Understanding More About Cocaine Addiction

Cocaine use disorder can begin to take over a person’s life, but treatment can help. In 2025, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that 1.4 million people ages 12 and older had a cocaine use disorder. Read on to learn how it affects daily life, what to expect during the first weeks without cocaine, the risks of continued use and which treatments have the strongest evidence behind them. 

What Is Cocaine Addiction?

Cocaine is a powerful stimulant, and cocaine addiction is the common name for what clinicians diagnose as cocaine use disorder. It falls under the broader category of stimulant use disorder. Someone with this condition continues using cocaine despite the harm it causes to their health, finances, work or relationships. Even when they want to stop, doing so can be difficult. A clinician can make that diagnosis alone, 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. It acts by binding to the dopamine transporter, blocking the removal of dopamine from the synapse. Dopamine is the neurotransmitter that signals reward, so instead of clearing it, it surges, driving the high and the desire to use again, all of which can lead to addiction.

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 wear off quickly, which can lead people to take repeated doses over a short period. These binges often last 12 to 18 hours, though some continue for two or three days or longer. People may keep using until they run out of cocaine or become too exhausted to continue.

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Cocaine and Crack

Crack is a form of cocaine processed into small rocks that are smoked. 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.

It contains the same drug as powder cocaine and can lead to the same cocaine use disorder. What’s different is the timing: a smoked high comes on fast and fades within minutes. That steep drop may prompt a person to take another dose soon after.

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 lasts only 5 to 10 minutes.

Treatment options are the same for both forms of cocaine. The same behavioral therapies and levels of care are used whether someone uses crack or powder cocaine. 

Signs and Symptoms of Cocaine Addiction

Cocaine addiction shows up in the body, in behavior and in mood. It can present as dilated pupils, nosebleeds and poor sleep and appetite. In addition, binges, money problems, pulling away from people, irritability, anxiety and paranoia are common.

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

Physical Signs

Many physical signs of cocaine use are obvious because it acts as a stimulant. 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 set of physical symptoms, including 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?

Choose a time when the person isn’t high or coming down and talk about what you’ve noticed. A doctor can help determine whether something else may be going on, and how to help a loved one with addiction offers guidance on what to do 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 symptoms typically persist for about 1 to 2 weeks, though the craving and depression can last for months after stopping long term heavy use. The greatest risk is self harm.

Symptoms commonly seen include fatigue, depressed mood, agitation, increased appetite, vivid and unpleasant dreams and slowed activity. How long each phase lasts varies by person and by the amount and length of use, so the timings are a guide rather than a schedule. The timeline breaks the phases down day by day.

There are no medicines to reduce cravings for cocaine, though research is ongoing.

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If someone has been abusing alcohol or benzodiazepines along with cocaine, stopping them abruptly, especially after heavy or regular use, can be dangerous. For this reason, talk to a doctor or a medical detox program 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.A chat option 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. Contingency management, an approach that rewards people for drug free tests, has 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 as part of a broader 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. Cognitive behavioral therapy (CBT) is also strongly recommended, with moderate certainty evidence.

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. A program or clinician can explain what each involves, and a clinical assessment will determine what 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 speeds up activity in the brain and body. It increases heart rate, blood pressure and body temperature and has the potential to trigger a heart attack, a stroke or a seizure. This can happen even with first-time use. Many cocaine-related overdose deaths also involve opioids. If you suspect an overdose, call 911 and give naloxone if available, as it can reverse an opioid overdose and may save a life.

 The Heart and Brain

Short term effects include 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. 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. 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., down from 29,449 in 2023, a drop of 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, with many people unaware that their drugs contain it. 

A stimulant overdose is commonly characterized by dangerous overheating, which can lead to unconsciousness. It can also include seizures, loss of awareness of surroundings, heavy sweating, bluish skin, fast or difficult breathing, and a very fast or irregular heart rhythm.  A crack overdose presents the same way.

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