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Symptoms of Cocaine Psychosis: Can You Recover From It?

Cocaine is a potent stimulant drug derived from the leaves of the coca plant, which grows in Bolivia, Colombia, and Peru. About 90 percent of powdered cocaine produced illicitly, mostly in Colombia, enters the United States and is sold on the black market.

Cocaine is a Schedule II drug. It has some rare but important medical uses, mainly as a local anesthetic in ear, nose, and throat surgeries.

Illicit cocaine is distributed as a crystalline, white powder, which may be off-white and likely contains dangerous additives. Most recently, it contains fentanyl, a deadly opioid drug that is produced cheaply in Mexico and mixed into several drugs. It may be turned into freebase, or crack, cocaine, which is not snorted but smoked or injected intravenously.

Regardless of how cocaine is abused, the drug binds to receptor cells in the brain very quickly, leading to a strong, euphoric high. It has various short-term effects. 

  • Extreme happiness or energy
  • Mental alertness
  • Hypersensitivity to sight, sound, and touch
  • Irritability
  • Paranoia
  • Dilated pupils
  • Increased body temperature
  • Rapid heartbeat
  • High blood pressure
  • Sweating

Prolonged cocaine abuse leads to serious, chronic health issues, including heart disease, convulsions or seizures, mood disturbances like depression, and lung disease. Abuse of large amounts of cocaine for a long time can also lead to cocaine psychosis.

What Is Cocaine Psychosis?

While people predisposed to mental health issues, due to genetics or family history, are more at risk of developing cocaine psychosis, this condition does not require this precondition to harm the brain.

The main way you can develop cocaine psychosis is through a cocaine binge — when a person abusing cocaine takes the drug several times in a row, in increasingly higher doses. This leads to several serious side effects that range from uncomfortable to disturbing. These side effects include:

  • Irritability
  • Restlessness
  • Panic attacks
  • Paranoia
  • Triggered psychosis

Cocaine is one of several drugs that can trigger psychotic symptoms, which may become permanent. Drug-induced psychosis can be difficult to distinguish from other psychotic disorders, like schizophrenia. These conditions are treated with similar approaches, primarily with antipsychotic medication and behavioral therapy.

What Are the Symptoms?

Psychosis is a cluster of conditions that affect the way an individual experiences reality. Typically, psychotic disorders are characterized by a loss of contact with reality, hallucinations, and delusions.

Periods in which symptoms are their most intense are called psychotic episodes. Either an existing mental condition, a drug, or an illness can trigger this episode. People who experience psychotic episodes will likely have to be hospitalized.

Other symptoms of psychosis include:

  • Garbled or nonsense speech
  • Behavior that is inappropriate to the situation
  • Aggression toward oneself or others
  • Intense fear
  • Depression or anxiety
  • Sleep dysfunction
  • Loss of motivation
  • Social withdrawal and other social problems
  • Difficulty functioning in other ways

Other specific risk factors for cocaine psychosis include

  • Starting cocaine abuse in adolescence or early adulthood
  • Using large amounts of cocaine
  • Abusing cocaine for a long time
  • Being male
  • Having a lower body mass index
  • Abusing cocaine intravenously

One study found that when individuals began abusing cocaine between the ages of 17 and 20, they were most at risk for rapidly escalating cocaine abuse, leading to binges and psychosis.

Medical Studies on Cocaine Psychosis

MRI of a brain


A study involving 231 cocaine-dependent individuals seeking addiction treatment examined their psychiatric symptoms alongside their withdrawal and treatment. Cocaine-induced psychosis was reported in 65.4 percent of the patients while a personality disorder of some type was reported in 46.8 percent.

Neuroticism-anxiety and aggression-hostility were measured on personality tests and were found to correlate with the highest risks of experiencing psychotic symptoms. The participants who developed drug-induced psychosis also tested high for both variables.

Another smaller study examined 20 male participants, who had reported experiencing cocaine psychosis, who took personality tests. The results suggested that those who experienced transient paranoia while intoxicated on cocaine were at greater risk of developing cocaine psychosis.

People who struggled with cocaine abuse and did not have schizophrenia were just as likely as those with schizophrenia, who abused cocaine, to develop a psychotic disorder. The pre-existing mental condition did not impact the severity of psychotic symptoms, especially hallucinations.

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Treating Cocaine Psychosis Can Lead to a Normal Life

Treatment for cocaine psychosis, like other kinds of psychosis, starts in the emergency room. The person must be physically and mentally stabilized. Benzodiazepines may be administered to calm down both physical and mental symptoms, including anxiety, chest pain, and extreme agitation.

