Cocaine dependence

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 21, 2016
StartDiseasesCocaine dependence

Cocaine is a highly addictive drug that is mostly used for recreational purposes. When used, cocaine produces a large amount of energy in addition to euphoria or the feeling of being 'high.' There are also negative side effects to using cocaine which include anxiety, panic attacks, and depression. After using cocaine for some time, a cocaine user may develop a cocaine dependence that can be a physical dependence or a psychological dependence or both. Most cocaine users also experience a 'come down,' which is a period of depression and anxiety following their drug use. 


Definition & Facts

Cocaine itself is a derivative of the coca plant. In many indigenous cultures, coca leaves are chewed in a way that is similar to nicotine in other countries and cultures. Coca leaves give a mild stimulant rush that is very comparable to caffeine. Cocaine is a highly refined version of this coca leaf.

Cocaine dependence is defined as an addiction that occurs when a cocaine user cannot function in their life without having cocaine. They may have all-consuming thoughts about finding cocaine or they may simply become depressed. They may also experience the physical symptoms of withdrawal

Symptoms & Complaints

When used on a regular basis, those with cocaine dependence will often appear to be manic or overly energetic. They may experience bouts of psychosis (cocaine psychosis), during which time they may either believe delusions or become extremely paranoid.

Those who have a cocaine dependency may become aggressive for seemingly no reason. They may also experience a crawling sensation around their skin and believe that there are bugs either on them or within their skin. Because of this, cocaine users will frequently pick at their skin and they may develop a rash or open sores. Other cocaine users may begin pulling out their hair.

Those with cocaine dependence who are going through withdrawal will experience a "crash." They may be exhausted and low energy and they may become nauseated and begin to vomit. They may experience depression and anxiety without cocaine and they will very frequently experience all-consuming thoughts about acquiring more cocaine.


Because cocaine is a highly addictive substance, any amount of regular use has the potential to create a dependency. How quickly a dependency and addiction forms depends on the individual. Most addictions and dependencies are both psychological and physical. There are physical elements of withdrawal but also often a psychological need to avoid the unpleasant emotional consequences of withdrawal.

Women may be more affected by cocaine dependence than men. Additionally, those who begin using cocaine in their pre-teens (12 to 13) are also far more likely to become addicted. Of those who have used cocaine for the first time, about 5% to 6% are at risk of becoming dependent. The psychological and social causes of cocaine dependency can be varied and complex, but physical dependency can occur if the drug is used often. 

Diagnosis & Tests

Diagnosis of a cocaine dependency usually comes along with the above listed symptoms in addition to a positive drug test. Some patients may not be physically addicted to the drug but instead may have a pattern of going back to the drug when they experience life stressors, such as a loss in their family or problems at work. Individuals who have this problem are often diagnosed with a cocaine use disorder, which involves dependence as well as compulsive behavior and persistent negative consequences of cocaine use upon a person's quality of life.

Often during the course of treatment for cocaine addiction, periodic drug tests will be administered. Cocaine generally stays within an individual's system for two to three days, but this is only for blood tests. Hair tests can give more information and are thus more useful for tests in which long-term use is suspected. 

Treatment & Therapy

Cocaine addiction is usually treated through the use of behavioral modification programs. These programs include twelve-step programs (like the popular Alcoholics Anonymous, which also has a version called Narcotics Anonymous and Cocaine Anonymous). These twelve-step programs outline a path to recovery with a set of guiding principles and an approach that involves group therapy. Cognitive behavioral therapy, a form of psychotherapy, has also been successfully used to treat cocaine dependency. 

There are also pharmaceutical treatments such as modafinil. Modafinil is a drug used to treat narcolepsy that is believed to ease the transition away from cocaine, much as methadone is used to ease a user's transition away from heroin. Other addiction treatments have also been applied to cocaine addiction like acupuncture and hypnosis. The most successful treatments usually involve either in-patient or out-patient drug rehabilitation.

Cocaine addiction often comes with other issues, such as untreated mental disorders such as anxiety and depression. When this is the case, these psychological issues generally have to be treated alongside the cocaine dependency; otherwise the patient may relapse or may simply start using other recreational drugs. It is called comorbidity when a patient has two different types of chronic illnesses at once.

Prevention & Prophylaxis

As noted, 5 to 6% of individuals who use cocaine are likely to develop a dependency. Dependency does have risk factors, but the most important risk factor is regular usage of the drug. By avoiding regular use of the drug, cocaine dependence can be largely prevented. However, there is no generally agreed upon "resting" period between periods of drug use that could be said to be safe. Every individual is different and even those who use the drug infrequently could eventually become dependent.

There are medications that are being studied that could potentially function as a prophylactic aid that would remove the effect of cocaine on the body, but these are still in the very early stages of study and are not yet prepared for human trials. The best way to avoid cocaine dependence is to avoid cocaine altogether.