Cocaine addiction: effects, risks, and treatment in South Africa

Cocaine produces a short, intense high, and that brevity is a large part of what makes the drug so addictive. The effects wear off within minutes, which pushes many users to take repeated doses in a single session, and regular use changes how the brain responds to reward.

This article covers what cocaine is and how it affects the brain and body. The article also sets out the signs of cocaine addiction, what withdrawal and treatment involve, and what the latest South African admissions data shows.

What is cocaine?

Cocaine is a stimulant drug made from the leaves of the coca plant, which grows in South America. On the street, the drug is sold in two main forms:

• Powder (cocaine hydrochloride), which is usually snorted, rubbed into the gums, or dissolved in water and injected
• Crack, a form of cocaine processed into small rocks and smoked, named after the crackling sound it makes when heated

Both forms contain the same active drug. The difference between them comes down to how quickly each one reaches the brain.

Crack cocaine vs powder cocaine

Crack and powder cocaine produce the same effects once they reach the brain. What differs is speed. According to the US National Institute on Drug Abuse, the effects of snorted cocaine last 15 to 30 minutes, while smoked crack wears off in 5 to 10. The faster a drug is absorbed, the more intense the high and the shorter it lasts.

A 1996 review comparing crack with powder cocaine concluded that the way the drug is taken has a bigger effect on addiction risk than the form it comes in. Smoking or injecting cocaine carries a greater risk of dependence, and more severe consequences, than snorting. The same review noted that snorting cocaine can lead on to smoking crack.

A person who starts by snorting cocaine occasionally and moves on to smoking or injecting the drug has taken on a much higher risk of addiction.

How cocaine affects the brain

Cocaine stops the brain from recycling dopamine, a chemical messenger involved in pleasure, motivation, and reward. Dopamine builds up between nerve cells, producing the euphoria and energy users feel.

With regular use, the brain adapts to these surges. Everyday sources of pleasure start to seem flat by comparison, and the person comes to need cocaine to feel normal rather than high.

Because the high is short, cocaine lends itself to binges. A user takes repeated doses over several hours to sustain the effect, then crashes into exhaustion, low mood, and craving once the supply runs out or the body can’t keep up.

That binge-and-crash cycle sits at the centre of cocaine addiction for many people, and each crash creates a strong pull to use again.

Short-term effects of cocaine

The effects of cocaine begin within seconds to minutes, depending on how it’s taken. Common short-term effects include:

• A rush of euphoria and energy
• Increased alertness and talkativeness
• Reduced appetite and need for sleep
• A faster heart rate and higher blood pressure
• Dilated pupils and raised body temperature

Higher doses can bring on anxiety and paranoia, along with irritable or aggressive behaviour.

Cocaine carries serious risks even for occasional users. The National Institute on Drug Abuse notes that sudden death can occur on the first use of cocaine or at any point afterwards, usually as a result of cardiac arrest or seizures.

Long-term effects of cocaine

Regular cocaine use affects the heart, the brain, and mental health. Some of the damage builds with repeated use, and some can happen after a single dose.

Cocaine and your heart

Cocaine speeds up your pulse and raises blood pressure while narrowing the arteries that supply the heart. A study of 3,946 heart attack patients found that the riskof heart attacks rose 23.7 times above normal in the first hour after cocaine use, then dropped quickly. Many of the people affected were otherwise at relatively low risk.

Over the longer term, a US national health survey of adults aged 18 to 45 estimated that frequent cocaine use accounted for about 1 in 4 non-fatal heart attacks in that age group. NIDA also lists heart rhythm disturbances, stroke, and bleeding in the brain among the drug’s possible health effects.

Mental health effects of cocaine

Regular cocaine use is associated with anxiety, paranoia, and depression, and heavy use can trigger psychotic symptoms such as hallucinations. Low mood between binges often becomes a reason to use again, which deepens the cycle.

Many people who use cocaine also live with an underlying mental health condition. When anxiety, depression, or trauma sits alongside addiction, both conditions need care at the same time, an approach known as dual diagnosis treatment. 

