Harbor insights: revealing the long-term effects of cocaine  

Cocaine, a powerful stimulant derived from coca leaves, is associated by many with high-octane lifestyles – but its destructive potential often remains sadly underestimated. 

According to the NHS1:

• Cocaine is the second most commonly used drug in the UK
• Approximately 3% adults aged between 16 and 59 report using cocaine

Cocaine use has risen year-on-year2, with its prevalence particularly high among young adults and professionals seeking to enhance performance or cope with stress. In tandem, many point to a significant prevalence among Gen X3 , as well as a British alcohol culture4 , as contributing to cocaine’s pervasiveness.

Often glamourised in media and culture, the drug’s purported allure overshadows a harsh reality: cocaine abuse can lead to devastating long-term effects, including irreversible damage to the brain, heart, and other vital organs.

Beyond physical health, cocaine’s impacts extend into mental health, leading to addiction, heightened anxiety, and severe mood disorders. Its grip can disrupt careers, relationships, and families, leaving a trail of emotional and social turmoil.

This blog explores the long-term effects of cocaine use, offering insights into its consequences and the importance of whole-person, clinically guided recovery pathways for those seeking to regain control of their lives. 

If you know someone struggling with cocaine misuse, make a referral today.

An overview of cocaine use and misuse

Cocaine, often consumed as a fine white powder or crack crystals, is known for its ability to deliver an intense, short-lived euphoria. The drug stimulates the central nervous system by blocking dopamine reuptake5, flooding the brain with the neurotransmitter responsible for pleasure and reward.

Behaviorally, individuals on cocaine often exhibit bursts of energy, heightened confidence, and rapid speech. These effects are often accompanied by dilated pupils, restlessness, and erratic movements6. Emotionally, users might feel “invincible”, with diminished judgement and heightened impulsivity7. 

From the outside, someone under the influence may seem unnaturally animated or agitated, with moments of paranoia or aggression.

Neurologically, cocaine disrupts normal brain function by overstimulating the reward pathway. Over time, this leads to desensitisation, requiring users to consume more to achieve the same high. These chemical imbalances contribute to the cycle of dependency, as the brain struggles to regulate its dopamine production8.

When things get out of hand

The transition from recreational use to dependency can be subtle but dangerous. Frequent use increases tolerance, meaning the brain and body require higher doses to feel the same effects9. This often leads to binge patterns, where users consume cocaine in excessive amounts over short periods, putting immense strain on the body and mind.

As misuse escalates, the behavioural, neurological, and emotional impacts worsen. 

Users may become irritable, paranoid, or overly aggressive. Neurologically, the overstimulation of dopamine pathways can lead to cognitive impairment, memory loss, and difficulty concentrating10. Emotionally, anxiety and depression frequently develop, fueled by the body’s inability to naturally produce sufficient dopamine.

At its most severe, cocaine misuse spirals into addiction, marked by cravings, withdrawal symptoms, and an inability to stop despite negative consequences. Relationships, careers, and mental health often deteriorate as the user prioritises the drug above all else. 

This dangerous cycle underscores the importance of timely intervention and whole-person treatment.

A window into the neurochemical effects of cocaine

Cocaine profoundly alters the brain’s neurochemistry, primarily by interfering with the neurotransmitter dopamine, which regulates reward, pleasure, and motivation. Normally, dopamine is released by neurons in response to rewarding stimuli and reabsorbed into the neurons through a process called reuptake. Cocaine blocks the dopamine transporter protein11, preventing this reuptake and causing an accumulation of dopamine in the synaptic cleft – the gap between neurons.

