Cocaine Psychosis

Pile of cocaine next to rolled up dollar bill

Cocaine takes a toll on your body. It is a potent stimulant that damages different organs, including the brain. One of the effects of cocaine use on the brain is mental status changes. In particular, cocaine interferes with the way your brain understands the world around you. One of the results is psychosis, a change in the mental status where you no longer are in touch with reality.

What Is Cocaine-Induced Psychosis?

Cocaine-induced psychosis is a common side effect of cocaine use. Up to 86% of people who struggle with cocaine will have psychotic symptoms at some point.

Cocaine psychosis occurs because of the drug’s effect on the brain. Cocaine triggers the brain’s reward system, which causes the release of the feel-good chemical dopamine. However, when the brain releases too much dopamine, psychosis can result.

Other neurotransmitters may also be involved in cocaine-induced psychosis. One of them is called brain-derived neurotrophic factor, or BDNF. Levels of BDNF can be abnormally low in people with psychosis, including cocaine psychosis. Scientists are still studying BDNF to learn more about it.

Symptoms of Cocaine Psychosis

Psychosis is a break from reality characterized by disturbed speech and behavior. During a psychotic episode, a person may have trouble understanding what is real and what is not.

Symptoms of cocaine psychosis include paranoia, hallucinations, delusions, and inappropriate behavior.


Paranoia is often one of the first symptoms of cocaine psychosis. It can start within hours of cocaine use and can last weeks. About 90% of people with cocaine psychosis have symptoms of paranoia. Examples of paranoia include:

  • Suspecting others of wanting to cause harm
  • Doubting the motivations of others


About 96% of people with cocaine psychosis have hallucinations. Hallucinations can come in several forms like:

  • Seeing things that are not there
  • Hearing things that are not there
  • Feeling things on your skin that are not there

Hallucinations are often linked to how much cocaine you have taken. The more cocaine you take, the more at risk you are for hallucinations. Hearing things that are not there is the most common kind of hallucination from cocaine.


Delusions are another symptom of cocaine psychosis, characterized by false beliefs. A person suffering from delusions may have a diminished sense of reality and an inability to distinguish the real from the unreal. Types of delusions include:

  • Persecution: The belief that something or someone is acting hostile towards them.
  • Grandiosity: The belief that they are a celebrity or that they have supernatural powers.
  • Guilt or unworthiness: The belief that they are bad or evil or that they have ruined their family.

Risk Factors for Cocaine-Induced Psychosis

Several factors increase the risk of cocaine psychosis. These factors include:

  • Severity of dependence: People with severe cocaine dependence are much more likely to have psychotic symptoms than those who do not take cocaine.
  • Dosage: Higher doses of cocaine are more likely to cause psychosis than lower doses. At higher doses, the brain is exposed to such high levels of stimulation from neurotransmitters that psychosis is more frequent.
  • Body Mass Index: People with a lower body mass index, or BMI, may be at higher risk of cocaine psychosis due to low BMI being associated with the neurological disorder Essential Tremor (ET).
  • Age: The younger a person was when they started taking cocaine, the higher the risk of psychosis. In particular, those who started using cocaine before age 20 may be at a higher risk of cocaine psychosis.
  • Co-occurring disorders: Co-occurring disorders refer to existing mental health issues like depression. Having existing mental health problems may lead to a higher risk of cocaine psychosis.
  • Route of cocaine use: Injecting or smoking cocaine, especially crack, leads to a higher risk of psychosis.
  • Other substances: Taking other substances may increase your risk of cocaine psychosis. This is especially true if you use alcohol or other drugs along with cocaine that can cause mental status changes.
  • Previous cocaine psychosis: A person who has previously had cocaine psychosis is at higher risk for future psychotic episodes. These episodes can occur even if the person is using less cocaine than they used to.

Cocaine Psychosis Treatment

Cocaine psychosis can be scary for the person going through it as well as their loved ones who watch them struggle. Luckily, cocaine psychosis can be treated. The exact treatment for cocaine psychosis depends on the symptoms. Sometimes the symptoms do not need treatment and can go away on their own. When this occurs, symptoms may start to improve 24-48 hours after cocaine was last taken. However, it can take several weeks for symptoms to completely resolve.

Other times, cocaine psychosis can be severe. In those cases, people may be a danger to themselves or others. Specialized treatment in a hospital may be needed. Doctors can use several kinds of medications to treat cocaine psychosis including antipsychotics, benzodiazepines, and sedatives.

If you or a loved one struggle with cocaine and are concerned about side effects like psychosis, help is here. We know cocaine psychosis can be frightening. Our experts at The Recovery Village Ridgefield can provide professional treatment to help you live a sober life. Don’t wait; contact us today.

Vallersnes, OM; Dines, AM, Wood, DM; et al. “Psychosis Associated with Acute Recreational Drug Toxicity: a European Case Series.” BMC Psychiatry, August 18, 2016. Accessed September 29, 2019.

Morton, WA. “Cocaine and Psychiatric Symptoms.” The Primary Care Companion, August 1999. Accessed September 29, 2019.

Roncero C,  Palma-Álvarez RF, Ros-Cucurull E. “Cocaine-induced Psychosis and Brain-derived Neurothrophic Factor in Patients with Cocaine Dependence: Report of Two Cases.” Clinical Psychopharmacology and Neuroscience, published February 29, 2016. Accessed September 29, 2019.

National Institute of Mental Health. “What is Psychosis?” Accessed September 29, 2019.

Brady, KT; Lydiard, RB; Malcolm, R; Ballenger, JC. “Cocaine-Induced Psychosis.” Journal of Clinical Psychiatry, December 1991. September 29, 2019.

Roncero, C; Grau-López, L; Palma-Álvarez, RF; et al. “Higher Severity of Cocaine Addiction is Associated with Tactile and Somatic Hallucinations.” European Psychiatry, May 2017. Accessed September 29, 2019.

Wood, Suzanne; et al. “Psychostimulants and Cognition: A Continuum of Behavioral and Cognitive Activation.” January 2014. Accessed September 29, 2019.

Roncero, C; Ros-Cucurull, E; Daigre, C; Casas M. “Prevalence and Risk Factors of Psychotic Symptoms in Cocaine-dependent Patients.” Actas Espanolas de Psiquiatria, July-August 2012. Accessed September 29, 2019.

Smith, Matthew J; et al. “Prevalence of Psychotic Symptoms in Substance Users: A Comparison across Substances.” Comprehensive Psychiatry, September 23, 2008. Accessed September 29, 2019.

Rosse, Richard, MD; Deutsch, Stephen, MD, PhD; Chilton, Melissa. “Cocaine Addicts Prone to Cocaine-Induced Psychosis Have Lower Body Mass Index Than Cocaine Addicts Resistant to Cocaine-Induced Psychosis — Implications for the Cocaine Model of Psychosis Proneness.” Israel Journal of Psychiatry and Related Sciences, 2005. Accessed October 8, 2019.

Kiran, Chandra; Chaudhury, Suprakash. “Understanding delusions.” Indian Journal of Psychiatry, 2009. Accessed October 8, 2019.

Medical Disclaimer: The Recovery Village aims to improve the quality of life for people struggling with a 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 provider.