Understanding More About Cocaine Addiction

Whether the drug is powder cocaine or crack, cocaine addiction can quietly reorganize a person’s days around the next binge and the crash that follows. This page explains how the condition develops, how to recognize it, what withdrawal is like and which treatments the research supports, in plain language with sources. If you are worried about yourself or someone you love, that is a reasonable place to start.

In This Article

• What Is Cocaine Addiction?
• Signs and Symptoms of Cocaine Addiction
• Cocaine Withdrawal: Symptoms, Timeline and Safety
• Treatment for Cocaine Addiction
• Risks and Effects of Cocaine Use
• Frequently Asked Questions About Cocaine Addiction

What Is Cocaine Addiction?

Cocaine is a strong stimulant, and cocaine addiction is what clinicians call cocaine use disorder, a form of stimulant use disorder. A person who has it goes on with cocaine after harm to their health, money, work or relationships, and stopping is hard.

Cocaine usually comes as a powder that is snorted or dissolved in water and injected, according to the Drug Enforcement Administration (DEA). Under the DEA, it is a Schedule II drug, with a high potential for misuse, and use can potentially bring severe psychological or physical dependence. In 2025, 1.7 percent of people aged 12 or older, or 4.9 million people, used cocaine in the past year, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

Cocaine’s effects fade quickly, so people who use it often take the drug over and over in binges. These binges typically last 12 to 18 hours, though they may last 2 to 3 days or longer, according to SAMHSA, and the DEA notes that people usually binge until they are exhausted or run out of cocaine. Tolerance builds quickly, which makes overdose easy. When cocaine or other stimulants are injected or smoked, they can also change the brain in ways that lead to stimulant use disorder, SAMHSA reports.

Cocaine and Crack

Crack is cocaine base, and it looks like small, irregularly shaped white rocks, according to the DEA. It is smoked rather than snorted or injected, but it is the same drug as powder cocaine and produces the same short, intense effects. Crack addiction is the same condition as any other cocaine use disorder, and treatment follows the same approaches.

Signs and Symptoms of Cocaine Addiction

Cocaine addiction shows up in the body, in behavior and in mood: dilated pupils, nosebleeds, and poor sleep and appetite; binges, money problems and pulling away from people; irritability, anxiety and paranoia. When cocaine keeps causing problems in someone’s life and cutting back never sticks, clinicians call that pattern a stimulant use disorder.

Physical signs

The Drug Enforcement Administration (DEA) names restlessness, dilated pupils, insomnia and loss of appetite among cocaine’s effects. MedlinePlus adds agitation, muscle tremors, a faster heart rate and higher blood pressure, sweating with fever, and pupils that stay enlarged instead of reacting to light. Nosebleeds are among the features of cocaine toxicity listed by StatPearls, and the Substance Abuse and Mental Health Services Administration (SAMHSA) notes that snorting can cause sinus problems, a stuffy or runny nose, loss of smell, nosebleeds and damage inside the nose.

• Pupils that stay large in bright light
• Nosebleeds, a runny nose or sinus trouble
• Trouble sleeping and loss of appetite
• Muscle tremors, sweating or fever
• Racing heart and higher blood pressure

Behavioral signs

Some of the clearest behavioral signs of cocaine addiction involve how a person uses and what use costs them. The DEA describes binge use, taking the drug over and over until the person is exhausted or runs out, and SAMHSA reports that after a binge of 2 to 3 days, a person may sleep excessively for 24 to 48 hours. The diagnostic pattern looks similar: use that continues despite money, legal or relationship trouble, and attempts to cut back that fail.

• Binges that end only when the person is exhausted or out of the drug
• Sleeping for a day or more afterward
• Money, legal or relationship trouble tied to use
• Pulling away from family, friends and activities
• Trying to cut back and not being able to

Psychological signs

The DEA lists irritability, anxiety and paranoia among cocaine’s effects. SAMHSA notes that stimulant-induced psychosis can occur, though psychoses in people who use cocaine tend to pass faster than in people who use methamphetamine.

• Irritability and a short temper
• Anxiety that outlasts the high
• Paranoia or suspicion toward people they trust
• In some cases, psychosis

Severity depends on how many diagnostic criteria a person meets: according to the American Society of Addiction Medicine, mild means 2 to 3 criteria, moderate means 4 to 5, and severe means 6 or more. Severe cases are common. SAMHSA reports that in 2025, about half (47.9%) of people who had a stimulant use disorder had a severe form of the disorder, while 29.8% had a mild one.

Worried About Someone Who Uses Cocaine?

Many of these signs have other causes, so the goal is a conversation and a doctor visit, not a verdict. Choose a calm moment, when they are neither high nor crashing, and tell them what you have noticed and that you care. Reading about the 10 symptoms of cocaine addiction can help you put words to it, and guidance on how to help a loved one with addiction can help you plan the conversation.