This dopamine surge overstimulates the brain’s reward circuit, particularly in areas like the nucleus accumbens and prefrontal cortex12. This results in the intense euphoria and heightened sense of energy associated with cocaine use. However, this process comes at a cost:

• Dopamine depletion: over time, the brain reduces natural dopamine production and receptor sensitivity13, leading to anhedonia (inability to feel pleasure) and emotional flatness when not using the drug.
• Structural brain changes: prolonged use can lead to neuronal damage, reduced grey matter14 in the prefrontal cortex (affecting decision-making and impulse control), and altered neural connectivity.
• Glutamate dysregulation: cocaine also affects glutamate, a neurotransmitter critical for learning and memory. Dysregulation of this system contributes to compulsive drug-seeking behaviours and cognitive deficits15.

Cocaine’s effects extend beyond dopamine and glutamate:

• Norepinephrine: this neurotransmitter, responsible for the body’s fight-or-flight response, is also affected, leading to increased heart rate, blood pressure, and heightened alertness16.
• Serotonin: cocaine influences serotonin levels, contributing to mood elevation but also increasing the risk of aggression and impulsivity17.

These neurochemical disruptions underpin both short-term high and long-term damage. The brain’s reward system becomes effectively hijacked, making it increasingly difficult for individuals to resist cravings or find joy in everyday activities. 

The long-term effects of cocaine

Cocaine use has far-reaching consequences that extend beyond the initial euphoria, deeply impacting physical, mental, and emotional wellbeing. 

Over time, chronic use leads to significant changes in the body and brain, with long-term effects that can alter the trajectory of a person’s health and life.

Physical health impacts

• Cardiovascular damage: cocaine’s stimulation of the nervous system increases heart rate and blood pressure, heightening the risk of heart attacks, strokes, arrhythmias, and cardiomyopathy18. Chronic use may lead to long-term damage to blood vessels, reducing their elasticity and function.
• Respiratory issues: for those who smoke or inhale cocaine, damage to the lungs can lead to chronic respiratory conditions, scarring, and frequent infections.
• Gastrointestinal complications: cocaine restricts blood flow to the gastrointestinal tract, increasing the risk of ulcers, bowel necrosis, and chronic digestive problems19.
• Neurological damage: long-term use can result in seizures, headaches, and reduced cognitive abilities, including memory impairments and slowed reaction times.

Mental health consequences

• Mood disorders: cocaine disrupts brain chemistry, leading to long-term risks of anxiety, depression, paranoia, and even psychosis. These effects often persist even after stopping use, as the brain struggles to rebalance its neurotransmitter systems.
• Cognitive decline: users may experience difficulties with attention, decision-making, impulse control, and memory, which can significantly affect daily functioning20.
• Addiction: the reinforcing cycle of dopamine release makes cocaine highly addictive, with long-term use deepening dependency and tolerance.

Emotional and social impact

• Isolation: cocaine use can alienate friends and family, causing breakdowns in relationships and increasing feelings of loneliness.
• Career instability: cognitive decline, erratic behaviour, and absenteeism can jeopardise professional responsibilities, leading to job loss or career setbacks – as seen in the careers of several high-profile individuals such as Cara Delevigne21, Frankie Dettori22, and Richard Gasquet23.

Specific risks of crack cocaine

The risks discussed are only heightened with crack cocaine, a more potent and fast-acting form of the drug24. 

Crack use exacerbates mental health issues, accelerates addiction, and increases the likelihood of acute medical emergencies like cardiac arrest. Its rapid absorption and short-lived high increase the likelihood of binge use, accelerating addiction and tolerance. 

• Crack use places extreme strain on the cardiovascular system, significantly raising the risk of heart attacks, strokes, and sudden cardiac arrest. 
• Neurologically, it exacerbates paranoia, aggression, and hallucinations25, often leading to long-term psychiatric conditions like psychosis. 
• The impact extends to respiratory health, with frequent users at risk of severe lung damage. 

Helping someone overcome cocaine addiction

At Harbor London, our approach to cocaine addiction is grounded in whole-person, clinically guided care designed to address the root causes of addiction while nurturing long-term recovery. We focus on more than just the immediate physical impacts of addiction – our bespoke treatment plans incorporate mental, emotional, and physical wellness, tailored to the individual’s unique needs.

