Updated on February 6, 2024
6 min read

Cocaine and Anxiety: How to Treat Dual Diagnosis

Key Takeaways

The Relationship Between Cocaine and Anxiety

Cocaine is an illegal stimulant drug used for thousands of years. It’s derived from the coca plant (Erythroxylon coca) and is highly addictive. In 2020, over 1.3 million people in the USA had a cocaine use disorder in the past year.1

Anxiety is one of the most common mental health conditions. Over 41.5% of people struggle with general anxiety disorder (GAD). Unfortunately, less than half of those aren’t getting treatment. GAD is often characterized by rumination or overthinking. 

Many people use cocaine in social settings to ease anxiety. However, people also report heightened anxiety during withdrawal or drug use. 

Does Cocaine Help With Anxiety?

Many people use cocaine to ease the pressure of social situations and to lessen anxiety. Although it may feel like cocaine helps with anxiety due to its euphoric effects, it actually does the opposite. 

Cocaine can induce anxiety and have several other dangerous side effects. Therefore, it should never be used to treat anxiety. 

If you’re struggling with GAD, speak with your healthcare provider about options.

Can Cocaine Use Cause Anxiety?

Yes, cocaine can cause anxiety.

Anxiety symptoms are often present when using cocaine, between uses, or during withdrawal. Cocaine is also linked to heightened phobias, compulsions, and obsessive thoughts. In addition, cocaine can cause panic attacks. 

Long-term use of cocaine is extremely dangerous. It can induce feelings of agitation, restlessness, and overall anxiety. 

That's because repeated use of cocaine speeds up neurotransmitters in the brain related to our reward pathway. After long-term use of cocaine, the brain starts to rely on cocaine’s ability to increase brain activity. Thus, the brain becomes less sensitive to natural reinforcers.

In addition, the circuits in the brain that are related to stress become much more sensitive. This sensitivity is directly linked to anxiety. When someone reliant on cocaine doesn’t take the drug, they can become increasingly agitated and anxious. 


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Does Drug-Induced Anxiety Go Away?

Drug-induced anxiety is common. It often triggers fear, panic, worry, dread, and uneasiness when taking or stopping drug use. 

This is because drugs, such as cocaine, change the balance of chemicals in our brains. Therefore, your thoughts, actions, and emotions may be negatively affected, especially when withdrawing from the drug. 

Symptoms of drug-induced anxiety include:

  • Chills and hot flashes
  • Obsessively thinking about negative scenarios
  • Being unable to concentrate
  • Not being able to sleep or sleeping too much
  • Feeling like you’re losing control
  • Losing weight due to loss of appetite
  • Vomiting and diarrhea 
  • Pounding heartbeat
  • Trouble breathing, swallowing, or sharp pains in the chest

Drug-induced anxiety isn’t usually permanent, but the amount of time symptoms last can differ. Cocaine can cause anxiety while on the substance and during the hours, days, or weeks after use. Cocaine stays in your system for one to four days usually, but can remain for a couple weeks in heavy users.

The amount of time that the effects of cocaine can be felt also depends on the method of use. Inhaling or injecting cocaine often produces an immediate high that wears off quickly. Ingesting or snorting cocaine can delay the effects and make it last longer.

The best way to deal with drug-induced anxiety is to consult a professional. If you’re struggling with anxiety and drug abuse, consider getting treatment for a dual diagnosis. 

A dual diagnosis is given when someone has a mental disorder and an alcohol or drug problem. 

Treatment centers and hospitals can help you detox safely. They can also provide you with anxiety medication that may help ease your symptoms.

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Cocaine Overdose Signs

If you suspect you or someone you know is overdosing on cocaine, call 911 immediately for emergency help.

When using cocaine, there is always a possibility of severe complications, overdose, and even death. The most common cause of death from an overdose are seizures or heart attacks. 

