Cocaine Psychosis

We've known about the dangers of cocaine for a long time. Even using it just once comes with a significant risk of overdose or long-term damage to your body and brain.

 One of these significant dangers is cocaine-induced psychosis. It can happen when you're overdosing or withdrawing, and the risk factors are numerous. While it can subside on its own, it's important to know how to keep yourself or others safe while it's happening.

What Does Cocaine Psychosis Look Like?

Cocaine is a stimulant that increases a lot of brain activity. One of the most recognized side effects of use is a burst of energy and euphoria. For some, using cocaine can lead to acts of aggression or paranoia.

Cocaine psychosis takes these aggressive and paranoid feelings up a notch. The primary symptom is intense, even delusional paranoia. People experiencing cocaine-induced psychosis might accuse those around them of deceit or claim danger from some unknown force. 

This paranoia eventually leads to hallucinations to back up their delusions. Psychosis hallucinations fall into three categories

  • Auditory—hearing voices that aren't there
  • Visual—seeing things that aren't there
  • Tactile—feeling something on or under your skin

Specifically, during cocaine psychosis, these tactile hallucinations are often referred to as "cocaine bugs" because many describe the itchy sensation as bugs crawling under their skin.

Cocaine Psychosis and Violence

Paranoia causes you to feel like you're in danger. People tend to lash out when they feel endangered, especially when inebriated. They may become violent due to the delusions and hallucinations they are experiencing.

Cocaine use, in and of itself, can increase aggressive or violent behavior. But psychosis amps up the behavior and makes it more likely. One study found that over half of those with cocaine-induced psychosis showed violent tendencies.  

Stimulant Psychosis

Cocaine is not the only substance to trigger a psychotic episode, as other stimulants can cause it. Amphetamines and methamphetamine, for example, are both known to cause stimulant psychosis in some people.

What Causes Cocaine Psychosis?

Because research correlates cocaine-induced psychosis to overdose and withdrawal, it can be tricky to pinpoint what exactly causes it. It is, however, linked to a vital chemical in the brain that is involved with neurodevelopment, memory, and learning.

Brain-derived neurotrophic factor, or BDNF, is a protein observed as a marker for psychotic episodes of schizophrenia. More research shows that it plays a direct role in cocaine psychosis, as well. 

Low levels of BDNF indicate psychosis, including cocaine-induced psychosis. Researchers believe it can even indicate substance use disorder.

Who is at Risk for Cocaine-Induced Psychosis?

While the odds that a first-time user will develop psychosis are low, they're not zero. Many things play a part in developing psychosis, including age, gender, length of use, and body composition.

Long-Term Users

A person's age of first use and length of use are the most significant determining factors of cocaine psychosis development. Essentially, the longer a person abuses cocaine, the more likely they are to have a psychotic episode.

Another risk factor relating to consumption is a sudden increase or decrease in use. Psychosis is more likely to occur when binging and could be a sign of overdose.

Cocaine withdrawal symptoms can also include psychosis when someone has used cocaine for a long time.


Some studies have suggested that men are at higher risk for developing cocaine psychosis. However, age might be more of a deciding factor.

Because the length of use plays a significant role in developing cocaine psychosis, most people diagnosed with it are around 30 years old and have been consuming it for many years. 


Cocaine users with a lower body mass index, or BMI, are also at a higher risk of cocaine psychosis. However, more studies are required to find out exactly why.

Co-Occurring Disorders and Cocaine Psychosis

We know that certain mental health disorders have a cyclical relationship with addiction. Substance use exacerbates disorder symptoms, which trigger self-medication via substance use. This scenario continues in a vicious cycle.

The difference for cocaine psychosis is that research implies certain mental health disorders may be significant risk factors. An interesting correlation is that while doctors commonly prescribe amphetamines to those with ADHD, ADHD patients are much higher at having cocaine-induced psychosis than others. 

Some personality disorders, such as Borderline Personality Disorder (BPD) and Antisocial Personality Disorder (ASPD), are also at much higher risk of developing psychosis.

Cannabis and Cocaine Psychosis

Cannabis is a psychoactive substance, so it might make sense why there seems to be a connection between cannabis use and cocaine-induced psychosis. Using cannabis chronically beginning in adolescence can dramatically increase the risk of psychosis—due to cocaine, other stimulants, or cannabis itself.  

Kick Addiction at Sequoia Behavioral Health

Cocaine and other substances carry too much of a risk to use. Abusing illicit drugs harbors the danger of psychosis, violence, and overdose.

Sequoia Behavioral Health is here to help you find a way out if you struggle with addiction. Our residential treatment center offers a safe environment to help you heal. Please schedule a consultation with us today to begin your recovery journey.