Diet and nutrition play a pivotal role in repairing the body’s systems damaged by substance misuse, while personalised wellness programs promote resilience and balance. A serene, confidential environment fosters safety and privacy, enabling clients to heal without stigma or distractions. By integrating therapies like cognitive behavioural therapy (CBT), stress management, and lifestyle coaching, Harbor ensures sustainable recovery that restores not only health but also self-worth and purpose.

Empowering recovery is a journey best undertaken with trusted, expert care – and Harbor London is here to support every step forward. Make a referral now if someone you know is affected by any of the issues discussed here. 

References 

1. https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-drug-misuse/2019/part-3-drug-use-among-adults 
2. https://rehabsuk.com/blog/what-s-behind-the-recent-rise-in-cocaine-addiction-in-the-uk/ 
3. https://www.theguardian.com/commentisfree/2023/dec/23/coke-consumption-uk-millennials-generation-x
4. https://www.lbc.co.uk/news/uk-second-highest-rate-cocaine-use-globally/ 
5. https://nida.nih.gov/research-topics/cocaine 
6. https://pmc.ncbi.nlm.nih.gov/articles/PMC181074/
7. https://www.nhsinform.scot/healthy-living/drugs-and-drug-use/common-drugs/cocaine/
8. https://www.rcpsych.ac.uk/mental-health/mental-illnesses-and-mental-health-problems/cocaine-dependence#:~:text=If%20you%20have%20started%20to,develop%20problems%20from%20cocaine%20use. 
9. https://pubmed.ncbi.nlm.nih.gov/9079787/
10. https://www.sciencedirect.com/science/article/abs/pii/S0163725805000197#:~:text=Repeated%20cocaine%20treatment%20causes%20an,D2%20dopamine%2Dlike%20receptor%20signaling. 
11. https://www.news-medical.net/news/20240807/Research-decodes-how-cocaine-alters-dopamine-transporter-function.aspx
12. https://pubmed.ncbi.nlm.nih.gov/38711205/#:~:text=Neuronal%20ensembles%20in%20the%20medial,projections%20to%20the%20nucleus%20accumbens.
13. https://www.sciencedirect.com/science/article/abs/pii/S0740547218300862 
14. https://pmc.ncbi.nlm.nih.gov/articles/PMC10215125/#:~:text=The%20results%20from%20our%20experiment,HCs) 
15. https://www.sciencedirect.com/science/article/abs/pii/S0163725820303284
16. https://www.jefferson.edu/academics/colleges-schools-institutes/skmc/departments/neurosurgery/research/cocaine-effects-norepinephrine-mygdala.html#:~:text=Cocaine%20inhibits%20the%20re%2Duptake,and%20norepinephrine%20transporter%20(NET). 
17. https://journals.physiology.org/doi/full/10.1152/jn.00420.2021 
18. https://www.ahajournals.org/doi/full/10.1161/circulationaha.110.940569
19. https://pmc.ncbi.nlm.nih.gov/articles/PMC1360478/#:~:text=Following%20intake%20of%20the%20drug,by%20up%20to%2048%20hours.
20. https://pmc.ncbi.nlm.nih.gov/articles/PMC6538444/#:~:text=In%20a%20recent%20meta%2Danalytic,Stavro%2C%20Rizkallah%2C%20%26%20Pelletier%2C
21. https://fashionista.com/2013/05/could-an-alleged-cocaine-scandal-put-cara-delevingnes-career-in-jeopardy
22. https://www.thetimes.com/article/frankie-dettoris-career-in-jeopardy-after-failed-drugs-test-provides-latest-twist-to-trying-year-nh97lbttqqg
23. https://www.theguardian.com/sport/2009/may/10/richard-gasquet-tests-positive-cocaine-drugs
24. https://americanaddictioncenters.org/stimulants/cocaine/differences-with-crack
25. https://www.sciencedirect.com/topics/neuroscience/cocaine-induced-psychosis