Cocaine use disorder: effects, risks, dependence and getting help in the UK

Cocaine is a stimulant that speeds up the central nervous system. FRANK, the national drugs information service, says there are three forms: powder cocaine (coke), crack, which looks like small lumps or rocks, and freebase, a crystallised powder. Most people snort the powder, while crack or freebase is smoked, and some people inject it, which FRANK says is much more dangerous.

Cocaine use disorder is the term clinicians use when use becomes problematic: strong cravings, using more than intended, difficulty cutting down, and continuing despite harm to health, relationships, work or money. It sits on a spectrum, and a person does not need to use every day to have a problem. The NHS emphasises that drug problems are health problems and that treatment is available.

FRANK says taking cocaine can make people feel happy, excited, wide awake and confident, and can also make the heart beat faster, raise body temperature, suppress appetite, cause sickness, and bring on anxiety, panic or paranoia. It can make people overconfident and lead them to do risky things.

The high is short, which encourages repeat use. FRANK says some people feel down, anxious and paranoid the next day or longer, and that users sometimes continue to use cocaine just to overcome the negative after effects, which can lead to a binge pattern and raise the risk of dependence.

FRANK describes a range of risks. Physical risks include seizures, heart attack and stroke even in healthy young people, and a higher risk of overdose when cocaine is mixed with other drugs or alcohol. Snorting damages the cartilage separating the nostrils over time. Smoking crack regularly can cause breathing problems and chest pains. Injecting can damage veins and cause ulcers and gangrene, and sharing equipment can spread HIV and hepatitis infections. Taking cocaine when pregnant can damage the baby and cause miscarriage, premature labour and low birth weight.

FRANK also warns that a form of heroin called white heroin is easily mistaken for cocaine, and people have died or been hospitalised after snorting it thinking it was cocaine. Its advice for an emergency is to call 999 for an ambulance and tell the crew everything you know.

FRANK says cocaine is very addictive because regular use changes the way the brain releases dopamine, and that it is mostly known for causing psychological dependence rather than physical withdrawal, though users may continue to use to cope with after effects. It also notes that frequent users find they begin to crave more of the drug, so it can become an expensive habit.

Signs that use may have become a problem include using more or more often than planned, spending a lot of time and money getting and using cocaine, feeling unable to cut down, using to cope with the comedown, neglecting responsibilities, and mood problems such as low mood, anxiety or paranoia. If you recognise this, it is worth speaking to someone, because earlier help tends to be easier to engage with.

The NHS says a GP may be a good place to start: they can discuss your problems with you and help get you into treatment, and will usually refer you to your local drug service. If you are not comfortable talking to a GP, you can approach your local drug treatment service yourself, and FRANK helps you find support near you.

At the first appointment, staff will ask about your drug use, work, family and housing situation, and may ask for a urine or saliva sample. They will talk through the options and agree a treatment plan, and you will be given a keyworker who supports you throughout treatment.

The NHS says treatment depends on your circumstances and the drug you are using, and may include a number of different treatments and strategies. Talking therapies such as CBT help you see how thoughts and feelings affect behaviour. Self-help groups and programmes such as Narcotics Anonymous or SMART Recovery help some people. Staff at the local drug service will also help reduce the risks associated with drug-taking, for example by offering testing and treatment for hepatitis or HIV.

The NHS page describes substitute medicines and detoxification for opioids such as heroin. It does not describe a specific substitute medicine for cocaine, and treatment for stimulant problems is generally psychological and supportive. Treatment may be delivered while living at home or, if more intensive support is needed, in a residential rehabilitation service.

The NHS says charities and the NHS provide most drug treatment in the UK, and that there are also private drug and alcohol treatment organisations, for which you need to pay. Local services funded by the NHS or local authorities are free at the point of use. If you consider private treatment, it is sensible to check that clinicians are registered and that the programme includes aftercare and links to your GP.