Cocaine is a powerful stimulant that acts directly on the central nervous system, producing an intense but short-lived euphoric effect. Identifying its use involves recognizing a combination of immediate physical changes, distinct behavioral shifts, and, in cases of regular use, long-term physiological and lifestyle markers. These signs result from the drug rapidly increasing levels of the neurotransmitter dopamine in the brain’s reward circuit. The effects appear quickly, often within minutes, but the intense high is brief, lasting from a few minutes to less than an hour, depending on the route of administration.
Immediate Physical Manifestations
One of the most noticeable physical signs during acute intoxication is mydriasis, the significant dilation of the pupils. This effect is caused by cocaine’s stimulation of the sympathetic nervous system, overriding the normal response to light. The eyes may also appear bloodshot, a secondary effect of the drug’s impact on small blood vessels.
The drug’s stimulant properties place significant stress on the cardiovascular system, leading to a rapid heart rate (tachycardia) and an elevation in blood pressure. This acute physiological response constricts blood vessels throughout the body, making cocaine use dangerous, even for first-time users. A person under the influence may also exhibit tremors, muscle twitching, or an inability to remain still.
This hyperactivity often manifests as restlessness and continuous fidgeting, as the body processes the intense stimulation. Due to the drug’s effect on body temperature regulation, an individual may appear flushed or sweat excessively, even in a cool environment. A visible white powder residue around the nostrils or on the face can be an immediate indicator, particularly after snorting the drug.
Behavioral and Psychological Indicators
The psychological impact of cocaine use is characterized by a rapid change in mood and energy. Users often experience intense euphoria, coupled with an inflated sense of self-esteem, grandiosity, and excessive confidence. This heightened state can manifest as incessant, rapid, or pressured speech that jumps quickly from one topic to the next.
While appearing energetic and alert, the person may display agitation, irritability, or hypervigilance. This shift often progresses to intense anxiety or paranoia, where the individual becomes overly suspicious and distrustful of their surroundings. In some cases, this paranoia can lead to tactile hallucinations, such as the sensation of insects crawling under the skin (formication).
The massive surge of dopamine drastically reduces the perceived need for sleep and food. A person may stay awake for long periods, exhibiting boundless energy disproportionate to their recent activity or rest. This intense alertness and lack of fatigue are hallmarks of acute stimulant intoxication.
Signs of Chronic Use and Lifestyle Changes
With repeated use, particularly through snorting, long-term physical damage becomes apparent in the nasal passages. Chronic users may experience frequent nosebleeds, a persistent runny nose, or ongoing congestion. Over time, this can lead to severe damage, including the perforation of the nasal septum due to the drug’s vasoconstrictive and corrosive properties.
The appetite suppression often results in significant, unexplained weight loss and a malnourished appearance. Chronic use often leads to a decline in personal hygiene and a neglect of physical appearance. This physical decline is frequently accompanied by a change in social and financial behavior.
Unexplained financial strain, borrowing money, or an inability to meet financial obligations can signal the costly nature of a sustained drug habit. The presence of specific paraphernalia, such as small plastic baggies, razor blades, mirrored surfaces, rolled-up currency, and cut straws, indicates administration methods. Absenteeism from work or school and withdrawal from previously enjoyed social activities are common markers of a lifestyle centered on drug seeking and use.
Post-Use Effects and Withdrawal
Once the immediate effects wear off, the individual experiences a distinct “crash,” the opposite of the high. This period is marked by a profound drop in energy, often leading to extreme fatigue and a desire to sleep for extended periods (hypersomnia). The crash is a direct result of the brain’s attempt to rebalance its neurochemistry after the intense dopamine depletion.
Mood shifts dramatically from euphoria to severe dysphoria, characterized by intense depression, anxiety, and irritability. This low mood and inability to feel pleasure can be debilitating and are often associated with intense cravings to use the drug again. This rebound effect frequently causes an increased appetite, which contrasts sharply with the lack of hunger during intoxication.
While physical symptoms like vomiting are not typical, the psychological distress is significant and can persist for days. The combination of profound fatigue and severe depression indicates that the stimulating effects have passed, leaving the central nervous system exhausted and depleted. This state often represents the beginning of a withdrawal phase.