One of the most addictive, naturally occurring drugs, cocaine initiates a “profound state of addiction” following repetitive use that exerts serious physical and psychological consequences on users.  Cocaine’s addictiveness stems from the drug’s ability to engage the brain’s reward pathway and release of mood-altering neurotransmitters. Like other stimulants such as methamphetamine and Adderall, cocaine also reduces the user’s ability to achieve the same sense of euphoria and pleasure experienced during previous cocaine “highs”, which results in tolerance build-up and ultimately, excessive cocaine abuse. 
Cocaine’s Effects on the Brain
By inhibiting reuptake of dopamine, norepinephrine and serotonin in the brain, cocaine allows abnormally high levels of these neurotransmitters to saturate the brain and induce addiction. In fact, cocaine rapidly crosses the blood-brain barrier and often leads to the breakdown of this barrier.  The importance of maintaining the blood-brain barrier involves the prevention of bacterial and viral pathogens from crossing the barrier. Consequently, long-term cocaine addicts are vulnerable to meningitis, encephalitis and even parasitic brain infections.
Physical Effects of Cocaine Use
Cocaine smokers and snorters suffer from the following side effects: 
- Chronic coughing/bronchospasms
- Coughing up blood due to ulcer development
- Chest pains
- Asthma/shortness of breath
- Flu-like symptoms
- Rapid heart beat
- Nausea and vomiting
- Bruxism (teeth grinding)/tooth decay/gingivitis
- Degradation of the septum nasi, or cartilage between the nostrils
- Permanent damage to blood vessels
- Elevated stroke risk and/or sudden cardiac death
- Reduced appetite/malnutrition/extreme weight loss
Cognitive/Psychological Side Effects of Cocaine Abuse
Cognitive effects of cocaine addiction are often evident before physical signs emerge. Someone using cocaine regularly may present the following: 
- Paranoid thoughts/delusions (cocaine addicts may be diagnosed with paranoid schizophrenia if their drug addiction is unknown to a healthcare professional)
- Visual/auditory hallucinations due to excess dopamine in the brain
- Severe insomnia (it is not unusual for cocaine addicts to remain awake for several days)
- Suicidal/homicidal tendencies
While high on cocaine, addicts may also resemble people in the “manic” phase of their bipolar disorder. Cocaine abusers often become gambling addicts as a result of their compulsive, pleasure-seeking behaviors, especially when they are desperate for money to buy cocaine.
Cocaine Withdrawal Symptoms
A cocaine high generally lasts between two and six hours, depending on the purity of the cocaine, whether the user smokes, snorts or injects cocaine and tolerance. Unless cocaine addicts continue fueling their addiction, they will suffer the following signs of cocaine withdrawal: 
- Severe depression/suicidal ideation/paranoia
- Overwhelming lethargy and fatigue
- Restlessness, agitation and anxiety
- Sleep disturbances
- Fever, aching joints and nausea
- Powerful craving for cocaine
Depression and cravings may continue for months following cessation of cocaine use, which is why cocaine addiction is difficult to defeat. Currently, there are no medications to help suppress cravings for cocaine. Medical detoxification from a cocaine addiction consists of supportive services such as pain medications, antidepressants and addiction counseling.
What is Crack Cocaine?
The pure form of cocaine is a white, almost translucent powder called cocaine hydrochloride. However, cocaine bought on the street is usually “cut” with mannitol, talc, caffeine, heroin and even strychnine to increase profits and bulk.  Crack cocaine is processed from cocaine hydrochloride by heating it to eliminate hydrochloride and other impurities. It is the most potent type of cocaine inhaled by users who heat the cocaine in glass pipes to produce vapor. Crack cocaine got its name by the crackling sound heard when cocaine rocks are being heated in a pipe.