Symptoms and Signs of Cocaine Addiction

Cocaine addiction is a prevalent health concern in the United States. Results of the 2020 National Survey on Drug Use and Health showed that 1.3 million Americans over the age of 12 had signs of cocaine addiction in the previous year.1 Inevitably, signs of cocaine addiction will manifest as an inability to quit despite all the problems it creates.2 If left untreated, long-term cocaine misuse increases the chances of adverse physical, mental, and social consequences, some of which are life threatening. Identifying these signs may help you or someone you know get the help necessary to avoid dangerous outcomes.3

In this article:

Signs of Cocaine Addiction

There are general signs of cocaine addiction commonly found among all users and via all routes of administration. These observable signs can be physical, behavioral, or psychological, and include:3

  • Dilated pupils
  • Energy levels swinging between high and low
  • Moods abruptly shifting from high to low
  • Extreme alertness followed by low concentration
  • Restless appearance
  • Frequent trips to the bathroom or other isolated places
  • Decaying teeth or gums
  • Losing weight without dieting
  • Lacking sleep but appearing alert
  • Increased heart rate

Some signs of cocaine addiction or stimulant use disorder vary depending on the method of ingestion. The route of administration determines how much and how quickly cocaine enters the bloodstream and travels to the brain. These affect the intensity and length of its effects. How one misuses cocaine ultimately influences whether one develops a cocaine addiction.3

Routes of administration include:3

  • Intranasal snorting
  • Inhalation or smoking
  • Intravenous injection
  • Oral ingestion or rubbing on gums

Intranasal Signs of Cocaine Addiction

Snorting cocaine has relatively noticeable signs, like the following:3

  • Sniffles and runny nose
  • Nose bleeds
  • Problems with swallowing
  • Loss of smell
  • Perforated nasal septum
  • White residue around or just inside the nose

Inhalation Signs of Cocaine Addiction

Smoking cocaine can produce the following:3

  • Coughing spells
  • Asthma or breathing problems
  • Pneumonia or other respiratory illnesses
  • Lips or fingers appearing burned, blistered, or blackened

Intravenous Signs of Cocaine Addiction

Injecting cocaine has observable signs, including:3

  • Needle, puncture, or track marks anywhere on the body
  • Skin infections
  • Scars from previous injections
  • Collapsed veins
  • Abscesses
  • Diseases such as Hepatitis C and HIV contracted by sharing needles

Oral Signs of Cocaine Addiction

Taking cocaine by mouth reduces blood flow to your intestines, leading to:3

  • Bowel decay
  • Blocked intestine
  • Intestinal tissue damage or death
  • Hole in the wall of the intestines causing leaks and infections

Cocaine Addiction Symptoms

Cocaine addiction symptoms are the behaviors you observe in yourself that lead to continued involuntary cocaine misuse. Symptoms are criteria for diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).4

To form a correct diagnosis and treatment plan, substance use providers classify signs of cocaine addiction as mild, moderate, or severe:4

  • Mild: you meet two to three DSM-5 criteria
  • Moderate: you meet four to five DSM-5 criteria
  • Severe: you meet six or more DSM-5 criteria

There are eleven cocaine addiction symptoms or criteria:4

  1. You misuse cocaine for longer periods and in larger amounts than you intend to do.
  2. You cannot quit using cocaine even though you want to and have tried to on different occasions.
  3. You spend much of your time in activities such as searching for money to buy cocaine, seeking, and buying cocaine, misusing cocaine, experiencing cocaine crashes, and recovering from cocaine addiction symptoms.
  4. You experience cravings and urges to use cocaine, and sometimes they become overwhelming and interfere with daily functioning.
  5. You find it difficult to complete tasks and fulfill responsibilities at home, work, school, and socially due to cocaine misuse.
  6. You continue to misuse cocaine even though doing so fractured meaningful relationships.
  7. You no longer participate in personal, professional, or social events and activities so you can use cocaine.
  8. You put yourself in dangerous situations to obtain and misuse cocaine.
  9. You continue to misuse cocaine even though it has caused or worsened a medical or psychological condition.
  10. The longer you misuse cocaine, you need more of it to achieve the same results.
  11. When you go without cocaine or try to stop using it, withdrawal symptoms appear, some of which can be debilitating.

Cocaine Tolerance

Tolerance to cocaine is number ten on the criteria list of cocaine addiction symptoms.4 Any substance tolerance is when you need more of the substance to achieve the results you felt in the beginning. For example, when you first used cocaine, snorting one line made you feel energized, aware, sociable, and happy.5

After using cocaine regularly for a month or more, you notice it takes two to three lines of cocaine to reach that same high. Tolerance is when you continue to use the same amount of cocaine, but the effects start to fade over time.5

As you increase the amount of cocaine to satisfy your tolerance, your body may become dependent on the stimulant. Dependence does not mean addiction. However, it does mean your brain and body have become so used to having cocaine in your system that they now rely on it to function—another cocaine addiction symptom.

