Cocaine-Induced Psychosis

Cocaine-induced psychosis is a type of mental illness in which psychotic symptoms are triggered or worsened by drug misuse, in this case the stimulant cocaine. There are known risk factors for the condition, including heavy, long-term cocaine use, early first use of cocaine, and having underlying mental illnesses, especially those with psychotic symptoms. Some cases of cocaine-induced psychosis resolve quickly, while some people will need ongoing professional treatment, which may include medication, therapy, and management of substance use disorder and co-occurring mental illnesses.

What Is Cocaine-Induced Psychosis?


Substance-induced psychotic disorder is a mental health condition listed in the Diagnostic and Statistical Manual of Mental Disorders, the book used by professionals to make diagnoses. It is grouped with other psychotic conditions and can potentially be triggered by any substance, including cocaine. Use of cocaine can cause psychotic symptoms, even after just one use, but it is more likely to occur in long-term users.

Cocaine-induced psychosis is an episode of psychotic symptoms, which may include delusions, hallucinations, disordered thinking, and unusual behaviors and emotional responses. This kind of psychosis may be a short episode, but it can also become a chronic issue that occurs over a longer period of time and that requires professional treatment to resolve.

Types of Cocaine-Induced Psychosis

Psychosis triggered by cocaine use isn’t officially divided into any subtypes, but it can be described by different qualities, types of symptoms, duration, and other factors. For instance, someone with cocaine-induced psychosis may have underlying mental illness with psychotic symptoms that are exacerbated or elicited by the cocaine use. Other users of cocaine may not have those underlying conditions and experience psychosis only because of the cocaine.

Some cases of this condition are short-term and resolve when use of cocaine has stopped and the drug has left the body. In other instances, most often in long-term and heavy cocaine users, psychotic symptoms can go on for longer periods of time and may become a recurring issue.

Facts and Statistics


Cocaine use to any degree can have very serious consequences, from addiction to side effects and even psychotic episodes.

Symptoms and Diagnosis of Cocaine-Induced Psychosis


Psychosis is a set of psychiatric symptoms that is not a condition in itself but rather is a consequence of certain mental illnesses and conditions. When a drug like cocaine causes psychosis, it is called substance-induced psychosis. It may also be a result of certain mental illnesses, like schizophrenia, bipolar disorder, and sometimes depression. Certain medical conditions and injuries, including brain injuries or seizure disorders, can also lead to psychotic symptoms.

There are a few types symptoms of psychosis, but all of these are characterized by some degree of loss of touch with reality. Someone who is experiencing a psychotic episode has a hard time distinguishing between what is real and what is not. Potential symptoms of cocaine-induced psychosis include:

  • Hallucinations. A hallucination is sensing something that isn’t real. During a psychotic episode, a person believes what they are seeing, hearing, feeling, or otherwise sensing is real. Hearing voices and feeling something crawling on the skin are examples of hallucinations.
  • Delusions. A delusion is a false belief. During psychosis, a person believes the delusion even when presented with contrary evidence. Delusions may be paranoid, persecutory, jealous, grandiose, or mixed.
  • Disordered thinking. Psychosis can cause confused and disordered thoughts that race through the brain and are jumbled. To observers, this is often expressed as racing speech that doesn’t make sense.
  • Emotional, behavioral, and mood symptoms. Psychosis may also cause changes in emotional responses, behaviors, and emotions that seem odd to other people. Emotional affect may become flat, or an individual may respond aggressively. Behaviors may become erratic and unusual, even violent.

Someone suffering from cocaine-induced psychosis may experience any kind of psychotic symptoms, but some are more typical as a result of stimulant use than others. For instance, paranoid delusions are among the most common cocaine-related symptoms. A cocaine user with psychosis may feel as if they’re being followed, as if someone they trust is actually trying to hurt them, or generally as if other people are out to get them. Hallucinations are the next most common of symptoms with cocaine and psychosis.

Causes and Risk Factors

Exactly what causes psychosis from cocaine use is not known. It is likely to involve complicated changes and mechanisms in the brain that are not yet fully understood. There may also be underlying factors that contribute to the psychosis, such as medical and psychiatric conditions, further complicating the pathway that leads to these symptoms.

There are several risk factors that have been recorded for cocaine-induced psychosis. These make it more likely that an individual will experience psychosis when misusing cocaine or as a result of having used it at all in the past:

  • Repeated, long-term use of cocaine
  • Being male
  • Being older
  • Having a lower body mass index
  • First use of cocaine at a young age
  • Being dependent on cocaine
  • Smoking crack cocaine
  • Having an existing mental health condition

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Co-Occurring Disorders


Someone who experiences psychosis with cocaine use does not necessarily have a cocaine use disorder; however, it is likely. Psychotic episodes are more likely with heavier, more frequent and long-term misuse of cocaine, as is addiction. So, it only follows that cocaine use disorder commonly co-occurs with cocaine-induced psychosis.

There are also other conditions that may occur with a stimulant use disorder, cocaine misuse, and cocaine-triggered psychosis. Fifty percent of people diagnosed with schizophrenia misuse substances, and cocaine is one of the most common of these. There is some evidence that cocaine use can trigger symptoms of schizophrenia, a psychotic condition, even the first signs of the mental illness in those predisposed to it. Cocaine use has also been shown to exacerbate symptoms of schizophrenia.

Some other mental illnesses that may co-occur in someone who is struggling with cocaine use and resulting psychotic symptoms include anxiety disorders, depression, and certain personality disorders. Suicide has also been connected with cocaine use, which may or may not be related to co-occurring depression.

Treatment and Prognosis of Cocaine-Induced Psychosis


For many people with cocaine-induced psychosis, the treatment involves simply stabilization and time. When the drug wears off the psychotic symptoms typically resolve. During stabilization, a patient may need basic care such as monitoring of vital signs and fluids. Psychiatric stabilization may also be required, though. This can include hospitalization for a short time and the use of antipsychotic medications or benzodiazepines to lower anxiety.

Many people in this situation need care and professional support beyond initial stabilization. They can benefit from being screened for mental illnesses and from treatment for those conditions as well as substance use disorder. With only stabilization until the psychotic symptoms resolve and without addressing the other issues, it is likely that substance use will continue and that psychosis will occur again.

Treatment depends on the specific mental illnesses, but if psychosis persists a patient may need to be on antipsychotic medications for a longer duration. This type of drug can help reduce psychotic symptoms. Therapy is also useful and helps patients learn how to identify their symptoms, discover triggers for episodes, and to take steps to make important changes for a healthier and more functional lifestyle.

It is also important to address and manage substance misuse. Not addressing even a mild substance use disorder can lead to relapse, which in turn can re-trigger psychosis and other mental illness symptoms. A patient with so many different mental health and substance use issues can benefit from a stay in a residential treatment facility. This allows the individual to get 24-hour support, professional and individualized care, and the ability to focus on getting better in a safe environment.

The prognosis for cocaine-induced psychosis is generally good for anyone who is willing to take steps to stop using drugs and to get treatment. When both mental illnesses and substance use disorders are recognized and managed, an individual who has experienced cocaine psychosis can get relief from symptoms and go back to living a more normal and rewarding life.