What Does Cocaine Do to Your Brain? Cocaine’s Neurological Effects

How Does Cocaine Affect the Brain Reward System?

The brain’s mesolimbic dopamine system – the reward pathway – is stimulated by stimuli like food, sex, and drug use. Cocaine produces psychoactive and addictive effects by impacting the limbic system in the brain. The limbic system encompasses interconnected areas responsible for controlling sensations of enjoyment and drive.[2]

Our brains release dopamine when exposed to natural stimuli, regulating our emotional and motivational responses through the mesolimbic dopaminergic system. Changes in this neurotransmission can impact how we react to rewarding behaviors. Substances like psychostimulants and drugs of abuse can greatly alter synaptic activity in this system.[3]

With substances like cocaine, this normal communication process is disrupted.[4] Cocaine binds to the dopamine transporter, preventing dopamine from being removed. It then accumulates in the synapse and produces an amplified signal – leading to euphoria.

With chronic cocaine use, the brain becomes less sensitive to dopamine. Larger amounts of cocaine are needed to produce the same euphoria.

How Does Cocaine Affect the Brain?

Structural Brain Changes

Aside from the immediate effects of cocaine on the brain, research shows that chronic cocaine use causes structural changes that impact cognitive function and memory. Some of these structural changes include a persistent indication of relapse and addiction in the brain after prolonged abstinence.

One of the pronounced changes is in the brain’s gray matter. Gray matter comprises a significant portion of a healthy brain and holds between 10 billion and 50 billion neurons that process information with axon signaling through white matter.[5]

Cocaine use decreases gray matter density with long-term impacts on memory and cognition.[6] However, research has shown higher grey matter volumes in individuals after 35 weeks of abstinence, with even higher volumes in individuals who have remained abstinent beyond 35 weeks.[7]

The use of cocaine decreases white matter as well, affecting the communication between nerve cells. This also happens with aging, but drug abuse can accelerate the process and affect emotions, thoughts, learning, and speech.[8]

Less is known about the full extent of white matter changes caused by drug use. It’s unclear to what extent these structural changes are permanent. At a certain threshold, there’s no guarantee that brain damage can be reversed with abstinence.

Mental Effects

Both powder cocaine and crack cocaine can cause long-term damage to mental health. Because cocaine affects the brain’s natural dopamine reuptake, withdrawal from cocaine can lead to significant depression.
With long-term cocaine abuse, the brain can’t return to its natural equilibrium, causing permanent depression that requires mental health treatment.

Cocaine use can also cause long-term mental health changes like:

• Auditory hallucinations
• Paranoia
• Restlessness
• Psychosis

People who are predisposed to mental health disorders may be at a higher risk of triggering long-term mental health changes if they binge cocaine. But even without psychosis, cocaine use can cause panic disorders, anxiety, or aggressive and violent behaviors.

What Part of the Brain Does Cocaine Affect?

Cocaine affects neurotransmission, some of which takes place virtually everywhere in the brain.[9] Dopamine is produced in the nerve cell bodies within the ventral tegmental area, and it is then projected to the nucleus accumbens and prefrontal cortex.

Cocaine use has a profound impact on neurons that release the neurotransmitter glutamate, which is responsible for excitatory signals in the brain. Consistent use of cocaine can greatly alter glutamate neurotransmission, affecting both its release levels and receptor protein levels in the reward pathway of the brain.[10]

As mentioned, cocaine also causes structural changes throughout the brain, including the gray and white matter.

Cocaine Addiction and Treatment

As mentioned, cocaine affects the brain’s reward system and triggers addiction. Officially, cocaine addiction is classified as a stimulant use disorder (specifically a cocaine use disorder) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).[11]

The criteria for a cocaine use disorder include:

• Using cocaine in greater amounts or for longer periods than intended
• Spending an inordinate amount of time obtaining, using, or recovering from cocaine
• Trying to cut back or stop using cocaine unsuccessfully
• Having problems at home, work, or school because of cocaine use
• Continuing to use cocaine despite problems
• Experiencing strong cravings
• Developing a tolerance for cocaine
• Going through withdrawal from stopping or cutting back on cocaine[12]

Cocaine is a highly addictive substance. Overcoming a cocaine use disorder can be challenging, but help is available.

Step 1

Though cocaine withdrawal is not usually life-threatening, like withdrawal from opioids or alcohol, it can be intense and often leads to relapse to relieve the symptoms. Detox is typically the first step in seeking cocaine addiction treatment to manage the symptoms of withdrawal and help you stay committed to abstinence.

Step 2

Following detox, inpatient or outpatient treatment options are available to suit your needs. Inpatient treatment occurs in a hospital or residential setting and provides round-the-clock care with structure and supervision. Outpatient treatment offers similar therapies but offers more flexibility to balance day-to-day responsibilities with recovery.

Step 3

Treatment for cocaine addiction often combines traditional therapies like individual counseling and group therapy with behavioral therapies. The two leading therapies in treating cocaine addiction are:

Cognitive behavioral therapy (CBT): a type of behavioral therapy that focuses on identifying unhelpful thoughts and behavioral patterns and replaces them with healthier ones.

Contingency management: a behavioral therapy that relies on motivational incentives to encourage behavioral changes.[13]