What is Cocaine Psychosis?

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Cocaine is a stimulant that causes brief feelings of euphoria and increased energy. 1.3 million individuals were diagnosed with cocaine use disorder in 2020. (1) If you or someone close to you has been struggling with cocaine use, it is important to understand the negative side effects and risks involved. One of the more serious side effects related to cocaine use is cocaine psychosis. Cocaine psychosis is a disconnection from reality caused by repeated or excessive cocaine use. When an individual experiences cocaine psychosis, they are unaware of their actions and behaviors. Cocaine psychosis occurs in over 50 percent of individuals who engage in cocaine use. Cocaine psychosis is critical and requires immediate medical care. (2)

Guardian Recovery offers cocaine specific detoxification services for those experiencing cocaine use disorder. If you or a loved one engage in cocaine use, despite the negative consequences that it elicits, substance use treatment may be beneficial. Guardian Recovery can provide you with the tools to overcome and maintain sobriety. With individualized care tailored towards your treatment needs, we will consistently provide you with professional and top-quality services. Contact us today to get started on your recovery journey.

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What Causes Cocaine-Induced Psychosis?

Chronic and excessive cocaine use can cause cocaine-induced psychosis. Cocaine use affects the brain’s rewards system, and too much can lead to psychosis symptoms. Paranoia and hallucinations are two side effects that can occur during cocaine use, and contribute to cocaine-induced psychosis. Once cocaine-induced psychosis begins, delusions often occur. Cocaine psychosis can occur during intoxication and withdrawal.

Psychiatric Symptoms, Effects, & Disorders

The effects of cocaine psychosis can be distressing and extreme, even leading to other disorders such as delusional disorder.

Symptoms of cocaine psychosis include: (3)

  • Paranoia
  • Hallucinations
  • Delusions
  • Anger and aggressiveness
  • Anxiety
  • Delirium or confusion
  • Suicidal and homicidal ideation

There are various psychiatric disorders in which the above symptoms can occur. Some of these include bipolar disorder or schizophrenia.


Paranoia is the presence of thoughts and feelings that someone is interested in causing you harm. Paranoia is distressing and is incited by the feelings of fear and anxiety. (4) Even without evidence, an individual experiencing paranoia wholeheartedly believes that they will be harmed. Cocaine use can lead to suspicion of others which can precede paranoia. A study found that approximately two-thirds of those who have used cocaine reported experiencing paranoia after use. (5)

Symptoms of paranoia include: (6)

  • Aggressiveness
  • Hostility
  • Defensiveness
  • Inability to trust others
  • Hypervigilance


Hallucinations are the false perceptions that you have seen, touched, tasted, smelled, or heard something that was not actually there. (7)

There are different types of hallucinations; these include: (8)

  • Visual hallucinations: Seeing things that are not real or there.
  • Tactile hallucinations: Feeling touch or movement on your body that is not there or real.
  • Gustatory hallucinations: Tasting things that are unpleasant that are not real.
  • Olfactory hallucinations: Smelling things that no one else can smell.
  • Auditory hallucinations: Hearing things that no one else can hear.

Using cocaine for an extended period of time can cause hallucinations. Hallucinations can cause individuals to become so focused on things that are not real, that they ignore real life dangers, such as stop signs. Hallucinations are a serious medical condition and emergency care should be seeked if you are experiencing them.


A delusion is a false belief that an individual refuses to believe is wrong. (9) Delusions are different from hallucinations because hallucinations are abnormal sensory experiences, while  delusions are irrational thoughts or beliefs.

There are different types of delusions, these include: (10)

  • Delusions of grandeur — Beliefs rooted in an over-inflated self-esteem and exaggerated sense of importance.
  • Delusions of jealousy — Beliefs that one’s partner or spouse is unfaithful.
  • Erotomanic delusions — Belief that someone is in love with them, often someone of great importance.
  • Persecutory delusions — Belief that one is being conspired against or attacked. Often by a group or organization.
  • Somatic delusions — Belief that one has a medical condition or a physical abnormality.


