Cocaine is a highly addictive central nervous system stimulant derived from the coca plant. Its effects stem from its ability to rapidly increase dopamine levels in the brain’s reward pathways. This flood of chemicals produces a short-lived feeling of euphoria and energy, which is followed by a sudden emotional crash. Understanding the distinct phases of cocaine use—intoxication, long-term damage, and withdrawal—provides clear, observable signs for concerned family members.
Recognizing Acute Intoxication
The immediate signs of cocaine use relate to its stimulating effects on the body and mind. Cocaine acts as a vasoconstrictor, narrowing blood vessels and rapidly increasing heart rate and blood pressure. The person may appear flushed or excessively sweaty, and their body temperature may be elevated (hyperthermia).
A person under the influence often displays mydriasis, or significantly dilated pupils, which may not react normally to light. They exhibit high energy and restlessness, speaking rapidly and sometimes rambling or jumping between topics. This hyperactivity is often accompanied by an inflated sense of confidence or extreme talkativeness.
Emotionally, the acute phase manifests as sudden shifts in mood. Initial feelings of intense euphoria can quickly give way to agitation, irritability, and aggression. Paranoia and anxiety are also common, where the individual may become highly suspicious of others or feel they are being watched. These intense psychological effects are a direct result of the chemical overstimulation in the brain.
Physical Indicators of Long-Term Use
Chronic cocaine use, particularly when snorted, leaves behind noticeable and often permanent physical evidence unrelated to the immediate high. Intranasal use constricts blood vessels in the nose, significantly reducing blood flow to the delicate tissues and cartilage. This lack of oxygen and nutrients can cause the tissues to die, leading to chronic damage.
Frequent nosebleeds, chronic sinus infections, and a persistent runny or stuffy nose indicate this damage. Over time, the septum—the cartilage wall dividing the nostrils—can become perforated, potentially leading to a collapse of the nasal structure. White powder residue around the nostrils or unexplained crusting inside the nose is a direct sign of intranasal usage.
Long-term use impacts the entire body beyond nasal damage. Cocaine suppresses appetite, often resulting in rapid weight loss or a malnourished appearance. For intravenous users, track marks or puncture sites may be visible on the arms, legs, or other areas. Chronic abuse also strains the cardiovascular system, contributing to elevated blood pressure and an increased risk of heart problems.
Behavioral Signs During Withdrawal
Once the stimulating effects of cocaine wear off, the user enters a “crash” or withdrawal phase, characterized by symptoms opposite to intoxication. This state occurs because the brain’s dopamine supply has been severely depleted, leaving the person unable to experience pleasure or motivation. This period often begins within hours of the last use and is marked by profound emotional and physical exhaustion.
Extreme fatigue, or hypersomnia, is a hallmark of this phase, with the individual often sleeping excessively for hours or days. When awake, they experience intense dysphoria (a general state of unease) and may display symptoms of severe depression, sometimes including suicidal ideation. The psychological craving for the drug is strongest during this time.
The withdrawal period includes slowed physical and mental activity, known as psychomotor retardation, making the person appear sluggish or lethargic. Difficulty concentrating and a lack of motivation contribute to an inability to perform daily tasks or maintain responsibilities. Anxiety and irritability can persist, along with an unusual increase in appetite as the body attempts to recover.
Taking Action and Seeking Resources
Identifying the signs of cocaine use involves approaching the situation with compassion and a focus on safety. When confronting a person, a non-judgemental and supportive stance is more likely to open a path toward treatment than accusatory language. Prioritize safety, especially if the person exhibits paranoia, aggression, or severe suicidal depression, which can occur during intoxication or withdrawal.
The most effective action involves directing the person toward professional resources for immediate support and long-term care. The Substance Abuse and Mental Health Services Administration (SAMHSA) operates a National Helpline that offers free, confidential treatment referral and information 24 hours a day: 1-800-662-HELP (4357).
For situations involving an immediate emotional crisis or thoughts of self-harm, the 988 Suicide & Crisis Lifeline is available nationwide by calling or texting 988. These services provide emotional support and connect individuals with local addiction specialists and medical detox facilities. Utilizing SAMHSA’s Behavioral Health Treatment Services Locator tool online also helps find appropriate services near home.