All About Cocaine

All About Cocaine & Crack

Cocaine and Crack

Cocaine is a highly addictive drug that ups your levels of alertness, attention, and energy.  It’s made from the coca plant, which is native to South America. It’s illegal in the U.S.

It comes in a few different forms. The most common is a fine, white powder. It can also be made into a solid rock crystal.

Most cocaine users snort the white powder into their nose. Some rub it onto their gums or dissolve it in water and inject it with a needle. Others heat up the rock crystal and breathe the smoke into their lungs.  The drug sends high levels of dopamine, a natural chemical messenger in your body, into the parts of your brain that control pleasure. This buildup causes intense feelings of energy and alertness called a high.

Other short-term effects of cocaine may include:  

  • Extreme sensitivity to touch, sound, and sight  
  • Intense happiness  
  • Anger/irritability  
  • Paranoid feeling  
  • Decreased appetite

People who use cocaine often may also have more serious side effects and health problems:  

  • Headaches 
  • Convulsions and seizures  
  • Heart disease, heart attack, and stroke  
  • Mood problems  
  • Sexual trouble  Lung damage  
  • HIV or hepatitis if you inject it  
  • Bowel decay if you swallow it  
  • Loss of smell, nosebleeds, runny nose, and trouble swallowing, if you snort it

You may have strong cravings for the drug and the high it brings. But the more you use cocaine, the more your brain will adapt to it. You’ll need a stronger dose to feel the same high. This can lead to a dangerous addiction or overdose.  Stronger, more frequent doses can also cause long-term changes in your brain’s chemistry. Your body and mind begin to rely on the drug. This can make it harder for you to think, sleep, and recall things from memory. Your reaction time may be slower. And you’re at risk for more heart, stomach, and lung problems.

What are the long-term effects of cocaine use?

With repeated exposure to cocaine, the brain starts to adapt so that the reward pathway becomes less sensitive to natural reinforcers. At the same time, circuits involved in stress become increasingly sensitive, leading to increased displeasure and negative moods when not taking the drug, which are signs of withdrawal. These combined effects make the user more likely to focus on seeking the drug instead of relationships, food, or other natural rewards.

With regular use, tolerance may develop so that higher doses, more frequent use of cocaine, or both are needed to produce the same level of pleasure and relief from withdrawal experienced initially. At the same time, users can also develop sensitization, in which less cocaine is needed to produce anxiety, convulsions, or other toxic effects. Tolerance to cocaine reward and sensitization to cocaine toxicity can increase the risk of overdose in a regular user.

Signs and Symptoms

The euphoric effects of cocaine use are accompanied by physical effects, including a rapid heart rate, sweating, and pupil dilation (widening of the pupils). Cocaine can also cause other adverse effects, such as anxiety, crawling sensations on the skin, hallucinations, and paranoia. Some of these feelings can persist, or might even increase, during the comedown (“crash”) as the euphoria is wearing off.

The signs of cocaine addiction extend beyond the physical symptoms and also involve emotional and behavioral changes. Signs of cocaine addiction can include:

  • Teeth grinding
  • Dry mouth
  • Dilated pupils
  • Persistent runny nose or nosebleeds (without a reason like allergies or a sinus infection)
  • Hyperactivity, excessive or unusually rapid speech
  • Overconfidence
  • Reckless behavior
  • Mood or behavioral changes
  • The presence of visible white powder or burn marks on the mouth, nose, or hands
  • Appetite changes and weight loss
  • New, erratic, or unusual sleeping patterns
  • Avoiding others, being secretive, or hiding drug use
  • Decreased interest in and participation in activities that had been previously enjoyable—such as socializing, work, or leisure activities
  • Unexplained spending or financial problems
  • Neglecting personal appearance or hygiene
  • Having drug paraphernalia, or other items for using cocaine in your home or apartment can be a sign of addiction too.

Symptoms of Crack Use Side effects that can develop as a result of smoking crack include

  • Coughing up blood
  • Hoarseness
  • Persistent sore throat, and
  • Shortness of breath.

Specifics of Cocaine and Crack

Cocaine is a hydrochloride salt in its powdered form, while crack cocaine is derived from powdered cocaine by combining it with water and another substance, usually baking soda (sodium bicarbonate). After cocaine and baking soda are combined, the mixture is boiled, and a solid forms. Once it’s cooled and broken into smaller pieces, these pieces are sold as crack.

The name crack derives from the crackling sound that is produced when the drug is heated and then smoked, according to the Center for Substance Abuse Research. Since crack is so highly concentrated, it is extremely addictive. While not common, it’s possible for a person to become addicted to crack after just one use.


There are a number of complications of cocaine addiction, and they can differ depending on your method of using the drug. 

  • You may develop thinning or deterioration of the septum nasi (the septal cartilage in your nose) 
  • if you snort the drug. Injecting the drug can increase your risk of a serious skin infection, such as a bacterial staphylococcus infection. Cellulitis (a severe type of skin infection) and necrotizing fasciitis (destruction of the infected tissue), and a systemic infection can develop as well. 
  • Sharing needles can increase the risk of HIV and hepatitis B. 
  • Cocaine use can also contribute to kidney injury and has been implicated in certain rheumatologic conditions.

The main complication of cocaine addiction is overdose, which results in cocaine toxicity. While cocaine can adversely affect every organ in the body, its most dangerous and life-threatening effects are on the cardiovascular system.

