Signs of Cocaine Use: How to Recognize Drug Abuse

Medically reviewed by Dr. Po-Chang Hsu March 10, 2025

Written by
Amanda Stevens, BS On March 10, 2025

Key Points

Cocaine is a commonly abused illegal stimulant drug. Known as coke, snow, blow, and crack – a smokable version of powder cocaine – cocaine is often viewed as a harmless party drug, but the truth is anything but. Cocaine is a highly addictive and dangerous substance that can have serious risks, including overdose, addiction, and mental and physical health problems.

If you think a loved one is using cocaine, it’s crucial to know the signs and symptoms to help them get treatment. Early treatment for drug abuse or addiction can help prevent the dangerous consequences of cocaine use.

What Is Cocaine?

Cocaine is a white, crystalline powder derived from coca leaves. The cocaine base, crack, looks like small, irregularly shaped white rocks. In either form, cocaine can bring an intense euphoria with powerful addiction potential.

Though cocaine used to have medical uses, it’s since been replaced with safer drugs. Nearly all cocaine use is illicit. The drug is classified as a Schedule II drug under the Controlled Substances Act, meaning it has a high potential for abuse with limited medical uses.[1] Cocaine goes by street names like blow, coke, coca, crack, crank, flake, rock, snow, and soda cot, though some of these refer specifically to the smokable crack cocaine form as opposed to the powder form, which is injected or snorted.

Signs and Symptoms of Cocaine Use

Cocaine produces a short-lived, intense high, typically lasting a few minutes to an hour. A cocaine high causes euphoria, alertness, high energy, and hypersensitivity to sight, sound, and touch due to its stimulant effects on the central nervous system.

There are many signs of cocaine use, including:[2]

Dilated pupils
Sniffing
Social isolation
Nosebleeds
Hoarseness
Chronic sinus infections
Weight loss
Bizarre, erratic, or violent behavior
Irritability
Anxiety or panic
Paranoia
Tremors and muscle twitches
Increased need for privacy
Poor hygiene
Changes in sleeping and eating patterns
Financial difficulties

You may notice other indicators, such as burn marks on the lips or fingers from smoking crack, track marks from injection, or drug paraphernalia like burnt spoons, needles, or pipes.

Short-term cocaine use produces effects like:[2]

Increased heart rate
High body temperature
High blood pressure
Panic
Vertigo
Nausea
Stomach pain
No sense of smell
Loss of appetite

Long-term cocaine use can cause:[3]

Lasting high blood pressure
Chronic sinus infections
Damage to the membranes in the nose
Dramatic weight loss
Heart attacks
Blood clots
Headaches
Heart attacks
Seizures
Strokes
Gastrointestinal problems
Auditory or visual hallucinations
Impaired cognitive function
Lung damage with crack cocaine

Cocaine Withdrawal

Every time someone uses cocaine, the body builds a tolerance. They eventually need more and more of the drug to get high. Many people start building tolerance after their first use. This builds high tolerance quickly, leading to physical dependence – when the body becomes used to the presence of a drug and needs it to function. If you stop using cocaine abruptly, withdrawal symptoms occur.

The symptoms of cocaine withdrawal include:[4]

Anxiety
Depression
Fatigue
Trouble concentrating
Drug cravings
Nightmares
Chills
Nerve pain and muscle aches

Symptoms usually begin 6 to 12 hours after last use. The first stage is the crash, which causes fatigue, depression, anxiety, and cravings. Then withdrawal symptoms get worse, lasting for weeks with intense cravings, challenges feeling pleasure, anxiety, trouble sleeping, and agitation.[5] The symptoms gradually lessen over several months, but it can be difficult to get through the withdrawal period without relapsing to relieve the discomfort.

Signs of Cocaine Addiction

Cocaine has high addiction potential because of its effects on the brain. It causes intense pleasure and activates several different chemical messengers, including the body’s naturally occurring opioids. It also affects dopamine, the “feel-good” neurotransmitter, teaching the brain that the reward is desirable and encouraging repeated use.[6] In addition, the intense but short-lived euphoria leads people to use cocaine over and over, often in increasing doses, to maintain the high.

