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Signs and Symptoms of Cocaine Addiction

The physical and mental side effects of cocaine can manifest almost immediately after a single dose and disappear within a few minutes to one hour. Small amounts of cocaine usually make the user feel euphoric, energetic, talkative, mentally alert and hypersensitive to sight, sound and touch. The drug can also temporarily decrease one’s need for food and sleep. Common behavioral signs of cocaine use include:

  • Increased agitation
  • Anxiety
  • Panic attacks
  • Paranoia
  • Psychosis
  • Euphoria
  • Reduced inhibitions
  • Changes in concentration and focus
  • Restlessness and increased movement (e.g. hyperactivity)1,2,3

Physical Signs of Cocaine Abuse

If cocaine use is suspected, a thorough physical examination is warranted to help confirm the diagnosis and analyze the detrimental effects on the body. Physical symptoms include:

  • Increased body temperature, heart rate and blood pressure
  • Signs of involuntary movements (e.g. muscle tics)
  • Narrowed blood vessels
  • Enlarged pupils
  • Headache
  • Insomnia
  • Abdominal pain and nausea
  • Inflammation of the heart muscle
  • Rupture of the aorta, the major artery leading from the heart
  • Kidney damage
  • Loss of smell
  • Nosebleeds
  • Nasal damage
  • Swallowing problems
  • Decreased appetite and weight loss1,2,3

Nasal Problems

The medical term for cocaine snorting is cocaine insufflation. Chronic cocaine insufflation can cause sinusitis, irritation and bleeding of the nasal membranes, a perforated nasal septum (the membrane that divides the two nostrils) and vasculitis. The vasoconstrictive effect of cocaine is thought to be the most important factor leading to nasal damage. When cocaine first enters the body, it overactivates a part of the nervous system called the sympathetic nervous system. Under the influence of cocaine, the sympathetic nervous system significantly narrows blood vessels throughout the body, including those sending blood to nasal cavity tissues. Without adequate blood supply, the tissues in the nasal cavity start to undergo destructive changes in normal functioning and overall health.4,5

The irritant effect of cocaine crystals and additives, the traumatic effect on the mucosa caused by cocaine snorted at high velocity and recurrent nasal infections are all contributing factors in chronic nasal tissue destruction. Cocaine inhaled through the nose directly irritates the nasal mucous membranes. Over time, repeated irritation of these membranes can lead to destructive changes in membrane health. Cocaine typically contains considerable amounts of other substances such as talc, borax and levamisole. The latter contaminates an estimated 70% of all cocaine in the U.S. and is used both as a stimulant enhancer and bulking agent. It is thought to be responsible for some cases of cocaine-related vasculitis.4,5

Diagnostic Criteria

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, cocaine use is classified under the category of stimulant-related disorders.6 Symptoms of cocaine addiction and stimulant use disorders include:

  • Craving for stimulants
  • Failure to control use despite attempts
  • Continued use despite interference with major obligations or social functioning
  • Use of larger amounts over time
  • Development of tolerance
  • Spending a great deal of time to obtain and use stimulants
  • Withdrawal symptoms after stopping or reducing use such as fatigue, vivid and unpleasant dreams, sleep problems, increased appetite or problems controlling movement6
  1. What are the short-term effects of cocaine use? National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/research-reports/cocaine/what-are-short-term-effects-cocaine-use Updated May 2016. Accessed January 10, 2017.
  2. Cocaine Abuse. Drug Abuse website. http://drugabuse.com/library/cocaine-abuse/ Accessed January 10, 2017.
  3. Cocaine (powder). Center for Substance Abuse Research website. http://www.cesar.umd.edu/cesar/drugs/cocaine.asp Accessed January 10, 2017.
  4. Berman M, Paran D, Elkayam O. Cocaine-Induced Vasculitis. Rambam Maimonides Med J. 2016 Oct 31;7(4). doi: 10.5041/RMMJ.10263.
  5. Cocaine Inhalation and Nasal Damage. Drug Addiction Treatment website. http://www.drugaddictiontreatment.com/types-of-addiction/cocaine-types-of-addiction/cocaine-inhalation-and-nasal-damage/ Published May 10, 2013. Accessed January 10, 2017.
  6. Cocaine-Related Psychiatric Disorders Clinical Presentation. Medscape website. http://emedicine.medscape.com/article/290195-clinical Updated April 14, 2016. Accessed January 10, 2017.
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