When someone uses cocaine for an extended period, cocaine-induced psychosis can occur, often involving potentially dangerous hallucinations and delusions.

Cocaine is a commonly used drug that produces feelings of euphoria, increased energy and a false sense of well-being. Cocaine psychosis is one of the dangerous side effects of using cocaine.

What is Cocaine-Induced Psychosis?

While some people may find that using cocaine allows them to feel happier and sociable, other people feel the effects of paranoia or symptoms similar to schizophrenia. When someone uses cocaine for an extended period, a condition referred to as cocaine-induced psychosis can occur.

Psychosis is a symptom of several mental health conditions, but the symptoms of cocaine-induced psychosis only occur during intoxication or withdrawal. It can produce elaborate hallucinations and delusions.

Does cocaine make you paranoid?

Cocaine paranoia is the main symptom of cocaine-induced psychosis. According to one study, more than two-thirds of the people who have used cocaine reported paranoia following use. Before the onset of cocaine paranoia, people may develop suspiciousness, which is a precursor of paranoia. Cocaine paranoia can cause someone to act aggressively or violently toward other people.

Does cocaine make you hallucinate?

When someone uses a large amount of cocaine over an extended period, they may experience hallucinations. Hallucinations may cause someone to be paranoid and delusional and could prevent them from managing real dangers. Hallucinations may cause someone to ignore environmental signs like traffic lights because they are instead focusing on something that isn’t real.

Does cocaine make you delusional?

Another primary symptom of cocaine psychosis is cocaine delusions, which are false beliefs that a person cannot be convinced are wrong. Someone may experience different types of delusions, including:

  • Identity delusions – Someone experiencing an identity delusion may not know who they are or think they’re someone they’re not.
  • Possession delusions – A possession delusion may involve someone thinking they own things they do not, like houses and cars.
  • Grandiose delusions – Someone who has grandiose delusions can have over-inflated self-esteem, power, knowledge or identity.
  • Imposter delusions – Imposter delusions are when someone is suspicious of the true identity of family members, friends or other people.

How Long Does Cocaine Psychosis Last?

Cocaine-induced psychosis lasts anywhere from a few hours to as long as days or weeks. More than half of the people who have used cocaine reported experiencing cocaine psychosis symptoms after using cocaine. The more someone uses cocaine, the more severe the symptoms of cocaine psychosis can become over time. Research suggests that cocaine-induced psychosis is a result of a dopamine imbalance.

Symptoms of Cocaine-Induced Psychosis

The symptoms of cocaine-induced paranoia can resemble the symptoms of a mental health disorder like bipolar disorder and schizophrenia. Some common symptoms of cocaine-induced psychosis include:

  • Paranoia
  • Anxiety
  • Disorganized thoughts
  • Delusions
  • Violence
  • Anger
  • Hallucinations
  • Delirium
  • Suicidal or homicidal thoughts

Risk Factors of Cocaine Psychosis

Because cocaine affects dopamine, there are several risk factors for someone developing cocaine-induced psychosis. Researchers found that studying these factors could provide answers for why psychotic symptoms emerge following substance use.

The risk factors of cocaine psychosis may include:

  • Amount of cocaine used
  • Diagnosis of an antisocial personality disorder
  • History of marijuana use

Related Topic: Cocaine Addiction Self-Assessment Quiz

Treatment Options for Cocaine Psychosis or Paranoia

The first step for treating cocaine-induced psychosis is detox in a hospital or a rehab facility that offers medical detox. It’s important the person stops their cocaine use so that the psychosis can be treated as well. Once detoxification is complete, the person can either inpatient or outpatient treatment depending on the severity of their addiction. In both programs, the person will likely engage in therapy and could be prescribed medication for their psychosis.

The type of therapy that the person receives is determined by their:

  • Mental health disorder
  • Overall health
  • Recovery goals
  • Potential threats to sobriety

In addition to treating the person’s cocaine addiction, treatment providers can address their psychosis as well. Clinicians may feel that the person needs to take medication to help manage their psychosis symptoms.

Some of the medications prescribed for psychosis treatment include:

Treatment providers may not consider using some anti-anxiety medications like benzodiazepines because of the high risk of addiction.

If you or someone you know struggles with cocaine use and psychosis, help is available. At The Recovery Village, a team of professionals can design an individualized treatment program to suit your specific conditions. Call and speak with a representative to learn more about which program could work for you.

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Editor – Melissa Carmona
Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more
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Medically Reviewed By – Dr. Jessica Pyhtila, PharmD
Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more

Morton, W. Alexander. “Cocaine and Psychiatric Symptoms.” The Primary Care Companion to the Journal of Clinical Psychiatry, August 1999. Accessed July 31, 2021.

Roncero, Carlos, et al. “Risk factors for cocaine-induced psychos[…]e-dependent patients.” European Psychiatry, March 2013. Accessed July 31, 2021.

Satel SL, et al. “Clinical Features of Cocaine-Induced Paranoia.” American Journal of Psychiatry, April 1991. Accessed July 31, 2021.

Kiran, Chandra, et al. “Understanding delusions.” Industrial Psychiatry Journal, January-June 2009. Accessed July 31, 2021.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.