Physical effects of cocaine

The physical damage caused by cocaine depends partly on how the drug is taken:

• Snorting damages the lining of the nose, causing nosebleeds and a reduced sense of smell, and in severe cases a hole in the wall between the nostrils
• Smoking crack damages the lungs and airways
• Injecting carries a risk of HIV, hepatitis C, and serious skin infections

Unintentional weight loss is also common, because the drug suppresses appetite.

None of these effects is inevitable after a single use, but the risk of each one rises with frequency and dose.

Cocaine and alcohol: Why the combination is more dangerous

Cocaine and alcohol are commonly used together, and the combination creates a separate risk. When both are in the body, the liver produces a third substance called cocaethylene.

A 2022 review of cocaethylene describes it as the only known case of a new psychoactive substance forming entirely within the body. Cocaethylene acts on the brain much as its parent drug does, makes the high longer and more intense, and may be more harmful to the heart than cocaine alone. A separate toxicology review puts its half-life at around two hours, roughly double that of cocaine.

People often drink to take the edge off a cocaine high, or use the drug to keep drinking for longer. In both cases, the combination extends the strain on the heart well beyond what either substance would cause alone.

Signs of cocaine addiction

Clinicians diagnose cocaine addiction as stimulant use disorder, using the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The criteria mirror those for other substance use disorders, including using more than intended, failing to cut down, and continuing despite harm.

For family members and friends, the signs are usually behavioural. Look out for:

• Frequent trips to the bathroom during social events, or disappearing for short periods
• Nosebleeds, a persistently runny nose, or constant sniffing
• Bursts of energy and talkativeness followed by long periods of sleep and low mood
• Unexplained spending, borrowing, or missing money
• Irritability, paranoia, or growing secrecy
• Loss of appetite and weight
• Falling behind at work or neglecting responsibilities

A single sign on its own doesn’t confirm a problem. Several together, over weeks or months, point to a pattern that needs addressing. Our family support programme helps relatives work out how to respond.

Cocaine withdrawal: What to expect

Most people who use cocaine heavily and then stop experience withdrawal effects. A 2023 review of psychostimulant withdrawal estimates that the majority of people who stop after sustained stimulant use go through withdrawal.

Under the DSM-5, stimulant withdrawal involves low mood alongside at least two of the following:

• Fatigue
• Vivid, unpleasant dreams
• Sleeping too much or too little
• Increased appetite
• Slowed movement or, in some people, agitation

Clinicians describe psychostimulant withdrawal in three phases:

• Acute withdrawal, covering the first week
• Early protracted withdrawal, from weeks two to four
• Late protracted withdrawal, beyond four weeks, when cravings can still return

No medication has proven reliably effective for cocaine withdrawal. The same 2023 review found an inconsistent signal for both medications and behavioural treatments during this period, which is why support and monitoring carry so much weight in the first weeks.

Low mood during cocaine withdrawal can be severe. If you or someone you know has thoughts of self-harm, call the SADAG helpline on 0800 12 13 14, which is open 24 hours.

Cocaine use in South Africa: What the data shows

Cocaine accounts for a smaller share of treatment admissions in South Africa than alcohol or cannabis, but the people it affects fit a distinct profile. According to the SACENDU Research Brief for January to June 2025:

• Crack/cocaine was the primary substance for 3% of people entering specialist treatment nationally, a rate that has held steady over recent reporting periods
• Rates ranged from 1% in Gauteng to 11% in KwaZulu-Natal, where crack/cocaine was the third most common primary substance after alcohol and cannabis
• In KwaZulu-Natal, 23% of people admitted used crack/cocaine as either their primary or secondary substance
• The average age of people in treatment for crack/cocaine was 33, compared to 22 for cannabis
• Between 67% (Western Cape) and 90% (KwaZulu-Natal and Eastern Cape) of those admitted were men
• Fewer than 1% of under-18s in treatment were admitted for crack/cocaine

Treatment data counts only people who reach a specialist centre. Those figures don’t show how many people use cocaine without ever seeking help.

Treatment for cocaine addiction

No medication is currently approved specifically to treat cocaine addiction in the US or Europe. As a result, cocaine addiction treatment relies on psychological and behavioural approaches.

A 2021 meta-analysis of 157 clinical trials involving more than 15,000 people compared treatments for active cocaine use. Contingency management was the only approach significantly linked to cocaine-free drug tests, roughly doubling the odds of a negative result. Contingency management rewards patients with vouchers or prizes each time they produce a negative drug test, which reinforces abstinence directly.

Houghton House is a fully licensed psychiatric hospital, which allows co-occurring conditions such as anxiety, depression, or trauma to be treated alongside the addiction itself.

Inpatient treatment

Our inpatient drug rehab programme runs for 30 days on a set daily schedule that includes:

• Individual counselling
• Group therapy
• CBT and DBT
• Trauma therapy
• Relapse prevention

Patients also work through the 12-step programme, a recovery framework built on peer support and personal accountability, and families take part through dedicated sessions.

Where someone has also been drinking heavily or using other substances, treatment may begin with medically supervised detox.

Outpatient treatment

Our intensive outpatient programme offers treatment without taking you away from work or family commitments. The programme suits people whose use hasn’t yet reached the point of needing round-the-clock support, or who are stepping down from inpatient care.

Psychiatric care and dual diagnosis treatment

Every patient is assessed for co-occurring mental health conditions on admission. Where depression, anxiety, or another condition is present, our psychiatric team treats both at the same time rather than one after the other.

Aftercare

Recovery continues after discharge. Patients move into our aftercare programme, which reinforces the skills developed in treatment and keeps them connected to support during the months when relapse risk is highest.

Medical aid cover for cocaine addiction treatment

Substance use disorders, including cocaine addiction, are prescribed minimum benefits in South Africa. All registered medical aid schemes must cover treatment, regardless of the plan you’re on.

Houghton House’s hospital licence means patients can also claim for mental health care where a co-occurring condition qualifies under psychiatric PMBs. If you’re a Discovery Health member, our guide to your rehab benefits explains how cover applies at Houghton House.

Our admissions team can check your cover at no cost and with no obligation. Call 011 787 9142, 24 hours a day.

Frequently asked questions about cocaine

How long does cocaine stay in your system?

Detection times depend on how much was used, how often, and the type of test. A review of drug detection times gives these typical windows for drugs of abuse, including cocaine:

• Urine: 1.5 to 4 days after a single dose, and around a week in regular users, sometimes longer with heavy use
• Blood: 1 to 2 days
• Saliva: 5 to 48 hours

Hair tests have the longest detection window of all.

Can you overdose on cocaine?

Yes. Cocaine overdose can be fatal, and deaths usually result from cardiac arrest or seizures. Signs of a cocaine overdose include:

• Chest pain or an irregular heartbeat
• Seizures
• A severe headache
• Extreme agitation, confusion, or paranoia
• Loss of consciousness

If you suspect a cocaine overdose, call an ambulance immediately on 10177, or 112 from a cell phone.

Is cocaine addictive?

Yes. Cocaine floods the brain with dopamine for a short period, and the crash that follows creates a strong urge to use again. Smoking or injecting the drug carries a greater risk of dependence than snorting it, because the effects arrive faster and more intensely.

What does cocaine look like?

Powder cocaine is fine, white, and crystalline. Crack cocaine comes as small, off-white or cream-coloured rocks.

What are the street names for cocaine?

Powder cocaine is commonly called coke or snow. Crack cocaine usually goes by its own name, which comes from the crackling sound it makes when heated.

Is crack more addictive than cocaine?

Crack and powder cocaine are the same drug, with identical effects once in the brain. Crack is more strongly linked to addiction because it’s smoked, and a 1996 review of the evidence found that smoking or injecting cocaine carries a greater risk of dependence than snorting it. The review concluded that the speed and intensity of the effect matter more than the form of the drug.

How can I help someone addicted to cocaine?

Choose a moment when the person isn’t high or coming down, and talk about specific behaviour you’ve noticed rather than labels. Avoid covering for them or paying off debts linked to their use. 

If they’re unwilling to accept help, our intervention process brings a trained facilitator together with the family to plan that conversation. You can also call our admissions team on 011 787 9142 to talk through the options confidentially.

If you’re looking at related substances, our articles on tik (crystal meth) and designer drugs cover their effects and treatment.