Cocaine and Co-Occurring Disorders

Ethan Cullen
Author: Ethan Cullen Medical Reviewer: Morgan Blair Last updated:

Cocaine is a highly addictive drug that can lead to or worsen many mental health disorders if you use it frequently. Commonly co-occurring disorders with cocaine addiction include depression, anxiety disorders, ADHD, and schizophrenia. Treatment of co-occurring disorders with cocaine addiction will depend on your individual needs, but can include therapies and medication.

How does cocaine affect the brain?

Cocaine is a central nervous system stimulant that has many short and long term effects on your brain.

Over time cocaine use will cause changes in the way your brain works. Neurons in your brain adapt to your use of the drug which makes you more dependent on it to function. Additionally, it can change the way your stress receptors work, meaning you are more likely to seek cocaine when stressed or anxious. [1]

People with pre-existing disorders may have their symptoms worsened by using cocaine and the effects that it has on their brain. [2]

What is a co-occuring disorder?

A co-occuring disorder or dual diagnosis, is when a person suffering from addiction or a substance use disorder also has a mental health condition, or vise versa. Common examples include having bipolar disorder and an alcohol use disorder. It is often the case that people with a mental health disorder will abuse substances to feel normal, and people with addictions will often develop a mental disorder as a result.

Having a co-occuring mental health disorder along with a cocaine use-disorder can make it difficult to provide effective treatment, as comorbid disorders require tailored treatment plans.

Which co-occurring disorders are common in cocaine users?

Cocaine use disorder can cause people to develop co-occurring disorders and vice versa. [3]

Major Depressive Disorder

Research has shown that people with a substance use disorder are more likely to have major depressive disorder than those who don’t. [4] Whilst it may seem to relieve symptoms of depression, it does more damage over time.

The symptoms of depression can make you more likely to look to use cocaine. Changes in the way the brain works in people with depression can make you more susceptible to addiction.

Alternatively the symptoms of cocaine use disorder can lead to the development of depression. Withdrawal symptoms, relationship problems, and other problems caused by the addiction can lead to low mood and depression if left untreated.

Anxiety Disorders

Cocaine is sometimes used by people with anxiety disorders (including generalized anxiety disorder, post-traumatic stress disorder, and panic disorder) due to the temporary increase in self-esteem. Under the effects of cocaine people with anxiety disorders may experience fewer symptoms for a short period of time.

However cocaine use over time can also lead to anxiety and make anxiety symptoms worse. Anxiety is a very common withdrawal symptom if you take cocaine for an extended period of time. The changes in your brain caused by cocaine commonly leads to stress and anxiety if you do not continue to take it. [1]


People with ADHD have been found to be up to 23% more likely to develop a substance-use disorder than those without [5]. This risk increases when ADHD symptoms have not been diagnosed in childhood. Effective and early treatment for ADHD in childhood may prevent addictive behaviours from developing through medication and interventions [3].

The co-occurrence of ADHD and cocaine abuse disorder is often made worse by other disorders strongly associated with ADHD. People with ADHD are at a higher risk of developing depressive and anxiety disorders which can make addiction and substance abuse more likely to deal with these symptoms [6].


Up to 42% of those living with schizophrenia are thought to have a substance abuse disorder.

Cocaine use does not cause schizophrenia, instead people with schizophrenia are thought to be more likely to develop a substance use disorder. They think it may help to alleviate some of their symptoms and can give them a sense of belonging with others that do it, something people with schizophrenia do not usually get to experience. [8]

  1. 2020, May 28. What are some ways that cocaine changes the brain? . Retrieved from
  2. Morton W. A. (1999). Cocaine and Psychiatric Symptoms. Primary care companion to the Journal of clinical psychiatry, 1(4), 109–113.
  3. 2022, September 27. Part 1: The Connection Between Substance Use Disorders and Mental Illness. Retrieved from
  4. Iqbal, M.N., Levin, C.J., Levin, F.R. (2019) ‘Treatment for Substance Use Disorder With Co-Occurring Mental Illness’ [Internet] in ‘Focus’. Available from:
  5. Van Emmerik-van Oortmerssen K, van de Glind G, van den Brink W, et al.: Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend 2012; 122:11–19
  6. Sobanski, E. (2006). Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). European archives of psychiatry and clinical neuroscience, 256(1), i26-i31.
  7. Hunt GE, et al. (2018). Prevalence of comorbid substance use in schizophrenia spectrum disorders in community and clinical settings, 1990-2017: Systematic review and meta-analysis.
  8. Asher, C. J., & Gask, L. (2010). Reasons for illicit drug use in people with schizophrenia: Qualitative study. BMC psychiatry, 10, 94.
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Ethan Cullen
Author Ethan Cullen Writer

Ethan Cullen is a medical writer with a Bachelor of Arts degree in Philosophy, Politics, and Economics from Oxford University.

Published: Feb 23rd 2023, Last edited: Sep 22nd 2023

Morgan Blair
Medical Reviewer Morgan Blair MA, LPCC

Morgan Blair is a licensed therapist, writer and medical reviewer, holding a master’s degree in clinical mental health counseling from Northwestern University.

Content reviewed by a medical professional. Last reviewed: Feb 23rd 2023
Medical Reviewer Medical Reviewer:
Morgan Blair
Last reviewed: Feb 23rd 2023 Morgan Blair