Cocaine users may lose touch with reality, become paranoid and have hallucinations. Learn more about why cocaine causes these mental status changes and the risks that come with them.

Cocaine use can harm many different areas of your body. One of the parts of the body that cocaine can damage is your brain. Cocaine can hurt your brain by interfering with the way you understand the world around you. Doctors have known for a long time that cocaine can cause changes in a person’s mental status. One of those changes is psychosis, which involves losing touch with reality.

Article at a Glance:

  • Psychosis occurs when someone loses touch with reality.
  • Cocaine psychosis is very common and is due to changes in brain chemicals from cocaine use.
  • Psychosis symptoms may go away on their own within a couple of days after cocaine use. However, they sometimes may last longer and may require a hospital stay.
  • You should seek emergency medical attention for someone with cocaine psychosis who seems to be a danger to themselves or others.
  • Having an episode of cocaine psychosis increases the risk for future psychotic episodes.

What Does Cocaine Do to the Brain to Cause Psychosis?

Cocaine is addictive because it triggers the brain’s reward system. This system causes a release of the brain chemical dopamine. Doctors believe that when too much dopamine releases, psychosis can be a result. Doctors also learned about a brain chemical called brain-derived neurotrophic factor (BDNF). Studies have shown that levels of this chemical can be abnormally low in people with different kinds of psychosis, including cocaine psychosis. Doctors are still learning more about BDNF and what it means for the brain.

Psychosis Symptoms & Risk Factors

Being paranoid is often one of the first symptoms of cocaine psychosis. Some doctors think that the more cocaine you use, the more you will be at risk of certain psychotic symptoms. For example, more cocaine use may put you more at risk for feeling objects (often described as bugs crawling) on your skin that are not there.

Other symptoms of psychosis include:

  • Having false beliefs
  • Being paranoid
  • Seeing, hearing or feeling things that are not there
  • Speech that does not make sense
  • Inappropriate behavior

Certain risk factors may put you more at risk for cocaine psychosis. These factors include:

  • How old you were when you first started using cocaine: People who started using cocaine before the age of 20 may be at a higher risk of psychosis.
  • How much cocaine you use: Higher doses of cocaine may be more likely to cause psychosis.
  • If you smoke or inject cocaine: Smoking or injecting cocaine have a high risk of causing psychosis.
  • If you use other substances along with cocaine: Using alcohol or other drugs, especially other drugs that may cause mental status changes, may increase the risk of experiencing psychosis.
  • If you already have any mental health problems: Pre-existing mental health issues may put you at higher risk of psychosis.
  • How much you weigh: The thinner you are, the more you may be at risk of developing cocaine psychosis.

How Common is Psychosis from Cocaine Use?

Cocaine psychosis is very common. Doctors have found that up to 86% of people who use cocaine may experience psychotic symptoms at some point. About 96% of people with cocaine psychosis will have hallucinations. Hearing the non-existent is the most common kind of hallucination experienced with cocaine. Additionally, along with that 96%, about 90% of people with cocaine psychosis experience symptoms of paranoia.

How Do You Treat Cocaine Psychosis?

Treatment of cocaine psychosis depends on the symptoms. Sometimes the symptoms may go away on their own without treatment. However, in severe cases, specialized care may be needed, like admission to a psychiatric hospital. You should seek medical attention if the person with cocaine psychosis seems to be a danger to themselves or others. Doctors may treat cocaine psychosis with medications like:

Cocaine psychosis may go away on its own 24 to 48 hours after the last dose of cocaine. However, in some cases, it may take a few weeks for symptoms to go away completely. It is also important to note that someone who has had cocaine psychosis is at higher risk for more episodes of psychosis. These future psychotic episodes can happen even if the person is using less cocaine than they did previously.

Thomas Christiansen
Editor – Thomas Christiansen
With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more
Jessica Pyhtila
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

National Institute of Mental Health. “What is Psychosis?” Accessed May 28, 2019.

Roncero C, Grau-López L, Palma-Álvarez RF, et al. “Higher Severity of Cocaine Addiction is […]matic Hallucinations.” European Psychiatry, May 2017. Accessed May 28, 2019.

Morton WA. “Cocaine and Psychiatric Symptoms.” The Primary Care Companion, August 1999. Accessed May 28, 2019.

Brady KT, Lydiard RB, Malcolm R, Ballenger JC. “Cocaine-Induced Psychosis.” Journal of Clinical Psychiatry, December 1991. Accessed May 28, 2019.

Roncero C,  Palma-Álvarez RF, Ros-Cucurull E. “Cocaine-induced Psychosis and Brain-deri[…] Report of Two Cases.” Clinical Psychopharmacology and Neuroscience, February 29, 2016. Accessed May 28, 2019.

Vallersnes OM, Dines AM, Wood DM, et al. “Psychosis Associated with Acute Recreati[…]European Case Series.” BMC Psychiatry, August 18, 2016. Accessed May 31, 2019.

Roncero C, Ros-Cucurull E, Daigre C, Casas M. “Prevalence and Risk Factors of Psychotic[…]e-dependent Patients.” Actas Espanolas de Psiquiatria, August 2012. Accessed May 31, 2019.

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.