  • Tachycardia (rapid heart rate), arrhythmia (irregular heart rate or rhythm), and malignant hypertension (severely high blood pressure) can lead to a heart attack, stroke, or death.
  • Acute kidney failure (rather than slowly deteriorating kidney function) is a life-threatening emergency that’s also common with cocaine overdose.


An overdose happens when a person uses enough of a drug to have a very bad reaction or death. A cocaine overdose can cause a heart attack or stroke, and you can die. If someone you know has any of these signs, you should call 911 right away.

Signs of a Cocaine Overdose Are:

  • throwing up
  • chest pain
  • fast heartbeat
  • Shaking
  • feeling hot
  • Panic
  • hallucinations (seeing things that aren’t there)

Seek emergency care if you experience any of the above symptoms. Cocaine toxicity can lead to death within a few hours.


It is easy to lose control over cocaine use and become addicted. Over time, it can change the way your brain works. If you stop taking the medicine, your body can get confused and you can start to feel really sick. This makes it hard to stop. This is called addiction.

People addicted to cocaine might take bigger doses or take it more often to get high. A cocaine high usually doesn’t last very long. So people take it again and again to try to keep feeling good.

People who are trying to quit taking cocaine might:

  • act nervous and restless
  • feel very sad and tired
  • have bad dreams
  • be suspicious of people and things around them
  • They will feel a strong need to take the drug.

Even with  treatment, it can be hard to stay off the drug. People who stopped using cocaine can still feel strong cravings for the drug, sometimes even years later.


Some people are more vulnerable to cocaine addiction than others. There is no way to predict who will develop cocaine addiction. With that said, studies have suggested that some groups are at the highest risk. These include people who also abuse alcohol and cannabis, as well as individuals who have depression.

While the reasons for the development of cocaine addiction are complex and not fully understood, cocaine addiction is associated with DeltaFosB, a protein that regulates the reward center of the brain. Chronic cocaine use impacts genes responsible for the expression of this substance. As DeltaFosB levels continue to build, permanent changes in the brain affect the following structures :

  • Nucleus accumbens: A region in the brain that serves as a reward center, where behaviors are reinforced.
  • The prefrontal cortex: An area of the brain where decisions and impulse control are regulated.

The impairment of these cognitive centers can lead to the compulsive use of cocaine—with little to no regard for the consequences. The impairment of judgment and loss of impulse control further promotes high-risk behaviors, sometimes increasing the risk of accidents or exposure to infections like HIV and hepatitis C.


Cocaine addiction is one of the different stimulant use disorders. Stimulant use disorders are a subcategory of substance use disorder. The criteria is outlined in the Diagnostic and Statistical Manual of Mental Disorders, Edition 5 (DSM-5), a guide used by psychiatrists and other mental health professionals for the diagnosis and treatment of mental health conditions.

Substance Use Disorder

Substance use disorder occurs when an individual continues to use a substance despite clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home. For a person to be diagnosed with stimulant use disorder, they must be more than just a user. For this diagnosis, a person must meet at least two of 11 criteria outlined in the DSM-5 within the previous 12 months.  The DSM-5 criteria for substance abuse disorder include the following:

  • Using more of the substance or taking it for a longer duration than prescribed or intended
  • Being unable to reduce or stop taking the substance, despite wanting or trying to
  • Devoting excessive time, money, or resources to obtaining, using, or recovering from use
  • Craving the substance
  • Neglecting or having difficulty carrying out responsibilities at work, school, or home because of the substance use
  • Persisting in using the substance despite its effect on relationships
  • Missing out on activities (social, recreational, school, work) because of the substance use
  • Using the substance in a dangerous or harmful way
  • Using the substance despite adverse emotional or physical effects
  • Developing a tolerance to the substance
    • Experiencing withdrawal symptoms when the substance is reduced or stopped

The severity of the disorder can be classified as “mild” if two to three criteria are met, “moderate” if four to five are met, and “severe” if six or more are met. These classifications may help direct the most appropriate course of treatment.

Detox and Treatment

Unlike heroin and opioid drugs, there are no medications used to treat cocaine addiction. The treatment is focused on detoxification (also referred to as detox) and behavioral therapies. You might receive treatment with a pharmaceutical drug if you have a co-addiction that can be treated pharmacologically, such as an addiction to alcohol or opioids.

Treatment may be delivered on an outpatient basis, but treatment for cocaine addiction often requires a period of inpatient care in a treatment center, particularly since withdrawal symptoms can lead to depression and a variety of serious psychiatric symptoms.


Coming off cocaine is a process that may take several weeks. Some people who are trying to stop using cocaine may experience better outcomes from inpatient rehabilitation, especially because cocaine cravings can be intense during withdrawal, and relapse is common.

If you seek an inpatient program, you would be in a supervised setting where you are not able to obtain or use the drug. When you stop taking cocaine, you can experience severe withdrawal symptoms that need to be managed. For example, you may need medication for the treatment of abrupt or severe changes in your blood pressure. You might need counseling, supervision, and medication if you develop depression and suicidal ideation.

Former cocaine users are at high risk for relapse, even following long periods of abstinence. Research indicates that during periods of abstinence, the memory of the cocaine experience or exposure to cues associated with drug use can trigger strong cravings, which can lead to relapse.