The Connection Between Cocaine and Anxiety


The Connection Between Cocaine and Anxiety

Table of Contents

What is Cocaine?

Cocaine and anxiety are comorbid, meaning they often occur together. Cocaine is a stimulant derived from the leaves of the coca plant (Erythroxylon coca). It is a highly addictive substance that’s been used for thousands of years. The indigenous groups of South America chewed and ate the coca leaves for their stimulant effects.

Nearly 100 years ago, scientists discovered how to isolate the stimulant chemical cocaine hydrochloride and use it as the main ingredient in beverages, including some of the first soft brand-name drinks. Cocaine is not used in commercial products because of its addictive qualities, and its only legal use is as an anesthetic for specific medical procedures.

Cocaine is an illegal substance if not used by a medical doctor. Cocaine’s highly addictive qualities make it a high risk for substance abuse. Typically, cocaine enters the body via injection or by inhaling a smokable substance.

The common nicknames for cocaine include:

According to the 2018 National Survey on Drug Use and Health, nearly 5.5 million people ages 12 and older reported using cocaine within the past year.1 The National Institute on Drug Abuse (2014) found that 505,224 of almost 1.3 million hospital visits related to substance-abuse involved cocaine.2

Signs of Cocaine Use

The effects of cocaine can be detected immediately but will disappear within an hour after the substance enters the body. Cocaine use may show the following immediate symptoms:

Additionally, some people who use cocaine have reported needing less sleep and food, while others have reported the opposite. Those who have become dependent on cocaine may isolate themselves from families and friends and may stop participating in the activities they once enjoyed.

What is Anxiety?

Anxiety is a part of everyday life. Many people experience it when faced with significant events such as big decisions, tests, or relationship problems. Experiencing anxiety throughout life is normal for everyone.

If someone is diagnosed with an anxiety disorder, however, then the anxious feelings don’t go away after the event has been resolved. Instead, the symptoms of anxiety persist or can even worsen over time.

There are several types of anxiety disorders, including:

Signs and symptoms of anxiety include:

Does Cocaine Cause Anxiety?

Many studies show that there is a co-occurrence between cocaine use and anxiety symptoms. Anxiety symptoms often present themselves during periods of cocaine withdrawal or between uses. The use of cocaine is also related to phobias, obsessions, and compulsions. Additionally, there is evidence that cocaine use can lead to panic attacks, a common side effect of cocaine use.4

It’s difficult to say if cocaine use causes anxiety disorders. While anxiety-related symptoms and panic are common side effects of cocaine use, not all users develop an anxiety disorder. However, research does show that there is a relationship between the two disorders. 5

Cocaine Side Effects

There are several side effects of cocaine use. When the drug enters the body, the physical high is short and intense. Once the substance has worn off, it is common to feel depressed, on edge, and anxious.

Some of the more severe immediate side effects can include:

Long-Term Effects of Cocaine

The long-term effects of cocaine use can have serious consequences. When a person uses cocaine repeatedly, the brain starts to change, particularly in the reward center. If used continuously, the brain becomes less sensitive to natural sources of positive reinforcers such as food, relationships, and favorite activities. Instead of seeking out these positive reinforcers, cocaine addiction creates more focus on the substance as a reinforcer.

The more cocaine is used, the higher tolerance becomes. The higher the tolerance, the more of the substance is needed to feel the same effects. Alternatively, it’s also possible to develop sensitization to cocaine, meaning it requires less of the substance to feel anxious and experience other negative effects.6

Once the body develops a physical dependence on cocaine, the effects of withdrawal may develop:

Other long-term side effects can depend on how the substance enters the body, but some of the long-term effects can include:

College Anxiety and Cocaine Use

College is meant to be a period of excitement, independence, and personal growth. However, the college years are also one of the most stressful times in a person’s life. With the stress of school, relationships, finances, and work, many college students use their free time to indulge in unhealthy coping mechanisms.

The prevalence of mental health issues in college students is high, and nearly 12% of college students have been diagnosed with anxiety disorders. It’s well known that substance use disorders and anxiety are highly comorbid, but there is limited research on the relationship between anxiety and substance use among college students.

When students feel anxious or depressed, they use substances as a form of self-medication to manage the anxiety and stress. While findings show that using substances to manage anxiety is more supported in the general population, there are not many studies that support the use of cocaine to manage anxiety at the college level.7

Research shows, however, that more anxiety symptoms were seen with students who use cocaine. Further research must be performed on the matter, however, before any true conclusions can be made in the relation between cocaine and anxiety during the college years.

Cocaine Overdose Signs

Unsafe amounts of cocaine usage can cause severe complications and even death. The most common causes of death from a cocaine overdose are cardiac arrest (a heart attack) or a seizure.

Although the symptoms will vary, the signs of a cocaine overdose may include:

Combing alcohol with cocaine can be extremely dangerous. When these two substances combine, they produce a chemical (cocaethylene) that damages the heart.

Additionally, using cocaine and heroin together can be lethal. Because cocaine is a stimulant (makes you feel active) and heroin is a depressant (creates feelings of calm and relaxation), the two can make the effects of the other feel weaker, and it is possible to overdose without knowing it.

Treating Anxiety as a Co-Occurring Disorder in Rehab

Research on the relationship between cocaine and anxiety reveals the following statistics:

  • The National Institute on Drug Abuse reported that 913,000 Americans met the DSM-5 criteria for dependence or abuse of cocaine in the past 12 months in 2014.
  • Anxiety disorders affect 40 million adults (18 and older) in the United States every year.8
  • In a study of 139 young adults who said they use cocaine regularly, 13% reported having an anxiety disorder.9
  • Paranoia occurs in 68% to 84% of patients who use cocaine.10

Because anxiety and substance use disorders (SUD) can occur together, they are often treated simultaneously in rehabilitation programs. Below are some of the common treatments and components of these programs.


Behavioral therapy and cognitive-behavioral therapy are counseling techniques to treat those who suffer from anxiety and SUD. These therapeutic approaches aim to change behavior and teach the skills necessary to cope with the stress of everyday life.


The substance withdrawal process, also known as detox, is when the substance is removed from the body naturally. The individual in a rehab program will likely need to go through a detox period before more intense treatment can occur.

With the right rehabilitation program, individuals will have the supportive staff and resources they need to complete the difficult detox process.

Relapse Prevention

When treating anxiety and SUD as co-occurring disorders, teaching the skills necessary to cope with stress and addition are the keys to success. Many rehabilitation programs use individual counseling, group counseling, and other treatments to create appropriate coping mechanisms.

Support Groups

Support groups can be a valuable aspect of a rehabilitation program or after a participant has left a program. According to the Journal of Substance Abuse Treatment, support groups such as Narcotics Anonymous (NA) can instill a sense of connection among those who have experienced addiction. Many support groups for anxiety disorders exist as well.

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