Understanding More About Cocaine Addiction

Cocaine use disorder can take over a person’s days, and it is treatable. In 2025, the Substance Abuse and Mental Health Services Administration (SAMHSA) put the number of people 12 and older with a cocaine use disorder at 1.4 million. Read on for how it shows up, what stopping involves in the first weeks, the risks that come with use and the treatments with the strongest evidence.

What Is Cocaine Addiction?

Cocaine is a strong stimulant, and cocaine addiction is the common name for the disorder clinicians diagnose as cocaine use disorder, one of the stimulant use disorders. A person who has it goes on using cocaine after harm to their health, money, work or relationships, and stopping is hard. A clinician alone can make that diagnosis, and the DSM-5-TR, the standard diagnostic manual, sets out the criteria it rests on.

Cocaine comes from the leaves of the coca plant, and it acts by binding to the dopamine transporter, blocking the removal of dopamine from the synapse. Dopamine signals reward, so it collects instead of clearing, and that surge drives the high and the pull to use again, part of how addictive cocaine is. Under federal law, cocaine is a Schedule II drug, which the Drug Enforcement Administration (DEA) describes as having a high potential for abuse.

In 2025, 4.9 million people aged 12 or older, or 1.7 percent, used cocaine in the past year, and 1.4 million, or 0.5 percent, had a cocaine use disorder, according to the National Survey on Drug Use and Health from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Cocaine’s effects fade quickly, so people who use it often take it over and over in binges. These binges typically last 12 to 18 hours (but may last 2 to 3 days or longer), and people often keep going until they are exhausted or run out of cocaine.

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Cocaine and Crack

Crack is cocaine that has been processed into a rock and smoked. The drug inside is the same as powder cocaine, and it leads to the same cocaine use disorder. What changes is the timing: a smoked high arrives fast and fades inside minutes, and that steep drop may prompt another dose soon after.

Cocaine becomes crack by processing the drug with ammonia or sodium bicarbonate (baking soda) and water. The name refers to the crackling sound the rock makes as it heats. In 2025, 986,000 people aged 12 or older, or 0.3% of that age group, used crack in the past year, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

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A snorted high lasts from 15 to 30 minutes, a smoked one only 5 to 10 minutes.

Smoking also reaches the lungs directly. Cocaine smoking can cause acute alveolitis, known as “crack lung.”

Treatment does not divide along those lines. The same behavioral approaches and levels of care are used for crack as for powder cocaine.

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. Many of these signs, though, have other causes, so the goal is a conversation and a doctor visit, not a verdict.

Physical Signs

Cocaine speeds the body up, and many physical signs of cocaine use show from the outside. These include enlarged pupils that don’t get smaller when a light shines into the eyes, muscle tremors, increased heart rate and blood pressure, fever and sweating. It can also temporarily decrease the need for food and sleep. Snorting adds its own: sinus problems, congestion and nosebleeds.

Behavioral Signs

How someone uses, and what it costs them, is often the clearest evidence. After a binge of 2 to 3 days, a person may sleep excessively for 24 to 48 hours.

Psychological Signs

Mood and thinking shift with use, and worsen during a binge. Heavy use can increase irritability and restlessness, bring on panic attacks and paranoia, and even lead to psychosis, agitation and confusion.

The DSM-5-TR grades cocaine use disorder by how many of its 11 criteria someone meets over 12 months: 2 or 3 is mild, 4 or 5 is moderate, and 6 or more is severe. In 2025, about 577,000 of the 1.4 million people with a cocaine use disorder, about 4 in 10, had a severe one, according to SAMHSA’s National Survey on Drug Use and Health.

Worried About Someone Who Uses Cocaine?

Pick a calm moment, when the person is neither high nor coming down, and say what you have noticed. A doctor can check what else might explain them, and how to help a loved one with addiction covers what comes next.

If they mention suicide, call or text 988, or chat online at 988lifeline.org. If someone is in immediate danger, call 911.

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Cocaine Withdrawal: What to Expect and How to Stay Safe

Cocaine withdrawal is not usually medically dangerous, but depression and suicidal thoughts can arise. A crash follows almost right away when use stops, and withdrawal lasts about 1 to 2 weeks, though the craving and depression can last for months after stopping long-term heavy use.

