The cocaine dilemma: the psychological impact of cocaine

Cocaine, the second most used illicit drug in the UK, is a powerful psychostimulant with a profound effect on the people who use it.

A 2018 survey reported that 56% of students in the UK had taken drugs, with cocaine being one of the most common substances taken. This is concerning, as cocaine addiction for students is associated with lower grades, taking longer to finish university, riskier sexual behaviours, greater impulsivity and treatment for psychological/emotional problems.

We’re going to explore the highs and lows of cocaine, its psychological impacts, and what to do if you’re struggling with it.

Highs and lows

Cocaine is most commonly snorted, meaning its effects hit the user fast, and the drug rapidly enters the bloodstream. The immediate psychological effects of cocaine are sensations of happiness, excitement, alertness, talkativeness, and confidence. It can induce a restless feeling and reduce the desire for food and sleep. Cocaine may feel euphoric. These effects are short-lived, wearing off after 30-40 minutes, meaning users will need to take more very quickly to maintain the high.

Cocaine affects the limbic system, a deep structure of the brain associated with emotional processing. Parts affected include the nucleus accumbens, amygdala, hippocampus and the frontal cortex. These all play a vital role in cocaine’s ability to induce pleasure, loss of control and compulsive drug-seeking behaviour. The effect on the nucleus accumbens, in particular, leads to intense pleasure and is associated with linking emotional responses to memories and affecting decision-making processes.

With so much of the brain caught up in these pleasurable sensations, the desire to take cocaine repeatedly can be intense. However, there is an extremely long list of negative psychiatric effects from taking cocaine compulsively.

This is your brain on coke

Chronic cocaine usage can trigger numerous psychiatric symptoms, such as paranoia, agitation, delusions and hallucinations. Concerningly one psychological effect of chronic usage is homicidal and suicidal ideation. It is not always clear if these effects are caused by cocaine itself or because of a comorbid psychiatric disorder, but cocaine itself does cause huge shifts in the brain and how it functions.

When cocaine is taken, it increases the amount of dopamine available in the brain, which feels good, as dopamine is associated with pleasure and motivation. However, over longer periods, the brain’s dopamine system becomes chronically disrupted, leading to mood swings, irritability and psychiatric symptoms. This dysregulation also leads to impaired judgement.

Disruption of the dopamine pathways also leads to an impaired ability to stay focused and pay attention in the long term. Chronic cocaine users show weaker connections between the midbrain and other areas on brain scans. These areas allow us to remain attentive when they work together – when they’re struggling to communicate, we lose our ability to pay sustained attention.

Chronic cocaine usage can also diminish the function of the orbitofrontal cortex. This region is critical for decision-making, emotion, and social behaviour, so it is not surprising that disrupting it leads to poor decision-making, an inability to adapt to the negative consequences of the drug and a lack of self-insight.


Because cocaine is very commonly taken at the same time as alcohol, another substance needs to be looked at – cocaethylene. Cocaethylene is the only known instance where two drugs taken together combine in the body to create a third drug.

Cocaethylene has similar properties to cocaine but may be worse for your heart. It also lasts longer than cocaine, which may be one reason why taking alcohol and cocaine together is so popular. Cocaethyleneis longer-lasting and has more intense psychological effects, meaning that the user feels higher for longer. Because of this, cocaethylene has the potential to make both addictions worse.

Cocaine addiction

The mechanisms that develop a cocaine addiction are complex, and many immediate and long-term effects on the brain facilitate it.

Using cocaine repeatedly over a long period causes structural changes in the brain and can make new dendrites grow in the nucleus accumbens. It has been proposed that this is one of the factors that underlie persistent cravings and the risk of relapse in people addicted to cocaine, even when someone has been abstinent for a long time.

Once addicted, people will experience a range of symptoms – cravings, needing to take more for the same effect, losing interest in hobbies and interests, continuing to use it despite negative consequences, and withdrawal symptoms when attempting to stop.

Cocaine addiction causes a range of physical effects, which can be mentally difficult to experience because they’re so frightening. This is because cocaine is extremely hard on the cardiovascular system. These include high blood pressure, hardening of the blood vessels supplying the heart, heart failure, and strokes. If a person continues to use cocaine despite these symptoms, these can be fatal.

Comedown and withdrawal

In the short term, the comedown after a night of cocaine usage is unpleasant but not dangerous – lethargy, runny nose, agitation, irritation, paranoia and depression. The effects of long-term usage are much more serious.

Withdrawal symptoms are similar to comedown symptoms but much more intense. They can include agitation, depression, fatigue, discomfort, increased appetite, vivid and unpleasant dreams and a general slowing down, known as psychomotor retardation. These symptoms can last for a long time after cocaine is discontinued, and people may feel intense cravings and have suicidal thoughts. Unlike alcohol or opioids, cocaine doesn’t tend to cause visible physical symptoms like shaking and vomiting.

Cocaine can be very difficult to quit because the withdrawal symptoms can last for a long time, and cravings can be persistent.

The last line – tactics for recovery from cocaine addiction.

Recovering from cocaine addiction requires sustained commitment. Factors found to be relevant in staying off cocaine permanently are strong social support, commitment to abstinence and high self-efficacy. Studies have found lower levels of depression in people who have managed to quit permanently.

The correct support, like cocaine rehab clinics, supportive communities, and the right therapy, are essential for creating healthier habits. Therapy helps to create new coping mechanisms and tackle underlying mental health problems like depression and anxiety. Addressing these lowers the risk of relapse. Uncovering the root causes of your addiction and learning to cope with stress, triggers, and cravings are essential for long-term recovery.

If you’re prepared to address your alcoholism and seek assistance, contact UKAT’s specialists in alcohol addiction. Discover the support and solutions they can provide to help you on your journey to recovery.

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