Clinically reviewed by the licensed clinical team at Shepherd Recovery Centers. Content is for informational purposes only and does not constitute medical advice. Sources include the National Institute on Drug Abuse (NIDA), Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA).
Cocaine Use Disorder in the U.S.
Cocaine remains one of the most widely used illicit stimulants in the United States. According to SAMHSA’s 2023 National Survey on Drug Use and Health, approximately 4.8 million Americans used cocaine in the past year, and an estimated 1.4 million had a cocaine use disorder. Cocaine-involved overdose deaths have increased substantially in recent years, largely driven by cocaine supplies increasingly contaminated with fentanyl.
Cocaine-involved overdose deaths increased from approximately 14,000 in 2017 to nearly 25,000 in 2021. Nearly 70% of those deaths also involved synthetic opioids, primarily fentanyl. (CDC, Drug Overdose Surveillance Data)
In Texas, cocaine use disorder is a consistent driver of treatment admissions. It crosses demographic lines, affecting people across income levels, professions, and backgrounds. The perception that cocaine is a drug used primarily at parties or by specific social groups is outdated and inaccurate. Cocaine use disorder is a medical condition that responds to evidence-based treatment.
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How Cocaine Affects the Brain
Cocaine produces its primary effect by blocking the reuptake of dopamine, serotonin, and norepinephrine in the brain, causing a buildup of these neurotransmitters in the synaptic cleft. The result is a rapid, intense euphoria accompanied by increased energy, confidence, and alertness. According to NIDA’s cocaine research summary, cocaine’s euphoric effects are short-lived, typically 15 to 30 minutes for powder cocaine, which drives the binge patterns characteristic of cocaine use disorder.
Repeated cocaine use disrupts the brain’s dopamine signaling system. Over time, the brain reduces its baseline dopamine production, leaving users unable to feel pleasure from normal activities (anhedonia) and craving the artificial dopamine boost that cocaine provides. This neurobiological change is a core driver of addiction and explains why quitting cocaine often requires professional support.
Signs of Cocaine Use Disorder
- Recurring binges followed by prolonged “crashes” involving depression, fatigue, and intense cravings
- Financial problems due to spending on cocaine
- Cocaine use beginning to interfere with work, family, or social responsibilities
- Physical signs: nosebleeds, nasal congestion, or septum damage from snorting; cardiovascular symptoms including elevated heart rate and chest pain
- Paranoia and irritability, particularly during heavy or prolonged use
- Continuing to use despite awareness of physical or psychological harm
- Failed attempts to cut down or stop
According to the DSM-5 criteria for stimulant use disorder, cocaine use disorder is diagnosed based on the pattern of use and its consequences, not the amount used or the frequency of use alone.
The Cocaine-Fentanyl Contamination Risk
A new and critical safety concern in cocaine use disorder is fentanyl contamination. The DEA reports that illicitly manufactured fentanyl has been found in cocaine supplies across the country, including in Texas. People using cocaine, many of whom have no opioid tolerance, are dying from fentanyl exposure they were unaware of.
This underscores the urgent need for treatment. If you are currently using cocaine, the risk of accidental fentanyl exposure is real and significant. Our team will discuss harm reduction alongside treatment options.
Cocaine Treatment at Shepherd Recovery Centers
No Approved Medication: Behavioral Therapy Is Central
There is currently no FDA-approved medication for cocaine use disorder, though research into several pharmacological candidates continues. Behavioral therapy is the primary and most evidence-supported treatment modality.
Cognitive Behavioral Therapy for Cocaine
CBT was originally validated for cocaine use disorder in landmark NIDA-funded trials and remains the gold standard behavioral treatment. NIDA’s Principles of Drug Addiction Treatment specifically identifies CBT as an effective approach for stimulant use disorders. At Shepherd, CBT for cocaine focuses on identifying the high-risk situations, emotional states, and thought patterns that precede use, and building specific skills to interrupt the use cycle.
Contingency Management
Contingency Management (CM), an approach in which clients earn tangible incentives for negative drug tests, has strong evidence for cocaine use disorder. Our group programming incorporates CM principles, and our clinical team uses motivational approaches consistent with the CM evidence base.
Treating the Post-Cocaine Crash
The crash following cocaine use, characterized by depression, fatigue, and intense craving, is one of the highest-risk periods for relapse. Our clinical programming specifically addresses the management of this post-use period, building clients’ capacity to tolerate the discomfort of early abstinence without returning to cocaine.
Cognitive Behavioral Therapy for cocaine use disorder demonstrates lasting effects beyond the treatment period, with research showing maintained gains at 12-month follow-up. (Carroll et al., NIDA-funded trials, Yale University School of Medicine)
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If you or someone you love is struggling with addiction, Shepherd Recovery Centers is ready to help. Our licensed clinical team serves Missouri City, Fort Bend County, and the greater Houston area. We accept most major insurance plans and can verify your benefits within 24 hours. The first call is confidential and carries no obligation.