Cocaine Psychosis & Paranoia: Identify the Symptoms

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Cocaine is a central nervous system stimulant drug that is processed from the leaves of the coca plant that grows in Central and South America. While most readers may identify cocaine as a significant drug of abuse, it does retain some medicinal uses and is classified in the Schedule II category of controlled substances by the United States Drug Enforcement Administration (DEA). Medicinal use of cocaine is limited to its anesthetic properties, and one of its most common medical uses is by dentists in this capacity.

As a drug of abuse, cocaine is often snorted, smoked, and even injected. The drug was a significant drug of abuse in the 1990s, but with the rising popularity of prescription opioid drugs and illicit opioid drugs like heroin, attention on cocaine waned. Moreover, according to figures provided by the Substance Abuse and Mental Health Services Administration, its reported abuse has also significantly declined.

Nonetheless, it is still a significant drug of concern. It has numerous negative ramifications when abused. One of these is the development of psychosis in individuals who abuse the drug.

Cocaine Psychosis

Psychotic symptoms can occur for numerous reasons. Psychosis is an overall term that is applied to the development of hallucinations (seeing or hearing things that are not there) and/or displaying delusions (having very fixed and rigid beliefs that are not true and conflict with reality). Other associated behaviors often occur with psychosis, such as manic-like behavior, lethargic behavior, aggression, and suicide attempts.

Psychosis can occur due to:

  • Numerous mental health disorders, including schizophrenia, bipolar disorder, and depression
  • Different neurological conditions, including stroke, dementia, and head injury
  • Different metabolic imbalances
  • Abuse or misuse of drugs or as a side effect of drugs used for medicinal reasons

When a person develops psychotic symptoms as a result of drug use, it may be due to intoxication or withdrawal. An individual who has abused cocaine could be diagnosed with stimulant intoxication due to cocaine use, stimulant withdrawal due to cocaine use, or a more formal substance/medication-induced psychotic disorder. Most often, if the individual is aware that their psychotic symptoms have resulted from their drug use, they would be diagnosed with either stimulant intoxication or stimulant withdrawal.

Individuals who are operating under the assumption that their hallucinations and/or delusions are real are more likely be diagnosed with a substance/medication-induced psychotic disorder, according to the diagnostic criteria put forth by the American Psychiatric Association (APA). Stimulant drugs like cocaine are very likely to produce some level of psychosis, and when individuals mix stimulants with other drugs, the risk is even higher.

Features of Cocaine-Induced Psychosis

Research has indicated that the prevalence of psychosis associated with stimulant drugs is higher than the psychosis associated with abuse of many other drugs. Upwards of half of individuals abusing cocaine—and some studies suggest even more than this—experience some type of psychotic symptoms either during use of the drug or afterward during the crash or withdrawal phase.

Research studies have suggested that there are variables that can increase the risk of psychotic symptoms from cocaine use.

  • The amount of the drug the person typically uses: Individuals who use larger amounts are more prone to develop psychotic symptoms.
  • The length of time the person has been using cocaine: Individuals who have histories of chronic cocaine abuse demonstrate more psychotic symptoms.
  • The method of use: Individuals that smoke or inject cocaine are more likely to experience psychosis than individuals who snort it.
  • Polysubstance abuse: As stated above, mixing cocaine with other drugs can increase the risk of psychotic symptoms.

The research also indicates that the psychosis associated with abuse of cocaine may have some features that differentiate it from other types of drug-induced psychosis.

  • Severe hallucinations that are very similar to the hallucinations that occur in schizophrenic patients are common.
  • There is a high prevalence of paranoid hallucinations and delusions.
  • Paranoia is associated with the use of cocaine. Users may believe they are being watched, that they are about to be arrested, that they are being followed or that others are trying to take advantage of them while they are on cocaine.
  • A somatic delusion that bugs are crawling all over the skin (cocaine bugs or delusional parasitosis with formication may suggest that someone is abusing cocaine although similar delusions occur in methamphetamine abusers.
  • Cocaine-induced psychosis does not appear to be associated with an increased risk of a later diagnosis of a psychotic disorder like schizophrenia, as is the case with the psychosis associated with cannabis use.
  • Individuals who develop psychosis associated with cocaine abuse are more likely to be male and thin, to inject or smoke cocaine, and to have a long history of cocaine abuse.

The research also indicates that the experience of psychotic effects from cocaine use demonstrates what is known as sensitization, meaning that once a person experiences psychotic symptoms from cocaine, any further use of the drug is more likely to produce additional psychotic symptoms. Over time, the symptoms may last longer and become more intense, and the person may be less prone to recognize them as resulting from their abuse of the drug.

There are signs that someone who is using cocaine may be experiencing psychosis.

  • Suspicious behavior, such as hiding, being hypervigilant, or making accusations about being followed or persecuted
  • Behaviors that suggest the person is hallucinating, such as the person saying they see or hear things that are not there
  • Displaying irrational beliefs
  • Constant scratching or complaining that it feels as if bugs are crawling all over their skin

Other signs of cocaine intoxication include hyperactivity, inability to pay attention, pressured speech, sweating, high body temperature, and increased heart rate or blood pressure.

In most instances, individuals who experience psychosis are not dangerous. That being said, people who are extremely paranoid can be potential dangers to themselves or others.

In the case of an individual who is extremely suspicious, take precautions to avoid potential issues. Always remain calm and approach the person in a deliberate, logical manner. Use reassurances. Attempt to get professional assistance to diffuse the situation.


The formal treatment for psychosis due to cocaine abuse is to stabilize the condition by administering intravenous fluids, using antipsychotic medications, and using other medications to slow down heart rate and stabilize blood pressure. Isolating the person from overwhelming environmental stimulation can also be extremely useful.

  • Call 911.
  • Ensure the person stops using all drugs, including alcohol and cocaine.
  • Attempt to reduce stimulation by getting other people out of the area, turning down the lights, lowering the temperature of the room, and making sure the room is well ventilated.
  • Talk to the person softy and slowly to keep them calm.

The best way to avoid cocaine-induced psychosis is obviously to avoid cocaine use. Individuals who experience psychotic symptoms as a result of cocaine are at an increased risk to continue experiencing these symptoms when they use the drug.

If cocaine abuse is an issue, comprehensive rehabilitation programs can help clients to leave cocaine abuse in the past and embrace a healthier future. In cases where cocaine-induced psychosis has been present, it’s important to find an evidence-based program with medical supervision. In some instances, an initial stay in a hospital-based or inpatient unit may be needed before progressing to a more traditional residential treatment program.

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