Blog - Beach House Rehab Center
January 17, 2019

How to Tell if Someone Is High on Coke


Cocaine is a powerful stimulant drug that comes from the leaves of the coca plant in South America. The drug is also highly addictive, its signature euphoric high causing many to get hooked— even upon first-time use. If you suspect that someone you love may be using cocaine, this guide will help you better determine whether cocaine is, in fact, the problem, so that you can take next steps in encouraging your loved one to get treatment.

How Common Is Cocaine Use?

In this country, rates of cocaine abuse have fallen from their historic high in the 1980s, when 5.7 million Americans—three percent of the U.S. population—were cocaine users, according to a report by the National Institute on Drug Abuse (NIDA). Still, today cocaine and its stepsister crack remain surprisingly popular, as evidenced by these disturbing statistics:

  • The same NIDA report cited above noted that rates of crack use in this country have largely stayed the same since the 1980s, (when crack and cocaine use were at their peak).
  • Cocaine has continued to be the most frequently mentioned illicit drug implicated in visits to the ER, the Foundation for a Drug Free World has reported. In fact, cocaine accounted for more than one in three (40 percent) of all drug abuse-related emergency room visits, in data from the 2011 Drug Abuse Warning Network.
  • And, the cocaine-related overdose death rate in this country has increased by 52.4 percent, according to a 2018 press release by the Centers for Disease Control (CDC), which compared overdose deaths from cocaine to those for opiates and other drugs. (Cocaine-related overdoses saw one of the largest increases.)

How to Tell if a Child or Loved One Is High on Coke

Young adults (ages 18-25) are the demographic most likely to use cocaine. If you’re a parent, it therefore helps to know and be able to recognize the signs of cocaine use— starting with how to tell if your child is high on coke. Any family member, in fact, can benefit from this information. On that note, here are some tips for how to tell if someone is high on coke.

First, pay attention to how long the high lasts. With cocaine, whether it’s snorted, smoked or injected, the effects happen almost immediately: cocaine enters the bloodstream and soon triggers a surge of dopamine in the brain’s limbic system. (Crack produces its effects almost instantly, whereas cocaine when sniffed can take a bit longer— five to 10 minutes.)

Cocaine also blocks the receptors that recycle the pleasure neurotransmitters serotonin and dopamine, creating an artificial overabundance of these feel good hormones. The result is an intense experience of pleasure and euphoria that is very short-lived: no more than 15-30 minutes tops.

Second, notice whether the person seems to be unusually:

  • Happy and/or ecstatic
  • Excitable
  • Alert and/or very energized or active
  • Highly talkative

These states can occur because of the surge in dopamine, which acts on two key brain circuits governing pleasure and movement. Here is how one user described the cocaine high, in a 1999 study in the Primary Care Companion to the Journal of Clinical Psychiatry: “It’s like a hurricane blast of pure white pleasure.”

After the initial ecstasy, several minutes of hyperarousal and restlessness ensue. As one user in the same study put it: “It’s like you’re speeding. Moving around a lot. Talking a lot. But the rush is gone.”

Third, if you can, check the person’s pupils. In the presence of higher levels of dopamine and serotonin, a person’s pupils will dilate, looking noticeably bigger.

Fourth, immediately following these signs of a high, look for a dramatic and rapidly ensuing mood swing. Another giveaway that a person is high on cocaine: if the joy, excitability and/or extremely high energy are followed by a dramatic mood change, such as depression, irritability, anxiety, paranoia, even violence. This change should occur in pretty quick time after the 15 to 30-minute window of pleasure and high energy has closed. In other words, the quick and fleeting, signature “high” of cocaine will probably be followed in quick succession by a noticeable “low.”

Fifth, ask yourself if the person is acting strange and appears to be paranoid, suicidal and/or homicidal. Research has revealed that cocaine and especially crack can produce a range of serious psychiatric symptoms in a significant number of users. For example, a 1999 study in the Primary Care Companion to the Journal of Clinical Psychiatry found that:

  • cocaine produces paranoia in 68 percent to 84 percent of users,
  • causes violent behaviors in as many as 55 percent of users,
  • is associated with suicide in 18-22 percent of cases,
  • and has been implicated in as many as 31 percent of homicides.

Psychiatric symptoms, in addition to being common among cocaine users, can indicate the presence of an underlying co-occurring disorder that can benefit from treatment. For instance, mood disorders and bipolar disorder are far more common among cocaine users than they are among the general population, according to a 2005 study in the journal Addiction Science & Clinical Practice.

Sixth, watch for any signs of psychosis. Psychosis is characterized by delusions, beliefs that are not real, and hallucinations, seeing, hearing or feeling things that are not real. Drug-induced psychosis is more common among people who use stimulants like cocaine, which increase dopamine levels. (High dopamine is known to contribute to psychosis.) In fact, the higher rate of psychosis among cocaine and methamphetamine users has inspired the classification of a condition known as “stimulant psychosis.”

Just how common is psychosis among cocaine users? Alarmingly, very common: over 50 percent of cocaine users reportedly experience psychotic symptoms, according to a 1991 study of cocaine-induced psychosis in the Journal of Clinical Psychiatry. There the researchers found that the most commonly occurring cocaine-induced psychotic experiences are these:

  • Delusions of being persecuted, having parasites or bugs on the skin, or being watches or followed by others.
  • Rocking, pacing, or jumping— roughly one out of four people with cocaine psychosis will exhibit one or more of these behaviors.
  • Hallucinations, experienced by over 95 percent of cocaine users with psychosis, and which are auditory, visual and/or tactile.

Keep in mind that the severity of a cocaine user’s psychosis typically depends on how long they have been using the drug— so if your loved one is exhibiting very bizarre behavior that is undeniably psychotic, the chances are this is not your loved one’s first time getting high on the drug.

Seventh, in the aftermath of the high, pay attention to whether your loved one exhibits cravings and cocaine seeking behavior. After the initial rush of ecstasy, your loved one will probably grow restless and agitated. Cravings for another hit can quickly develop as an effort to relieve this discomfort. If your loved one seems frantic and obsessed with getting more of the drug, they are probably experiencing post-high cravings.

Intervention and Treatment for Cocaine Addiction

If, based on the above litmus test, you determine that your loved one is indeed high on cocaine, immediate intervention is key. Anyone who is using cocaine, whether for the first time or for an extended period of time, faces the dangers of overdose and addiction, in addition to a string of scary long-term health effects.

Professional treatment is often the best line of protection from these perils— and the sooner you intervene, the better your loved one’s prospects for recovery. By enrolling in a trusted inpatient rehab program for cocaine, your loved one will receive proven behavioral therapies that help them develop healthy coping tools for managing their triggers to use cocaine. They will also have the advantage of 24/7 medical monitoring, including, potentially, medications to relieve the discomfort of withdrawal. (While there is currently no medication-assisted treatment (MAT) for cocaine cravings, NIDA notes that medications that treat other substance use disorders are being tested, including the drugs buprenorphine, disulfiram, modanifil, and lorcaserin.)

Yes, coming to terms with the fact that a loved one is high on coke can be incredibly hard. But do not underestimate the power of new beginnings— and, the hope for recovery that time in rehab offers.

For more information related to cocaine, please see the following articles: