What Does Cocaine Do to Your Brain? Cocaine’s Neurological Effects
Both powder cocaine and crack cocaine have powerful effects on the brain, even with infrequent use. Cocaine is a central nervous system stimulant that alters the brain’s reward system and dopamine, leading to addiction.[1] Chronic cocaine use can cause long-term – even permanent – physical and mental changes.
Wondering about your brain on cocaine? How does cocaine affect the brain? Is there a link between cocaine and anxiety? Cocaine and depression? Here’s everything you need to know.
Key Points
- Cocaine is a highly addictive stimulant drug with powerful effects on the brain.
- Cocaine alters the brain’s reward system, fueling misuse and addiction.
- Chronic cocaine use can cause short-term changes in mood, mental health, and cognition.
- With long-term abuse, cocaine’s effects on the brain can trigger a permanent depression.
- Over time, cocaine causes structural changes in the brain, some of which may be permanent.
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, including cocaine. This pathway is located in the ventral tegmental area in the midbrain and the nucleus accumbens, one of the brain’s reward areas.[2]
During the communication process with natural stimuli, dopamine is released by a neuron into the synapse between two neurons.[3] It bonds to dopamine receptors – specialized proteins – on the neuron and carries a signal. Dopamine transporters remove dopamine from the synapse to be recycled for future use.
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. In a healthy brain, gray matter comprises about 10% of the brain and holds between 10 billion and 50 billion neurons that process information with axon signaling through white matter.[5] Gray matter also assists in movement, memory, and emotion.
Cocaine use decreases gray matter density with long-term impacts on memory and cognition.[6] However, research shows that gray matter increases after 35 weeks of abstinence.[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]
Much less is known about white matter disease with 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 ability to reabsorb dopamine, coming down from the cocaine euphoria can cause 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 to trigger 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 production takes place in the ventral tegmental area and nerve cell bodies, then it’s released into the nucleus accumbens and prefrontal cortex.
Glutamate and GABA, two critical excitatory and inhibitory neurotransmitters in the brain’s reward pathway and cocaine use, are found throughout the brain. In this respect, cocaine use affects the whole 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 to overcome, but help is available.
Step 1
Though cocaine withdrawal is not usually life threatening like withdrawal from opioids or alcohol, it can be intense – often leading to relapse simply 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 takes place 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 type of behavioral therapy that relies on motivational incentives to encourage behavioral changes.[13]
Frequently Asked Questions About Cocaine Effects on the Brain
Does Cocaine Kill Brain Cells?
Gray matter declines naturally with the aging process and creates complications like impaired memory and cognition, but cocaine and other drugs can accelerate the process. Cocaine can also cause autophagy, a process in which the brain cells die in response to the neurological stress and neurotoxicity brought on by cocaine use.[15]
Does Cocaine Cause Memory Loss?
Cocaine can cause memory loss, though indirectly. Cocaine causes short- and long-term cognitive impairment, including memory problems, but some of the damage may be reversible with abstinence. Cocaine use increases the risk of stroke, which can also cause memory loss.[16]
How Does Cocaine Affect the Nervous System?
Cocaine affects many systems in the body, but the primary target is the central nervous system. It blocks the reuptake of neurotransmitters – primarily dopamine – and leads to euphoria. Many of cocaine’s short- and long-term effects are associated with its impact on the brain.
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U.S. Department of Health and Human Services. (n.d.). Chronic cocaine use changes brain structure and cognitive function in Rhesus Monkeys. National Institutes of Health. Retrieved from https://archives.nida.nih.gov/news-events/nida-notes/2021/08/chronic-cocaine-use-changes-brain-structure-and-cognitive-function-in-rhesus-monkeys on 2023, June 30.
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