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Cocaine Psychosis: Signs, Symptoms And Risk Factors

Joseph Sitarik, DO

Medically reviewed by

Joseph Sitarik, DO

April 2, 2019

Cocaine has powerful effects on the brain and may cause symptoms of cocaine-induced psychosis. Treatment for cocaine psychosis may include an inpatient rehab program, which can provide care to help individuals overcome their problem with cocaine.

Cocaine psychosis is a drug-related side effect that may be experienced by up to 53 percent of those who use cocaine. Long-term use of cocaine can put a person at greater risk for symptoms linked with this condition, including hallucinations and extreme paranoia.

Cocaine may also worsen psychotic symptoms experienced by people with co-occurring mental disorders.

Symptoms of cocaine psychosis may last hours, days, or weeks depending on the amount used and other factors. People who experience cocaine psychosis are often dependent on cocaine and may need inpatient treatment to recover from problems related to their drug use.

What Is Cocaine Psychosis?

Cocaine psychosis is a psychological effect that can occur when a person has taken cocaine. Most often it includes symptoms of extreme paranoia, irrational thinking, or hearing things that are not real.

The term psychosis on its own refers to a condition in which someone may experience distorted perceptions of sight, sound, and sense of reality. People who are psychotic may act out in ways that are violent or aggressive. They may also display severe paranoia about others and their surroundings.

How Does Cocaine Psychosis Occur?

Cocaine is a powerful stimulant that can cause changes in the levels of certain brain chemicals. This includes dopamine, a neurotransmitter linked with feelings of pleasure and the brain’s ‘reward’ system — which can encourage repeated drug use.

Cocaine causes both an increase and release of dopamine in the brain. A release of dopamine in the brain can cause feelings of pleasure and an increased sense of well-being. Increased levels of dopamine, on the other hand, have been linked to aggressive, angry, and psychotic behavior.

Repeated use of cocaine can further disrupt dopamine levels. This disruption, as well as cocaine’s effects on other brain chemicals, can cause greater instability in mood and behavior over time.

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Symptoms Of Cocaine Psychosis

The primary symptoms that can occur with cocaine psychosis include hallucinations, paranoia, and delusional thinking.

General signs of cocaine psychosis include:

  • violent or aggressive behavior
  • pinching skin
  • increased agitation
  • compulsive behaviors
  • suspiciousness
  • confusion

Cocaine Hallucinations

Hallucinations can be common among those who use cocaine, particularly in cases of chronic abuse. Cocaine hallucinations can be visual, auditory, or tactile (touch). The most common hallucinations experienced with cocaine abuse are auditory hallucinations. This can involve hearing sounds and voices that are not real. Visual and tactile hallucinations may involve seeing people that are not there, or feeling as though there are parasites crawling underneath the skin.

Cocaine Paranoia

Paranoia may be the most common symptom experienced with cocaine psychosis. This symptom has been observed in up to 84 percent of those who use the drug. This paranoia may cause a person to show signs of distrust, withdraw from others, or act out in violent or aggressive ways. Before experiencing a full-blown episode of paranoia, the person may also act increasingly suspicious of others.

Cocaine Delusions

Delusions are irrational beliefs that often affect how a person behaves. Cocaine-related delusions may overlap with symptoms of paranoia, such as believing someone is following or watching them.

Those who take cocaine may also experience grandiose delusions, in which they feel an inflated sense of power or authority (e.g. believing themselves to be a ‘God’ figure). Identity delusions can also occur. This involves a person doubting who they are, or questioning the identity of a family member or friend.

Risk Factors For Cocaine Psychosis

Research shows that certain biological and personal factors can increase the risk of experiencing psychosis with cocaine dependence.

These risk factors include:

  • The Frequency of Use: People who repeatedly use cocaine over an extended period of time may be more likely to experience psychotic symptoms. This may be due to the effects repeated drug exposure can have on brain pathways, causing disruption severe enough to result in symptoms of psychosis.
  • Dose/Amount: Large amounts of cocaine, or multiple doses within a short window, may be more also likely to result in psychotic symptoms.
  • Method of Use: Those who inject cocaine intravenously or use crack cocaine may more likely to experience drug-induced psychosis. The difference in risk is believed to be tied to how quickly cocaine may be absorbed in the body. Thus, methods of use that cause faster absorption of cocaine may result in more intense drug effects, including psychosis.
  • Body Mass Index (BMI): Body mass index refers to a ratio of height to weight used for measuring body size. It is believed that people of a smaller body size may be more likely to experience cocaine psychosis. Those with a higher BMI then may be better protected against cocaine psychosis than lower-BMI individuals, depending on the amount used and other factors.
  • Age: Those who began using cocaine at a younger age may be more likely to experience psychiatric disturbances due to the effects of cocaine on brain development. Additional research on crack cocaine found that older age may also put a person at greater risk for psychotic symptoms.
  • Co-Occurring Mental Disorders: People who have certain co-occurring mental disorders may be at greater risk for cocaine psychosis. This includes people with:
    • ADHD
    • schizophrenia
    • bipolar disorder
    • antisocial personality disorder (ASPD)
    • borderline personality disorder (BPD)
  • Polydrug Use: Those who take other substances in addition to cocaine, such as marijuana or hallucinogens like PCP, may be at increased risk for cocaine psychosis.

Signs Of Cocaine Use

Chronic use of cocaine over a long period of time can cause severe damage to a person’s physical and mental wellbeing. Cocaine’s effects on the brain can make it harder for a person to stop using the drug on their own, causing people to feel out of control and unable to quit.

Being able to identify signs that you or a loved one may be addicted to cocaine can help you identify when it may be necessary to seek treatment for cocaine abuse.

Common signs of cocaine abuse include:

  • dilated pupils
  • nosebleeds (with snorting)
  • bloodshot eyes
  • tremors or muscle twitches
  • restlessness
  • extreme sensitivity to touch, sight, and sound
  • irritability

Long-term health effects can also occur with chronic cocaine use. Some long-term consequences of chronic cocaine use include poor nutrition due to cocaine’s effect on appetite, and the development of certain movement disorders such as Parkinson’s disease.

Additional long-term effects may vary depending on how the drug is used (i.e. snorted, smoked, injected, taken by mouth).

Treatment For Cocaine Abuse And Addiction

Cocaine dependence is a serious illness that requires comprehensive treatment to address all aspects of the addiction. The first step in treating symptoms of cocaine use is to detox from the drug. The safest and most effective way to do this is under the supervision of doctors in a medical detox program.

Additional treatment within an inpatient drug rehab program may also be needed to address the emotional and mental sides of addiction. This includes treatment for persisting symptoms of cocaine psychosis and other problems related to cocaine use.

Dual-diagnosis treatment, which involves treating both substance abuse and co-occurring mental health disorders, can be effective in treating psychosis that persists after drug withdrawal. Behavioral therapy and medication-assisted treatment can also be beneficial in the treatment of cocaine addiction.

If you or a loved one are showing signs of cocaine psychosis, contact us today to learn more about cocaine treatment options.

U.S. National Library of Medicine - Cocaine and Psychiatric Symptoms

National Institute on Drug Abuse - DrugFacts: Cocaine

Actas Esp Psiquiatr - Prevalence and risk factors of psychotic symptoms in cocaine dependent patients

Taylor and Francis Online - An International Perspective and Review of Cocaine-Induced Psychosis: A Call to Action

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