegar or lemon juice to make it soluble
  • Crack cocaine can be smoked

Where eaten, cocaine can take up to half an hour to take effect and then the sensations will last anything up to a couple of hours.

If snorted, the effects can take around 10 minutes to hit, and the effects last anything from half an hour to a few hours depending on the quality of the cocaine being used.

If injected or smoked, the effects can be felt in a few minutes or less but these wear off very quickly too.

PRO TIP: Learn how long cocaine stays in your system.

Physical Effects While High and the Comedown

After it is consumed, there is a period where the user awaits the high.

The cocaine then hits the system, giving a feeling of extreme euphoria, pleasure and ecstasy (1).

The user feels more socially confident and may well be a lot more chatty with those they are dealing with.

This is one of the reasons cocaine is so widely used in nightclubs and parties as people feel more able to mingle as their social insecurities evaporate.

As the drug wears off, so users report restlessness and arousal without the high, and then start to feel irritable and uncomfortable as the substance leaves their system.

It isn’t all pleasurable. Other effects that people have include:

  • Feelings of persecution and paranoia
  • Anxiety
  • Risk taking, including risky sexual behaviour (2)
  • Aggression and violence
  • Not responding to pain
  • Unpredictable behaviour

Together these can make the experience of taking cocaine less than pleasurable when all the positives and negatives mount up.

Neurophysiological processes associated with cocaine use

When cocaine hits the central nervous system, a flood of neurotransmitters cascade across nerve synapses.

Two of these, dopamine and glutamate, are associated with energy and happiness.

The body takes time to rebuild its levels of these neurotransmitters and consequently when the cocaine leaves the system, there are feelings of deep depression, tiredness and discomfort.

With persistent or prolonged use, the nervous system releases less and less of these neurotransmitters and consequently the user feels the need to use more and more to achieve the same effect.

This is part of the presentation of cocaine dependence and addiction.

Mental Health Experiences While Intoxicated on Cocaine

There are a number of mental health effects that can present while intoxicated on cocaine.

As well as the initial feelings of social confidence, people can experience:

  • Anxiety
  • Paranoia
  • Hearing, feeling or seeing hallucinations
  • Mood swings
  • Aggression
  • Have blunted emotions
  • And have issues around lacking self-awareness of how their behaviour affects others

It is worth noting that these symptoms can be dose-dependent, with a higher dose making one more aggressive or paranoid for example.

These can affect the user’s behaviour negatively. Paranoia can lead to the user accusing another person of bad behaviour towards them and can commit acts of violence.

We will discuss the social issues associated with cocaine use later.

Cocaine psychosis, which includes paranoia, hallucinations, blunted emotions and aggression, can present even after the drug has worn off, and this can be a scary experience for the user.

Combined with a lack of social awareness, these too can have effects on personal and family life.

Longer-Term Mental Health Effects of Cocaine Use

As well as the immediate negative mental health effects of cocaine use, there are longer-term issues that the user can experience.

These include:

  • Depression
  • Cocaine psychosis
  • Lack of concentration between uses of the drug
  • Difficulty in maintaining a lower dose of cocaine
  • Increased tolerance of the substance
  • Dependence
  • Physical addiction
  • Bipolar disorder
  • Other drug addictions

Depression is associated with the comedown from cocaine thanks to the physiological effects of the way it works on the nervous system.

One of the quickest ways to resolve the depression is to fix on more cocaine! This can lead to a cycle of ever-diminishing returns where the drug is used to cure a problem it actually creates.

A research paper published in 1999 (1) showed that 18% to 22% of suicides in the United States were associated with cocaine use.

Mood swings, both when intoxicated and between uses of the drug can eventually present as a bipolar disorder where the person feels on top of the world one day and extremely low the next.

This too can lead to suicide or violence toward others.

Finally, a 2007 research paper (3) showed that up to 90% of those admitted to treatment centres for cocaine use had other substance misuse problems.

Poly-drug addiction is very difficult to treat, especially if there are co-occurring mental health issues.

Social Problems associated with Cocaine Use

The person misusing cocaine can encounter problems that in turn can lead to mental health problems.

Either through their lifestyle becoming dominated by the need for more drugs or through errors made due to being under the influence, they can up being isolated and jobless.

Thanks to psychosis, mood swings and aggression caused by cocaine use, the user can develop family problems and lose close friends.

The same issues can result in them losing their employment.

Impulsive behaviour can lead to risky sexual behaviour. This can include cheating on existing partners and not using adequate protection during impulsive liaisons.

For women, this can mean pregnancy, and for both men and women, this can mean catching sexually transmitted infections including HIV.

As dependence on the drug progresses, so the person can resort to committing crime to be able to afford more cocaine.

The 1999 paper (1) reported that 46% of crack users had committed violent crime to get money for to buy more drugs. Arrest and imprisonment can lead to employment and housing problems.

All of the issues we have described can lead to mental health problems brought about by the situations created by addiction and dependence on cocaine.

These indirect problems add to the issues that are brought about by the impact of the substance on the nervous system.

Addiction to Cocaine

When misuse reaches a certain point, the psychological dependence on cocaine leads to a physiological need for the drug.

Symptoms of addiction to cocaine include:

  • Cravings for the substance
  • Agitation between fixes
  • Anxiety
  • Irritability
  • Exhaustion thanks to the lack of stimulants in the system
  • Hunger for food
  • Sleep problems
  • Heart and blood pressure problems

These can make it very difficult for the individual to stop taking cocaine.

The nervous system has become so accustomed to the presence of the compound that it has adjusted to tolerate it.

It produces fewer neurotransmitters when the cocaine is not present and when cocaine hasn’t been introduced the body takes a long time to readjust to not having it in the system.

The good news is that in most cases, time away from cocaine can allow things to return to normal.

You will feel normal again without it. Even psychosis can disappear as the body ceases to malfunction without it.


Unlike for opioid and alcohol abuse, there is no licensed medication to alleviate the chemical effects of cocaine withdrawal.

Where it comes to acute addiction it is recommended to undergo a residential detox so you can have professionals treat your symptoms from withdrawal before they become dangerous.

Medications like anti-anxiety drugs, antipsychotics and antidepressants can be prescribed for mental health symptoms too.

At the same time, cravings and behaviours need to be challenged.

Talking therapy, including couples therapy and cognitive behavioural therapy (CBT) can help one work out ways to best avoid relapsing.

It is important to understand that few people ever achieve complete success in the first time of the addiction/recovery cycle.

This is where one needs to dig deep, learning lessons from the last relapse every time.

One day, as millions have found around the world, will be the last time you take it and never look back.


1. Cocaine and Psychiatric Symptoms

2. Cocaine use in university students: relationships with demographics, mental health, risky sexual practices, and trait impulsivity

3. Comorbid Psychiatric Diagnoses and Their Association with Cocaine-Induced Psychosis in Cocaine-Dependent Subjects



Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field.  His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline.