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A man emptying a packet of cocaine onto a table, preparing to ingest it.
April 25, 2019

What Happens When You Do Coke?

Drug use is sometimes glamorized in movies and television, leading viewers to think the behavior is not all that problematic or dangerous. Sniffing, snorting or injecting powdery substances to achieve a highly pleasurable state of mind may seem like a quick and easy way to lose your troubles, but such experimentation and use comes with a price. You may not realize the real risks and long-term consequences stemming from this practice. What happens when you do coke?


Coke is the slang term for cocaine, a highly addictive psychoactive substance that’s illegal in the United States. It carries a Schedule II classification according to the Drug Enforcement Agency (DEA) drug scheduling under the Controlled Substance Act. This means it has a high abuse potential, which may lead to severe psychological or physical dependence.

Coke may be packaged as a powder, or in a paste, free-base or rock form (crack). Coke can be sprinkled on marijuana or tobacco and smoked. It may also be taken in combination with an opiate, like heroin, a practice called “speed-balling.” Coke injection, snorting, and smoking are common routes of administering cocaine.

PHYSICAL EFFECTS OF DOING COKE says the effect produced by cocaine is described by users as euphoric, with an energy boost, reduced fatigue, and elevated mental alertness. After doing coke, users may act in an extroverted manner, be talkative, lacking appetite or need to sleep. The effects, both euphoric and psychoactive, are of short duration unless the user administers the drug again.

What happens in the body when someone does coke is that levels of dopamine, a brain chemical, are released in the brain’s reward center. This is the same brain area registering pleasure. While dopamine release is a normal brain function, releasing and recycling, cocaine use can disrupt the process, causing an accumulation of dopamine and transmitting a much greater reward signal to the brain. This is what users describe as the cocaine euphoria.

Within a short time of doing coke, the user experiences immediate physical effects, such as increased blood pressure, heart rate, temperature, and constricted blood vessels and dilated pupils. There are health complications associated with doing coke, including chest pain, heart rhythm disturbances, heart attacks, headaches, nausea, stomach pain, respiratory failure, strokes, and seizures.


Most people who do coke are after the euphoric effects of the drug. Indeed, after repeated use, many are driven to search out and use the drug in an often vain attempt to recapture the cocaine high. Some who continue to use the drug experience anxiety, irritability, and restlessness. Prolonged use of coke may result in tolerance, meaning that continued drug use fails to produce the same type and intensity of sensations as initial exposure. In an effort to replicate the high and have it last longer, users may resort to taking greater coke doses. However, users can also develop a greater sensitivity to cocaine’s pain-relieving and convulsant effects even without a dose increase. Some deaths that have occurred from apparent low cocaine doses may be explained by this heightened sensitivity.

Binge coke use, which refers to repeatedly taking the drug at higher and higher doses, may propel users to increasing irritability, paranoia, and restlessness. This state can bring about paranoid psychosis, a mental condition where the coke user loses touch with reality and starts to experience auditory hallucinations.


Doing coke may result in a number of adverse reactions, depending on method of ingestion, frequency, dosage, other drug use, and any co-occurring medical and/or psychological conditions.

Ingesting Cocaine – Tissue death in the bowel (severe bowel gangrene) may occur from this method of cocaine use. The adverse reaction is due to reduced blood flow.

Injecting Cocaine – Drug injection can lead to severe allergic reactions, as well as putting the IV user at greater risk for contracting blood-borne diseases, including HIV and viral hepatitis.

Smoking Cocaine – This method of doing cocaine subjects users to asthma, cough, respiratory distress, and a higher infection risk for diseases like pneumonia.

Snorting Cocaine – Users who snort cocaine powder may experience hoarseness, difficulty swallowing, chronic runny nose, nosebleeds, and loss of sense of smell.

Risks to the Heart

Abusing coke may result in serious heart problems, including irregular heart rhythm, heart attack, or stroke. These acute cardiovascular or cerebrovascular emergencies could cause sudden death. In many cases of death, the precipitating factor is often cardiac arrest (the heart stops) or seizure, followed by breathing failure (respiratory arrest).

Alcohol and Cocaine

The National Institute on Drug Abuse (NIDA) highlights the dangerous interaction between alcohol and cocaine. The NIDA research indicates that the liver in humans combines the two substances and manufactures a third, cocaethylene, which not only intensifies both drugs’ euphoria effects, but also may increase sudden death risk.

Anabolic Steroids and Cocaine

Research presented by the American Physiological Society (APS) during its annual meeting at Experimental Biology 2019 found that teens using performance-enhancing drugs such as anabolic steroids may have increased risk of cocaine abuse and addiction, and have fertility damage. Researchers from the University of Puerto Rico, in a rat study, found that exposure to anabolic steroids increased cocaine’s psychoactive properties. Besides muscle-building effects, anabolic steroids are known to affect behavior and mood. Prior studies found that about one-third of young adults who use anabolic steroids also use cocaine. Researchers said in this study that androgen exposure in teens during the critical brain formation years “modifies the brain circuitry that regulates addictive behaviors, increasing the psychoactive properties of cocaine.”

Long-Term Effects of Doing Coke

Addiction is one of the most significant long-term effects of doing coke, although it is by no means the only one. Other sometimes lifelong effects of cocaine use include:

Mood Alteration, Irritability – Coke abuse can lead to disturbances in moods, depression, and irritability. It can also lead to violent mood swings.

Hallucinations (Auditory) – Long-term coke use can result in the user experiencing hallucinations, where he or she hears things that others do not.

Restlessness – Coke addicts are often plagued by restlessness and anxiousness, which are visibly apparent. Such heightened maladaptive behavior may interfere with relationships, work, school, or other areas of the user’s life.

Paranoia – Another serious long-term effect of chronic coke abuse or cocaine addiction is the development of paranoia. This mental illness, which is characterized by extreme and unreasonable distrust of others, can jeopardize everyday life functioning, making it difficult to interact with other people and carry out responsibilities.


Individuals who began using alcohol or drugs during adolescence or teens are at higher risk for problems resulting from doing coke. That’s because young brains are not fully developed until the mid-20s and introducing drugs at an early age may cause damage, which magnifies the risk for developing a drug dependency and/or addiction later on.

The 2016 Treatment Episode Data Set (TEDS) from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that 91,000 children admitted for any substance use treatment (for alcohol, opiates, cocaine, other substances) were under the age of 11 at first use. Thirty percent (510,000) of the total of 1,632,139 individuals admitted for SUD treatment that year were between the ages of 18-30 when they initiated substance use. For cocaine-specific treatment admission, 22 percent (11,120) were under the age of 18 at first use, 607 under the age of 11, while 56 percent (28,294) were between the ages of 18-30 when they first began smoking cocaine.

Trauma experiences during childhood and high stress levels during adolescence are also risk factors for doing coke, as individuals seek relief from the psychological effects of those events by drug use.

In addition, self-medicating for underlying physical and mental health issues (anxiety, depression, eating disorders, etc.) could also lead to substance abuse and drug dependency. The National Alliance on Mental Illness (NAMI) estimates that more than 50 percent of drug abusers suffer from a co-occurring (dual diagnosis) mental health disorder.


The National Institute on Drug Abuse (NIDA) states that, as with other drugs, long-term use of cocaine (coke) leads to changes in the brain, in the reward system and other brain system areas governing behavior. Eventually, the brain’s reward circuit adapts to the flood of extra dopamine, becoming less sensitive to it over time. Such persistent coke use can lead to addiction. When someone becomes addicted to coke, they have to use more of the drug more often to achieve the same effects. Even when they fail to achieve the former high, they keep using coke to stave off the effects of coke withdrawal, which include:

  • Depression
  • Fatigue
  • Increased appetite
  • Unpleasant dreams
  • Slowed thinking

Using cocaine and other substances of abuse, including alcohol, the stimulant amphetamine, or the synthetic opiate fentanyl, increases the risk of addiction to multiple drugs.

A study published in Biological Psychiatry, looking at intermittent access and self-administration of cocaine in rats found that it caused increased drug seeking and craving during abstinence. This was more pronounced than continuous access in both rat sexes. Female rats showed significantly higher craving during estrus in both intermittent and continuous cocaine access.


Spotting someone who may be experiencing a cocaine overdose is important to be able to summon emergency medical attention in time. Whether the overdose was intentional or unintentional, it’s important to know when the person may be in the midst of a life-threatening overdose on the drug. Signs of possible cocaine overdose include:

  • Dangerously rapid pulse
  • Excessive sweating
  • Intense pain in the chest
  • Hallucinations
  • Heavy breathing or difficulty breathing
  • Nausea
  • Vomiting

Note that some of these signs may be indicative of overdose on another substance, such as opiates, or a combination of substances that may include alcohol, benzodiazepines, cocaine and other drugs of abuse. Regardless, when these signs are apparent, it’s necessary to get the person immediate medical assistance by calling 911.


According to the 2017 National Survey on Drug Use and Health (NSDUH), an estimated 966,000 people aged 12 and older had a cocaine use disorder in 2017. That figure includes about 19,000 adolescents aged 17 and under, 243,000 young adults from 18-25, and 703,000 adults 26 and older.

While there are no currently FDA-approved medications to treat cocaine use disorder (coke addiction), testing is underway by researchers to determine if approved medications for treating other substance use disorders (SUDs) and disorders may be effective for coke addiction. These include buprenorphine, used to treat opiate use disorder (OUD), disulfiram, used in the treatment of alcohol use disorder (AUD), locaserin that is used to treat diabetes, and modafinil, which is used to treat narcolepsy.

Besides the potential for these medications or others currently in development and research for use in medication-assisted treatment (MAT), cocaine rehab may include the following:

  • Inpatient or outpatient treatment
  • Cocaine detox
  • Cognitive behavioral therapy (CBT)
  • Contingency management or motivational incentives
  • Therapeutic communities
  • Recovery groups in the community, such as 12-step programs (Cocaine Anonymous, etc.)
  • Cocaine aftercare programs

For more about cocaine, substance abuse, addiction and recovery, check out these articles:

Alcohol and Cocaine: A Deadly Combination

Are Women More at Risk of Cocaine Addiction?

Cocaine and Adderall: Dangers, Contraindications and Statistics

Cocaine and Xanax : A Dangerous Duo

Cocaine Detox Guide

Do I Need Cocaine Rehab?

How Long Does a High Last?

How Long Does it Take to Get Addicted to Coke?

The Benefits of Inpatient Rehab

What Is a Speedball? Cocaine & Heroin’s Deadly Combination