If they ever mention suicide or seem to be in danger, call or text 988 or chat with the 988 Suicide & Crisis Lifeline, which is free and confidential, available around the clock and open to people with alcohol or drug use concerns. If someone is in immediate danger, call 911.

Cocaine Withdrawal: Symptoms, Timeline and Safety

Cocaine withdrawal is not usually medically dangerous, and StatPearls reports no mortality linked to stimulant withdrawal, but StatPearls and MedlinePlus both warn that depression and suicidal thoughts can arise, a reason it should be taken seriously. MedlinePlus says a crash follows almost right away when use stops, and the Substance Abuse and Mental Health Services Administration (SAMHSA) puts withdrawal at about 1 to 2 weeks, though MedlinePlus cautions that the craving and depression can last for months after stopping long-term heavy use. For thoughts of suicide, yours or those of someone you know, reach the 988 Suicide & Crisis Lifeline by call or by text at 988, or chat online.

> Call or text 988 now if suicide is on your mind, or on the mind of someone you love. Call 911 if someone is not responding, or has chest pain, a seizure, or a very high temperature.

MedlinePlus lists the common symptoms of cocaine withdrawal:

• Agitation and restless behavior
• Depressed mood
• Fatigue
• Increased appetite
• Vivid and unpleasant dreams
• Slowing of activity
• Strong cravings for cocaine

How long each phase lasts varies from person to person and with the amount and length of use.

TIP 33, SAMHSA’s treatment protocol for stimulant use disorders, describes the acute phase as dysphoria, anxiety and agitation, followed by fatigue and an intense desire for sleep that is often accompanied by insomnia. SAMHSA cautions that the greatest risk during stimulant withdrawal is of doing harm to self. The American Society of Addiction Medicine (ASAM) adds that post-acute symptoms of stimulant withdrawal can last for weeks to months and that suicidality may increase during waning intoxication and acute withdrawal.

There is no medication that reverses cocaine withdrawal: StatPearls finds that no specific medications can abate symptoms, and MedlinePlus notes there are no medicines to reduce cravings for cocaine, though research is ongoing. Supportive care is the approach. Specific symptoms may be treated by a clinician as they come up. A medical detox program can provide monitoring and a safe place through the first days. Crack cocaine follows the same pattern and timing, a first phase StatPearls calls the “crack crash,” so what crack withdrawal is like closely matches the table above. The cocaine withdrawal timeline breaks the phases down day by day.

When to get medical help:

• Suicide or self-harm thoughts: call or text 988.
• Not responding, bluish skin, trouble breathing, very high body temperature, seizure or chest pain: call 911. Among the signs of cocaine intoxication, MedlinePlus names severe sweating, seizures, high body temperature, loss of awareness, bluish skin, fast or difficult breathing, and a very fast or irregular heart rhythm.
• Hallucinations or severe paranoia: get urgent care.
• Alcohol, benzodiazepines or opioids as well: see a doctor or detox program before those are stopped, since alcohol withdrawal, MedlinePlus warns, “may quickly become life-threatening,” while the 2020 FDA Drug Safety Communication cautions that a benzodiazepine stopped suddenly can bring on seizures, “which can be life-threatening.”

Treatment for Cocaine Addiction

Treatment for cocaine addiction relies on behavioral therapies, and contingency management, an approach that rewards a person for drug-free tests, is supported by the strongest evidence. The Centers for Disease Control and Prevention (CDC) confirms that no FDA-approved medication exists for cocaine or for any other stimulant use disorder. Contingency management is what it calls the treatment strategy that has the widest scientific support.

Medications

No medication is FDA-approved for managing stimulant use disorders, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). MedlinePlus adds that no medicines currently reduce cravings for cocaine, though research is ongoing. A 2024 guideline from the American Society of Addiction Medicine (ASAM) notes that pharmacotherapies may be used off-label, and a doctor may treat conditions that often come with cocaine use, such as depression, anxiety or sleep problems.

Contingency management

Contingency management, or CM, gives a person tangible rewards, often vouchers or prizes, when a drug test comes back negative. SAMHSA reports that ample research supports CM as the leading psychosocial treatment for stimulant use disorders, and the CDC calls it the single most effective treatment for stimulant use disorder while noting it remains underused. The ASAM guideline makes CM a primary component of the treatment plan, its strongest recommendation, backed by high-certainty evidence, and reports that CM has outperformed every other intervention studied.

CM works best inside a full plan, and programs offering contingency management and other therapies usually pair it with counseling. In a 2018 network meta-analysis of 50 randomized trials with 6,942 participants, De Crescenzo F et al. found that CM plus the community reinforcement approach was the only one that raised the number of patients abstinent when treatment ended, compared with usual care, and called it the most effective and acceptable option.

Other therapies with evidence

Alongside CM, SAMHSA gives its “Strong Evidence” rating for stimulant use disorders to cognitive behavioral therapy (CBT), motivational interviewing and the community reinforcement approach (CRA), and it notes that, unlike with opioids, no FDA-approved medication is currently available for them. CBT helps a person spot and change the thinking and situations that lead to use, while SAMHSA describes CRA’s goal as identifying the behaviors that reinforce stimulant use and making a substance-free lifestyle more rewarding. Motivational interviewing helps a person resolve mixed feelings about stopping. Family involvement, often through family therapy, and mutual support groups can strengthen any of these approaches.

After Treatment

Recovery continues after a formal program ends. Many people keep up with continuing care, which can mean regular counseling check-ins, mutual support groups and family therapy to rebuild trust at home. These supports give a person somewhere to turn when cravings or low moods resurface months later, and they keep the people closest to them involved in what happens next.

Treatment spans several levels of care, from outpatient to residential, and a program or clinician can explain what each involves. If you are weighing treatment for yourself or someone you love, learning how to ask for help is a practical first step, and SAMHSA’s National Helpline, a public treatment information line listed by the CDC, is at 1-800-662-HELP (4357).

If you or someone you love is experiencing a substance use disorder, help is available.

800-681-1058

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Risks and Effects of Cocaine Use

Cocaine speeds the body up: heart rate, blood pressure and body temperature climb, and use can bring on heart attack, stroke or seizures. Fentanyl in the cocaine supply has raised the stakes, and most overdose deaths that involve cocaine now involve an opioid too.

Effects on the Heart and Brain

The Drug Enforcement Administration (DEA) names “irregular heartbeat, ischemic heart conditions, sudden cardiac arrest, convulsions, strokes, and death” among cocaine’s effects (ischemic means reduced blood flow), and warns that “tolerance builds quickly, easy to overdose.” The strain builds over years: the Centers for Disease Control and Prevention (CDC) associates long-term stimulant use with cardiovascular disease, which raises overdose risk.

Risks by How Cocaine Is Used

• Snorting: the Substance Abuse and Mental Health Services Administration (SAMHSA) ties snorting (nasal insufflation) to sinusitis, loss of smell, nosebleeds, and perforation or necrosis of the nasal septum.
• Smoking crack: SAMHSA describes acute alveolitis, known as “crack lung,” in people who smoke cocaine: severe chest pain, difficulty breathing and a high fever.
• Injecting: SAMHSA warns of infections from “the use or sharing of unsterile needles, including HIV and hepatitis B and C,” plus “skin infections (cellulitis, skin abscesses)” and “infectious endocarditis,” a heart infection.

Overdose and Fentanyl

Overdose deaths involving cocaine have been falling. In 2024, 21,945 U.S. overdose deaths involved cocaine, and the CDC reports the rate fell 26.7% from 2023, from 8.6 to 6.3 per 100,000. Provisional 2025 figures show about 69,973 overdose deaths overall, a third straight decline, and deaths involving cocaine and psychostimulants “decreased as well,” the CDC says. Even so, from January 2021 to June 2024, 30.0% of overdose deaths involved cocaine, and 79.1% of those also involved opioids, the CDC reported in 2025.

Fentanyl drives much of that overlap. The CDC has confirmed stimulant products contaminated with fentanyl, usually cocaine and crack cocaine, and people who use stimulants may be exposed to opioids without knowing it: fentanyl “is commonly mixed with drugs like heroin, cocaine, and methamphetamine,” and “many people may be unaware that their drugs contain it.” MedlinePlus likewise notes cocaine “is often cut (mixed) with other substances.” A stimulant overdose may not look like unconsciousness: the CDC lists “dangerous overheating,” dilated pupils, tremor, confusion, nausea or vomiting, hallucinations and psychosis as signs, and people “are often conscious and may be breathing quickly.” MedlinePlus adds seizures, loss of awareness of surroundings, bluish skin, fast or difficult breathing, and a heart rhythm that is very fast or irregular. A crack overdose shows the same signs.

Because opioids may be involved, the CDC advises: “Administer naloxone if opioids could be involved,” though naloxone “is not effective in treating a stimulant ‘overdose.'” The American Society of Addiction Medicine says clinicians should prescribe or distribute naloxone to patients who use stimulants from nonmedical sources.

Emergency Warning Signs

Get emergency help for:

• A seizure or convulsions
• A very fast or irregular heart rhythm
• A high body temperature with severe sweating
• Bluish skin, or fast or difficult breathing
• Loss of awareness of surroundings
• Stroke signs the CDC names: sudden numbness or weakness on one side, sudden confusion or trouble speaking, sudden trouble seeing or walking, or a sudden severe headache

Call 911.

Frequently Asked Questions About Cocaine Addiction