Harm to self is the greatest risk. The common symptoms are fatigue, depressed mood, agitation, increased appetite, vivid and unpleasant dreams and slowed activity. How long each phase lasts varies from person to person and with the amount and length of use, so the timings are a guide rather than a schedule, and the timeline breaks the phases down day by day.

Nothing reverses cocaine withdrawal: there are no medicines to reduce cravings for cocaine, though research is ongoing.

Stopping alcohol or benzodiazepines suddenly is dangerous for people who drink heavily or take them regularly, so a doctor or a medical detox program is worth talking to first. Crack cocaine follows the same pattern and timing, so crack withdrawal closely matches the table above.

Call or text 988 now if suicide is on your mind, or on the mind of someone you love. The line is free and confidential, and a chat is open at 988lifeline.org around the clock.

Call 911 if someone is not responding, or has chest pain, a seizure, trouble breathing or a very high temperature.

Treatment and Help 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. Contingency management, or CM, gives a person tangible rewards, often vouchers or prizes, when a drug test comes back negative. CM works best inside a full plan, and programs offering contingency management and other therapies usually pair it with counseling. Currently, there are no medications approved by the U.S. Food and Drug Administration to treat cocaine use disorder.

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CM should be a primary component of the treatment plan, a strong recommendation backed by high-certainty evidence, and CM has the best results of any intervention studied for stimulant use disorder. Cognitive behavioral therapy (CBT) is also strongly recommended, at moderate certainty.

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.

Treatment spans several levels of care, from outpatient to residential, and a program or clinician can explain what each involves, with a clinical assessment deciding which fits. Every Marketplace plan covers mental health and substance use services as essential health benefits, so checking your insurance benefits is a practical first step. FindTreatment.gov lists treatment programs, and SAMHSA’s National Helpline, a public treatment information line, is at 1-800-662-HELP (4357).

Risks and Effects of Cocaine Use

Cocaine drives the body’s systems harder: heart rate, blood pressure and body temperature rise, and the drug can trigger a heart attack, a stroke or a seizure, occasionally the first time someone tries it. An opioid is involved in most overdose deaths that involve cocaine, so calling 911 and giving naloxone can save a life.

Effects on the Heart and Brain

The short-term effects are constricted blood vessels; dilated pupils; and increased body temperature, heart rate, and blood pressure. A narrowed vessel and a racing heart are part of why a stimulant can trigger a heart attack, a stroke or a seizure, and in rare instances, sudden death can occur on the first use of cocaine or unexpectedly thereafter.

Risks by How Cocaine Is Used

• Snorting (nasal insufflation): sinusitis, loss of smell, nosebleeds, and perforation or necrosis of the nasal septum.
• Smoking crack: acute alveolitis, known as “crack lung,” in people who smoke cocaine: severe chest pain, difficulty breathing and a high fever.
• Injecting: sharing unsterile needles can pass on HIV and hepatitis B and C, and injecting can also cause skin infections such as cellulitis and abscesses, along with infectious endocarditis, a heart infection.

Overdose and Fentanyl

Overdose deaths involving cocaine have been falling. The cocaine-involved death toll for 2024 was 21,945 people in the U.S., against 29,449 in 2023, and the rate dropped 26.7%, taking it to 6.3 per 100,000 from 8.6, according to the Centers for Disease Control and Prevention (CDC). Among overdose deaths in 49 states and Washington, D.C. between January 2021 and June 2024, 30.0% involved cocaine, and 79.1% of those deaths also involved opioids.

As of 2022, the CDC had recorded confirmed cases of fentanyl-contaminated stimulant products, usually cocaine and crack cocaine. Fentanyl is “commonly mixed with drugs like heroin, cocaine, and methamphetamine,” and many people “may be unaware that their drugs contain it.”

A stimulant overdose is commonly characterized by dangerous overheating, and the person often stays conscious. It can also include seizures, loss of awareness of surroundings, a high body temperature with severe sweating, 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 giving naloxone when opioids could be present, though naloxone does not reverse the effects of a stimulant. The American Society of Addiction Medicine says clinicians should prescribe or distribute naloxone to people who use stimulants from nonmedical sources, and recommends drug checking, including fentanyl test strips.

Emergency Warning Signs

Get emergency help for:

Call 911.

Frequently Asked Questions About Cocaine Addiction