Cocaine Withdrawal Symptoms

If you suddenly stop using cocaine, your body will undergo withdrawal, in which adverse symptoms may appear. These cocaine addiction symptoms are number eleven on the diagnostic criteria list for a stimulant use disorder.4

Withdrawal symptoms can range from mild to severe. For many, the only way to get rid of the withdrawal symptoms is to use cocaine again. This keeps users in a recurrent cycle of wanting and trying to quit but being unable to do so. Cocaine withdrawal symptoms include:6

  • Dysphoric moods including depression, dissatisfaction, or unhappiness
  • Fatigue or extreme tiredness
  • Vivid dreams that are often disturbing
  • Sleep problems such as insomnia or hypersomnia
  • Increased appetite
  • Psychomotor agitation such as pacing, tapping your toes, or manic behaviors

To avoid withdrawal symptoms, most continue to misuse cocaine.

Treatment for Cocaine Misuse

Researchers have studied signs of cocaine addiction and treatments thoroughly, and their findings inform treatment modalities used worldwide. Specialists create formal treatment plans that not only help you quit cocaine use but also teach you how to live soberly in the long term.

Motivational Interviewing

Much evidence supports the use of motivational interviewing (MI) when treating cocaine addiction symptoms. MI can begin any time, no matter how ready a person is to change. The purpose of MI is to explore why you are not ready to change, the consequences of that choice, and the benefits of entering recovery.

The process of MI internally motivates you to make behavioral changes. Evidence shows MI reduces the amount of cocaine a person uses daily and the overall number of days of stimulant misuse.7

Contingency Management

With contingency management (CM), therapists reward desired behaviors to encourage you to repeat those behaviors. Examples of incentives to promote recovery from cocaine addiction include:7

  • Earn cash for attending therapy sessions
  • Get a prize for having negative urine screens
  • Enjoy privileges for reaching recovery milestones
  • Earn vouchers for the exchange of products in community stores

CM, like motivational interviewing, reduces the number of days of stimulant misuse. However, it also reduces signs of cocaine addiction, including cravings for cocaine and risky behaviors.7

Community Reinforcement Approach

The community reinforcement approach (CRA) works best in conjunction with contingency management. The combination produces positive results, including reduced addiction severity and overall substance use. CRA teaches skills needed to succeed in all areas of your life, from career to relationship and drug refusal. Each time you reach a milestone in developing skills, you can earn a reward.7

Examples of CRA include:7

  • Relationship counseling
  • Job skills training
  • Vocational counseling
  • Social skills
  • Relapse prevention
  • Implementing recovery activities
  • Building social supports

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a popular, evidence-based therapy for treating cocaine addiction. You can receive CBT in individual, group, and family therapies. There is a recent increase in people receiving CBT through computer-based programs. Results show CBT reduces the amount and frequency of stimulant use and risky behaviors.7

Cognitive-behavioral therapy works to change thinking patterns to change unhealthy behaviors. It is a great technique to help those with co-occurring disorders such as depression and anxiety.

The Matrix Model

The Matrix model treats cocaine addiction using specific guidelines for helping you engage in therapy, set goals, and reach goals. Therapists act as coaches who help build your self-esteem, giving you the confidence and desire to succeed in recovery. Components of the Matrix model include:8

  • Relapse prevention skills
  • Early recovery skills
  • Family therapy
  • Group therapy
  • Education on stimulants for you and your family
  • Urinalysis
  • 12 Step and self-help participation

Finding the Right Stimulant Use Treatment Provider

Recovering from stimulant misuse is doable with the help of treatment professionals. When you begin your search for a provider, there are specific characteristics that can help you decide on a program. You want to find a program that:9

  • Understands there is no one-size-fits-all treatment program
  • Treats the whole person to offer the best outcomes for recovery
  • Provides quick access to treatment and allows you to stay for as long as needed
  • Believes medication can be beneficial to treatment
  • Uses traditional and alternative therapies

Addiction treatment specialists can help you narrow your search for the proper cocaine use treatment provider. You may call 866-968-5444Who Answers? at any time and they will connect you directly to the appropriate facility.


  1. Center for Behavioral Health Statistics and Quality. (2021). Key Substance Use and Mental Health Indicators in the United States: Results From the 2020 National Survey on Drug Use and Health. (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD. Substance Abuse and Mental Health Services Administration.
  2. National Institute on Drug Abuse. (2021). Cocaine Drug Facts.
  3. Center for Substance Abuse Treatment. (2021). Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series 33. SAMHSA Publication No. PEP21-02-01- 004. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  4. McLellan A. T. (2017). Substance Misuse and Substance use Disorders: Why Do They Matter in Healthcare?. Transactions of the American Clinical and Climatological Association, 128, 112-130.
  5. National Institute on Drug Abuse. (2018). Media Guide: The Science of Drug Use and Addiction, The Basics.
  6. S. National Library of Medicine. (2022). Cocaine Withdrawal. MedlinePlus.
  7. National Mental Health and Substance Use Policy Laboratory. (2020). Treatment of Stimulant Use Disorders. SAMHSA Publication No. PEP20-06-01-001 Rockville, MD. Substance Abuse and Mental Health Services Administration.
  8. National Institute on Drug Abuse. (2020). The Matrix Model (Stimulants).
  9. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction Drug Facts.
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