Anger is a human emotion, often elicited after doing something wrong or being wronged by another individual. (11) As an individual continues to be paranoid and delirious, their distress and aggressiveness increases. This creates a higher risk for an individual experiencing cocaine psychosis to develop thoughts and feelings of wanting to harm someone else or themself.


Anxiety is a persistent feeling of worry and fear about things that could happen currently or in the future. (12) Cocaine psychosis can cause such extreme levels of psychosis that medication may be needed in order to reduce anxious thoughts and feelings. Cocaine-induced anxiety disorders can also be developed following cocaine psychosis.

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Risk Factors For Developing Psychosis From Cocaine

There are several risk factors that increase the likelihood of an individual experiencing cocaine-induced psychosis.

The risk factors for developing cocaine psychosis may include: (13)

  • The amount used — Increasing the amount or doses of cocaine used can increase your chances of developing cocaine psychosis.
  • Antisocial personality disorder — Having a past diagnosis of antisocial personality disorder was found to be a precursor for cocaine-induced psychosis for certain individuals who had cocaine dependencies.
  • Marijuana use — Having a history of marijuana use can make you more likely to develop cocaine psychosis. This is partly due to both substances affecting the neurotransmitter dopamine in the brain.
  • Repeated use — Continuously using cocaine, whether binging or daily use, was found to be a risk factor.

How Long Does Psychosis Symptoms & Effects Last?

The exact timeframe of cocaine psychosis varies. Depending on the individual, the amount of cocaine used, and prior conditions, the effects and symptoms of cocaine psychosis could last anywhere between a few hours to months.

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Treating Cocaine-Induced Psychosis

The first step in the treatment process for cocaine-induced psychosis is stabilization. Medically supervised detox, or the process of removing cocaine from the body, is crucial during this process. Detox requires the user to cease their cocaine use so that both cocaine use and psychosis can be treated. Medication assisted treatment may be utilized to help decrease psychotic symptoms. Antipsychotics, antidepressants, and anti-anxiety medication are often used if medication is needed throughout treatment. Certain medications may be exempt from treatment if they also have a high risk of addiction.

Inpatient and residential treatment is often the next step in the treatment process. Inpatient and residential treatment offers structured care in a 24-hour facility. Outpatient treatment may be attended in replace of or following inpatient and residential treatment, depending on the severity of the individual’s symptoms. Inpatient, residential, and outpatient treatment provide individual therapy, group therapy, family therapy, recreational therapy, psychoeducation, and life skills classes.

Guardian Recovery offers treatment for those experiencing cocaine-induced psychosis. With dual diagnosis options for those also experiencing additional mental health disorders, we offer comprehensive care for those wanting to take control of their substance use. One of our Treatment Advisors will provide you with information, and guide you through the admissions process. Contact us for a free, no obligation insurance benefits check. Our professional staff is ready to aid you in reaching your sobriety goals.


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Disclaimer: Does not guarantee specific treatment outcomes, as individual results may vary. Our services are not a substitute for professional medical advice or diagnosis; please consult a qualified healthcare provider for such matters.

  1. https://nida.nih.gov/publications/research-reports/cocaine/what-scope-cocaine-use-in-united-states
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181074/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC181074/
  4. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/paranoia
  5. https://pubmed.ncbi.nlm.nih.gov/2006696/
  6. https://www.forbes.com/health/mind/paranoia-causes/
  7. https://www.nidirect.gov.uk/conditions/hallucinations-and-hearing-voices
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3105559/
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016695/
  10. https://www.news-medical.net/health/Delusion-Types.aspx
  11. https://www.apa.org/topics/anger#:~:text=Anger%20is%20an%20emotion%20characterized,to%20find%20solutions%20to%20problems.
  12. https://www.apa.org/topics/anxiety
  13. https://pubmed.ncbi.nlm.nih.gov/22118812/

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Reviewed professionally for accuracy by:

Ryan Soave


Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

Written by:

Cayla Clark

Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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