Cocaine addiction is more than physical dependence, however. It’s a compulsive use of cocaine despite the problems it causes. In the Diagnostic and Statistical Manual of Mental Disorders, cocaine addiction is a stimulant use disorder with the following criteria:[7]

Unsuccessful attempts to reduce or stop using cocaine
Using cocaine in higher amounts or for longer periods than intended
Spending a lot of time obtaining, using, or recovering from cocaine use
Experiencing strong cravings for cocaine
Having problems in daily life due to cocaine use
Recurrent use of cocaine despite problems at work, home, or school
Using cocaine despite physical or mental health effects
Developing a tolerance for cocaine
Experiencing withdrawal symptoms from stopping or reducing cocaine use

Cocaine Addiction Treatment

Cocaine addiction can be difficult to overcome, but help is available. Though withdrawal isn’t usually life-threatening, it can have intense symptoms that may cause relapse just to find relief. This can continue the addiction cycle.

The first step in cocaine addiction treatment is often medical detox. This treatment provides a medical team to manage withdrawal symptoms, monitor your health, and prevent complications, keeping you as safe and comfortable as possible while the drug clears your system.

Detox can help with the challenges of withdrawal, but it’s not enough to treat addiction on its own. There’s a powerful psychological aspect to addiction, and a comprehensive treatment program addresses these contributing factors to support long-term sobriety. Treatment plans are individualized but may include a combination of individual therapy, group counseling, support groups, holistic therapies, and behavioral therapies that have proven successful in treating addiction.

Know the Signs of Cocaine Use

Though it’s often viewed as harmless, cocaine is a highly addictive stimulant drug that can have serious risks. It’s important to learn the signs of cocaine use, abuse, and addiction so you can help yourself or a loved one get help for drug abuse.

Cocaine Addiction Resources

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Frequently Asked Questions About the Signs of Cocaine Use

How Can You Tell That Someone Is Using Coke?

The signs of coke use can vary, but you may notice signs like excitability, dramatic mood swings, sniffing, nosebleeds, weight loss, talkativeness, changes in sleep patterns, appetite, or weight, increased isolation and secrecy, or social withdrawal.

What Are Cocaine Abuse Symptoms?

When someone starts abusing cocaine, there may be behavioral signs like stealing or lying, giving up hobbies, financial problems, poor personal hygiene, social isolation, and violent or aggressive behaviors. Physically, someone abusing cocaine may have dramatic weight loss, frequent sinus infections, and indicators like track marks from IV use or burns on the lips and fingers from smoking a crack pipe.

What Are the Signs of Cocaine Addiction?

Cocaine addiction is distinct from cocaine use in that it’s an inability to control drug use, no matter the problems it causes at work, home, school, or with interpersonal relationships. There are strict diagnostic criteria for cocaine addiction, however, and the diagnosis requires a healthcare professional.

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Sources

[1] Drug scheduling and penalties | Campus Drug Prevention. (n.d.). https://www.campusdrugprevention.gov/content/drug-scheduling-and-penalties

[2,3] U.S. Department of Health and Human Services. (2024b, September 27). Cocaine. National Institutes of Health. Retrieved from https://nida.nih.gov/research-topics/cocaine on 2024, December 2.

[4] Cocaine withdrawal: MedlinePlus Medical Encyclopedia. (n.d.). https://medlineplus.gov/ency/article/000947.htm

[5] U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, Substance Abuse and Mental Health Services Administration, & Center for Substance Abuse Treatment. (2010). Substance abuse treatment ADVISORY. In Substance Abuse Treatment (Vol. 9, Issue 1). https://store.samhsa.gov/sites/default/files/sma10-4554.pdf

[6] U.S. Department of Health and Human Services. (2024b, September 27). Cocaine. National Institutes of Health. Retrieved from https://nida.nih.gov/research-topics/cocaine on 2024, December 2.

[7] Stimulant use disorder. PsychDB. (2024b, July 25). Retrieved from https://www.psychdb.com/addictions/stimulants/1-use-disorder on 2024, December 2.

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Signs of Cocaine Use: How to Recognize Drug Abuse

Table of Contents

Key Points

What Is Cocaine?

Signs and Symptoms of Cocaine Use

Cocaine Withdrawal

Signs of Cocaine Addiction

Cocaine Addiction Treatment

Know the Signs of Cocaine Use

Cocaine Addiction Resources

Begin Your Journey

Frequently Asked Questions About the Signs of Cocaine Use

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