Cocaine comes from the leaves of the coca plant, which is native to South America. The ancient Incas would chew the leaves centuries before chemist Albert Niemann identified cocaine within the leaf. He observed that when he placed cocaine crystal on his tongue, it became numb. In the mid and late nineteenth century, doctors experimented with using cocaine as anesthesia for surgery. By the early twentieth century, cocaine was known to be highly addictive, but could still “be easily obtained from a local chemist,” according to an article published in the journal Anesthesiology and pain medicine.

In 1914, cocaine became illegal in the United States. Currently, it is classified as a Schedule II drug, which means it has a high potential for abuse and addiction, but also has limited medical use as a local anesthetic for specific surgeries.

How Cocaine Is Used

Cocaine is typically sold as a white crystalline powder. It is also known as coke, snow, blow, crack, and rock. The powder can be sniffed into the nose (also called snorting) or it can be dissolved into a solution and injected into the bloodstream. Another form is crack cocaine, or crack, which is a solid crystal. Crack is heated to create vapors that are inhaled into the lungs. Users can also sprinkle cocaine and crack into marijuana or tobacco cigarettes and smoke them.

How quickly a cocaine high occurs and how long it lasts depends on how the drug is taken. When cocaine is snorted, the high typically lasts longer, up to 30 minutes, compared to smoking in a marijuana or tobacco cigarette. The high from crack cocaine is much shorter-lived, lasting only 5 or 10 minutes. As a result, users require more frequent hits to maintain the intense but brief high.

Cocaine or crack users quickly develop a tolerance, or a need to increase the frequency and the dosage of the drug in order to maintain the desired high.

How Does Cocaine Affect the Brain?

Cocaine inhibits nerves from reabsorbing dopamine, a neurotransmitter associated with the brain’s reward center, producing an excess of dopamine in the system and a resulting “high.” Nerve receptors adjust to the increased levels of dopamine, so over time, more cocaine is needed to re-create the same high.

In 2011, research from the University of Cambridge found “cocaine users had a widespread loss of grey matter that was directly related to the duration of cocaine abuse.”

How Addictive is Cocaine?

Many sources, including the National Institute on Drug Abuse (NIDA), identify cocaine as “a powerfully addictive stimulant drug.” A study conducted by a team at Johns Hopkins University presents evidence about the “risks for progression from first drug use to the onset of drug dependence.” Of the three drugs included in the study, marijuana, alcohol, and cocaine, “cocaine dependence emerged early and more explosively” than the others.

Within the first year of cocaine use, the study estimates that “5-6% of cocaine users [became] dependent.” The study also noted that of the three drugs, cocaine has the highest risk of developing a dependency after just the first use. Researchers at the University of Cambridge call cocaine “one of the most addictive drugs on the illicit drug market.”

Many variables, such as family history, age, gender, socio-economic status, past trauma, and previous drug use, influence the likelihood of substance dependency.

Because the brain adapts to the ever-increasing levels of dopamine, part of cocaine’s addictiveness is the need to take it more frequently and in higher doses. The loss of grey matter in the brain, discovered by the research team at the University of Cambridge, compounds the need for increased dosages and frequency; they believe that the “reduction [of grey matter] was associated with greater compulsivity to take cocaine.”

Addiction is more likely to occur with repetitive use, but for some, cocaine addiction will happen with the first use. Research done at the University of Cambridge has shown that the brain’s basal ganglia, an area associated with the reward system, is enlarged in the brains of cocaine users. Because the “size of the enlargement was not related to the duration of the cocaine use” and “predate[s] cocaine abuse,” it is possible that individuals with larger basal ganglia may be more susceptible to cocaine addiction than the general population.

Dangers of Cocaine Use

Cocaine’s highly addictive nature is a danger unto itself, however, there are additional risks associated with the drug. These risks include but are not limited to, physical and psychological changes, the possibility of dangerous contaminants added to the drug, combining cocaine use with other drugs, especially alcohol and heroin, and losing friends, family, and jobs as a result of addiction.

Physical and Psychological Effects

In addition to the changes in the brain’s reabsorption of dopamine and the loss of grey matter, cocaine causes a variety of physical changes in the body. Short-term effects include headaches, nausea, and abdominal pain. Cocaine has earned the reputation of “the perfect heart attack drug” because it constricts blood vessels and increases body temperature, heart rate, and blood pressure. These effects stress the cardiovascular system and can cause a heart attack, even with a single use. Other severe side effects can include stroke and coma.

NIDA reports that long-term effects of cocaine include nasal damage (from snorting), lung damage (from inhaling or smoking), and risk of HIV (from injecting). Over time, because cocaine suppresses appetite, users can suffer poor nutrition and extreme weight loss.

Psychological effects of cocaine use include, but are not limited to, anxiety, paranoia, panic attacks, and insomnia.


Street sellers often mix cocaine with other materials, known as adulterants, such as talcum powder, cornstarch, or flour to dilute their product and maximize their profits. The BBC UK reported other adulterants, including benzocaine (a local anesthetic), boric acid (an insecticide and antiseptic), and even different types of sugars have been identified in cocaine. These adulterants only benefit the seller and can be harmful to the user.

Mixing cocaine with other drugs

Cocaine is frequently used alongside alcohol and heroin. Combining drugs amplifies the potential risks of each substance, increasing the chances of an overdose.

Cocaine is a stimulant, so many users also drink alcohol, a depressant, to help reduce irritability or anxiety that can occur with cocaine use. Stimulants and depressants have opposite physical effects on the body, so using them together can create a variety of symptoms such as heart palpitations, confusion, chest pain, nausea, and seizures. When cocaine and alcohol are consumed together, the liver produces cocaethylene, which increases the risk of sudden death compared to using either coke or alcohol alone.

Combining cocaine with heroin is known as speedballing, a method by which the two drugs are simultaneously snorted or injected. The combination of these two substances can create erratic side effects, including confusion, paranoia, blurred vision, and drowsiness. If done over time, users who combine heroin and cocaine risk respiratory failure, heart attack, and stroke.

Impact on relationships and daily life

Cocaine addiction, like any other substance use disorder, impacts users’ personal and professional relationships. Because cocaine is highly addictive, it can quickly become a user’s primary focus. Medical News Today states, “lifestyles may alter completely as addiction takes hold.” Losing the trust of family, friends, and coworkers isolate the user and makes creating a support network for rehabilitation difficult.

Treatments for Cocaine Addiction

Treatment for cocaine addiction must start with the user acknowledging they need to make changes in their life. Attempting to stop using cocaine without professional assistance is not recommended. The highly addictive nature of cocaine makes it challenging to stop and relapses are common.

Behavioral therapy is often used to provide the user strategies and skills to make healthier life choices. A critical step to overcoming cocaine addiction is to have a plan in the event a relapse occurs. Because cocaine is highly addictive, the odds of relapse are extremely high. Knowing and recognizing various triggers that will tempt a person to use again is invaluable.

At this time, unlike treating alcohol or opioid dependence, there are no prescription drugs to help assist recovery from cocaine addiction. Researchers continue to search for methods to minimize withdrawal symptoms, such as depression, fatigue, insomnia, and sluggish thinking.

If cocaine addiction is a concern, seek out professional help. Because it is one of the most addictive drugs worldwide, users who want to recover need a stable support network of licensed treatment providers, friends, and family who help them lead a sober lifestyle.

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