Physical Signs of Cocaine Addiction

Calendar icon Last Updated: 06/20/2024

Rates of using cocaine as a recreational drug have steadily increased, and now it is the second most widely used illegal drug, after cannabis. It is so commonly used that often signs of cocaine use go unnoticed.

In its pure form, cocaine is a white powder which is usually snorted but may also be rubbed on the gums, smoked, or mixed with water and injected. The effects which make cocaine attractive to users – such as increased energy and euphoria – quickly take their toll on the user’s body with a range of physical symptoms that develop as use becomes abuse and progresses to addiction.

Physical Signs of Cocaine Use

Dilated Pupils

One of the easiest cocaine addiction symptoms to spot is dilated pupils, yet so many miss it, as the dilated pupils only last as long as the high. Someone who is on cocaine experiences a relatively short high of 15 to 30 minutes, though younger people and those more susceptible to the drug may be under the influence of cocaine for longer. While dilated pupils is a symptom shared with many other illicit drugs, it can usually be taken a warning sign of some sort of drug use.


Cocaine affects three primary neurotransmitter chemicals: dopamine, norepinephrine, and serotonin. Norepinephrine regulates a person’s “fight-or-flight” responses to external stimuli. Hyper-alertness or “jumpiness” results from high levels of norepinephrine in a person’s bloodstream. Cocaine’s over-stimulation of these chemicals will also make users restless and talkative while high. After chronic use, this overstimulation can have significant neurological effects that are long lasting or permanent.

Fast Heart Rate, Rapid Pulse, and Fever

Cocaine constricts blood vessels while at the same time raising blood pressure and body temperature and speeding up the heart rate.

Frequent Runny or Stuffy Nose

Snorting cocaine can damage the intranasal cavity and cause adverse consequences such as a reduced or lost sense of smell, chronic congestion, runny nose, and hoarseness. You may notice someone using cocaine frequently sniffing, wiping or blowing their nose. These symptoms can then lead to the skin around the nose to be very tender, painful and red. Basically, somebody who is snorting cocaine may appear to always have a bad cold.

Physical Signs of Cocaine Abuse

Like most all alcohol and drug abuse, cocaine addiction impairs a person’s mind, physical health and overall ability to function in everyday life. Chronic abuse of cocaine causes all the above physical symptoms to worsen, while also deteriorating cognitive functions to the point where psychiatric symptoms develop. If someone is abusing the drug, they should seek out cocaine rehab centers to get the help they need.

Nosebleeds, Sinusitis, and Perforated Septum

The “bad cold” caused by cocaine use can progress to chronic sinusitis in cocaine abuse. Nosebleeds may often reoccur and become severe because the drug destroys the membranes inside the nose. Long term abusers may develop a perforated septum (a hole in the nasal wall between the two nostrils) or a deviated septum (one nostril is wider than the other because septum becomes misaligned).


An individual who is abusing cocaine may frequently complain of headaches, or take a large number of pain relievers. Headaches associated with cocaine are typically severe and long-lasting. Just the same as many other symptoms, most people will turn to more of the drug in an attempt to find relief.


Tremor is one of the most common signs of cocaine use and is difficult to hide from someone who is looking out for it. This sign is usually seen in chronic users.

Extreme Weight Loss

Cocaine is an appetite suppressant, and abusers not only avoid eating while they are high but often have difficulty maintaining healthy eating habits as the abuse progresses. They tend to develop nutritional deficiencies and become increasingly malnourished the longer they abuse the drug.

Problems Sleeping

The three primary neurotransmitter chemicals—dopamine, serotonin, and norepinephrine—regulate almost every bodily process, sleep included. Neurotransmitter imbalances and an overstimulated nervous system can easily affect a person’s ability to sleep when cocaine is used frequently.


After a long cocaine binge, someone abusing cocaine will wear out and “crash.” Once they come down from their high, they will become very tired and may sleep for abnormally long periods. It is common for a cocaine addict to sleep for about 24 hours straight during their crash period.


The repeated energy surges that accompany cocaine highs take a considerable toll on the body as a whole. After a while, a person experiences an overall sense of fatigue or feeling “burnt out,” even when using the drug.

Problems Thinking

Cognitive impairments involving the brain’s thinking processes can be a particularly troublesome sign of cocaine abuse. A person’s decision-making abilities, concentration, and reasoning progressively deteriorate the longer a person uses. Poor focus and memory, strange and flighty ideas, disoriented thinking patterns, and difficulty with logical thought can lead to problems in school, at work, or communicating in relationships.


Regardless of how often a person uses, after a certain point, no amount of cocaine will produce the desired high effects. Eventually, dopamine neurotransmitter secretions can no longer maintain a person’s emotional equilibrium, which results in ongoing depression. Although depression is often thought of as a psychological symptom, the root cause is a chemical imbalance in the brain that points to a significant decline in cognitive function.

Erratic Behavior

Chemical imbalances in the brain and declining cognitive function can also lead to unpredictable moods, rapid emotional shifts, and uncharacteristic behavior. A person chronically abusing cocaine may even become irrationally paranoid, aggressive, and violent, acting in ways they would never have acted before they started using cocaine.

Risk of Serious Cardiac Complications and Organ Damage

The way that cocaine constricts blood vessels and speeds up the heart rate can damage the heart valves and linings, and cause decreases in oxygen levels, ruptures or bleeding in the brain, seizures, coma, heart failure, and damage to other vital organs, resulting in long-term impairments or death.

Physical Signs of Cocaine Addiction

Since cocaine abusers often binge on cocaine until supplies or finances run out, or until they become exhausted, the risk of dramatically compromised health is significant. Tolerance develops quickly with cocaine, and addicts will need to continually increase the amount of cocaine they use, often without ever experiencing the level of intoxication they are craving. This intensive drug-seeking behavior will create a range of negative consequences in a person’s life, many of which show up as physical signs of cocaine addiction.

Track Marks, Needle Marks, and Bruises on Arms or Legs

A serious cocaine tolerance may lead someone addicted to cocaine to switch from snorting cocaine to injecting it. Common signs of IV use are track and needle marks (or a tendency to wear long sleeves in hot weather) and bruises on arms and legs. They may frequently scratch at their skin and may also develop wound infections.


A damaged immune system and an exhausted body combined with the danger of using unsterilized or shared needles in IV drug use can lead to a range of serious viruses and infections, including pneumonia, viral or bacterial endocarditis, abscesses, hepatitis, cellulitis, tuberculosis, and HIV.

Switching from Cocaine to Crack

When snorting or smoking cocaine no longer gets someone high, they may start using a stronger drug, like crack. Crack has a shorter, more intense high than cocaine, and will only accelerate all the adverse physical effects already in progress. It will also significantly increase the chances of cognitive impairments becoming permanent.

If you or someone you know is suffering from an addiction to cocaine, please seek out cocaine rehab treatment at a trusted facility.