If the psychotic episode was triggered by acute cocaine toxicity or overdose, there is the potential that the symptoms will ease with this amount of treatment in a hospital. However, it is possible that the person may develop chronic cocaine psychosis, so they will need long-term treatment with antipsychotics. However, they must be stabilized during their psychotic episode for a medical professional to make this diagnosis.

The next step is to detox from cocaine and enter a rehabilitation program. The goals of treatment for cocaine addiction include: 

  1. Achieve abstinence from cocaine.
  2. Prevent relapse.
  3. Change behaviors around substances like cocaine.

Detox leads to abstinence from cocaine through medically supervised withdrawal from the drug. While there are no prescription medications to taper the body off cocaine dependence, as there are for opioids, medical professionals will provide support for withdrawal symptoms and reduce the risk of relapse during this time. Doctors can also recommend medications to ease some withdrawal symptoms, like nausea or physical discomfort. Entering a detox program after suffering a psychotic episode will also ensure you have access to mental health support to diagnose your risk of ongoing psychotic episodes and begin appropriate treatment.

Cognitive behavioral therapy (CBT) works well in rehabilitation to change behaviors and further prevent relapse. Counseling in group sessions, and more often in individual sessions, too, is the core of rehabilitation. Behavioral therapy is also important for people struggling with psychosis because it helps clients determine reality and symptoms of their condition so that they can function.

People who have co-occurring disorders, like addiction and psychosis, benefit greatly from inpatient treatment. They are in a safe environment in which they can work on their specific struggles and slowly reintegrate into their lives.

After rehabilitation, it is important to work with a counselor, therapist, social worker, or case manager to develop an aftercare plan, especially when contending with both addiction and mental illness. This plan should include social support from friends, family, therapists, and mutual support groups, along with any medications you need, nutritional planning, exercise plans, and more.

There are medical treatments for cocaine psychosis, which can help you live a normal life and reduce the risk of a recurring psychotic episode.


SOURCES

(2017). Cocaine: Drugs of Abuse, a DEA Resource Guide. U.S. Department of Justice (DOJ), Drug Enforcement Administration (DEA). Retrieved November 2018 from https://www.dea.gov/sites/default/files/sites/getsmartaboutdrugs.com/files/publications/DoA_2017Ed_Updated_6.16.17.pdf#page=51.

(November 26, 2018). Fentanyl in Cocaine: The Deadly Truth of New Drugs Cocktail. BBC News. Retrieved November 2018 from https://www.bbc.com/news/av/world-us-canada-46350497/fentanyl-in-cocaine-the-deadly-truth-of-new-drugs-cocktail.

(July 2018). What is Cocaine? National Institute on Drug Abuse (NIDA). Retrieved November 2018 from https://www.drugabuse.gov/publications/drugfacts/cocaine.

(October 29, 2013). Cocaine (Powder). Centers for Substance Abuse Research (CESAR). Retrieved November 2018 from http://www.cesar.umd.edu/cesar/drugs/cocaine.asp.

(May 2016). What are the Long-Term Effects of Cocaine Use? National Institute on Drug Abuse (NIDA). Retrieved November 2018 from https://www.drugabuse.gov/publications/research-reports/cocaine/what-are-long-term-effects-cocaine-use.

What is Psychosis? National Institute of Mental Health (NIMH). Retrieved November 2018 from https://www.nimh.nih.gov/health/topics/schizophrenia/raise/what-is-psychosis.shtml.

(2005). Risk Factors for Experiencing Psychosis During Cocaine Use: A Preliminary Report. Journal of Psychiatric Research. Retrieved November 2018 from https://www.sciencedirect.com/science/article/pii/S0022395605000610.

(2006). Psychosis Among Substance Users. Medscape.com. Retrieved November 2018 from https://www.medscape.com/viewarticle/528487_5.

(March 19, 2014). Neuroticism Associated with Cocaine-Induced Psychosis in Cocaine-Dependent Patients: A Cross-Sectional Observational Study. PLoS ONE. Retrieved November 2018 from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106111.

(April 2006). Cocaine-Induced Paranoia and Psychosis Proneness. The American Journal of Psychiatry. Retrieved November 2018 from https://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.148.12.1708?journalCode=ajp.

(April 14, 2016). Cocaine-Related Psychiatric Disorders Medication. Medscape. Retrieved November 2018 from https://emedicine.medscape.com/article/290195-medication

(April 14, 2016). Cocaine-Related Psychiatric Disorders Follow-Up. Medscape. Retrieved November 2018 from https://emedicine.medscape.com/article/290195-followup.

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