Symptoms of cocaine overdoses vary from person to person. However, the most common things to look for are:

  • Tight chest or sharp chest pain
  • Seizures
  • Vomiting and nausea
  • Irregular and inconsistent breathing
  • High body temperature
  • Increased heart rate
  • Panic or anxiety 
  • Agitation
  • Paranoia
  • Hallucinations
  • Extreme confusion 
  • Tremors or shaking
  • Death

Treatment for Co-Occurring Anxiety and Cocaine Use

Cocaine is highly addictive. In 2020, 25% of people who reported having a cocaine addiction relapsed within a year of treatment.3

If you’re dealing with a cocaine addiction and anxiety simultaneously, it’s recommended that you treat these conditions together. Because anxiety and cocaine feed off one another, a dual diagnosis is necessary.

You can take many routes to address your mental health and substance use disorder (SUD). However, some options are more intensive than others. The best fit for you depends on your conditions, and support system.

You may need to attend more intensive rehab if you have been abusing cocaine for a long time. Luckily, there are many options to choose from that can help your specific situation.


There are a few types of rehab that are often used for co-occurring mental health conditions and substance abuse:

Outpatient Treatment 

This type of rehab is often considered a lower-intensity and less restrictive treatment. People can attend counseling and receive medication while still living at home. 

Here, people usually spend about 10 hours a week or more getting help from a local treatment center. The length of time varies, but is often between 3 months and up to a year.

Most outpatient treatment centers will include individual or group counseling, substance abuse education, and teaching coping methods. 

Inpatient Treatment

Inpatient treatment, also known as residential treatment, is when people live in the facility full time. These treatment centers are often of higher intensity than outpatient treatment. 

People at inpatient treatment centers receive 24/7 medical and emotional support. These types of rehabs are intensive and are designed to treat severe addictions.

Residential treatment can help manage withdrawal and aid in detoxification through intensive therapy and medication-assisted treatment (MAT).


Counseling can be a beneficial way to help manage your anxiety and SUD. Individual or group therapy in or out of a rehab program are successful in helping treat addiction. 

Group therapy can be helpful when recovering from cocaine addiction. Programs like Narcotics Anonymous (NA) allow addicts to hear others’ stories and relate personally to recover fully.

NA uses a 12-step model where people work together in a group toward a full recovery.  


Medication for both anxiety and drug addiction can help during treatment. 

Currently, there are no drugs that are FDA-approved to treat cocaine addiction. However, some medications can help offset the intensity of cocaine withdrawals. 

Many different drugs are used to treat general anxiety disorder (GAD). Medication for anxiety can help relieve some or all of the painful symptoms of GAD.

Speak with your doctor to see if anxiety medication is right for you.

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  • Cocaine addiction and anxiety disorder are frequently co-occurring conditions
  • Anxiety symptoms are often present when using cocaine or during withdrawal
  • Cocaine is linked to heightened phobias, compulsions, obsessive thoughts, general anxiety, and panic attacks
  • The best way to treat a dual diagnosis of cocaine addiction and anxiety is to treat both conditions simultaneously

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Updated on February 6, 2024
6 sources cited
Updated on February 6, 2024
  1. Anjel Vahratian, PhD1; Stephen J. Blumberg, et al. “Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic — United States, August 2020–February 2021.” Centers for Disease Control and Prevention, 2021.
  2. Baik JH. “Dopamine signaling in reward-related behaviors.” Front Neural Circuits, 2013.
  3. Cocaine Research Report: What are the long-term effects of cocaine use?” National Institute on Drug Abuse, 2021.
  4. Cocaine Research Report. “What are the short-term effects of cocaine use?” National Institute on Drug Abuse, 2021.
  5. Kampman KM. “New medications for the treatment of cocaine dependence.” Psychiatry (Edgmont), 2005.
  6. Haasen C, Prinzleve M, et al. “Relationship between cocaine use and mental health problems in a sample of European cocaine powder or crack users.” World Psychiatry. 2005.

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