The risks and difficulties with cocaine use

Cocaine: the risks, the realities, and how to get help

Cocaine is often talked about as a high-energy, nightlife drug, something used “socially” at clubs or events. In the UK over recent years that image has become more complicated: availability and purity have risen, use has spread beyond a narrow cultural group, and the harms we see in hospitals, coroners’ reports and treatment services are increasingly significantly (ONS, 2024; GM TRENDS, 2024). This post explains the major risks and practical difficulties associated with cocaine use, focusing on UK evidence and local data from Cheshire and Greater Manchester, and ends with how Cheshire Sobriety Clinic supports people using a combined approach of Rapid Transformational Therapy® (RTT®) and talking therapy.

What cocaine does, briefly and to the brain

Cocaine is a powerful central nervous system stimulant. It raises levels of dopamine and other monoamines in the brain’s reward circuits, producing intense euphoria, confidence and energy but also increasing heart rate, blood pressure and stress on vascular systems. Repeated exposure reshapes brain circuits controlling reward, impulse control and decision making. Neuroimaging studies of people with cocaine use disorder show reduced grey matter in frontal and limbic regions and evidence of accelerated brain ageing compared with non-users (Beheshti et al., 2023). Those structural changes help explain common problems: poor planning, reduced impulse control, memory and attention problems, and difficulty sustaining change.

Key health risks (evidence from UK and academic studies)

1. Acute cardiovascular and cerebrovascular events.Cocaine constricts blood vessels and increases cardiac workload. UK clinical series and international reviews document increased risk of myocardial infarction, arrhythmia and stroke, even in younger adults without prior heart disease (Leung et al., 2023). When cocaine is used with alcohol (producing cocaethylene) or opioids, acute toxicity and death risk rises.

2. Neuropsychiatric harm, including psychosis.Repeated cocaine use can produce paranoia, hallucinations and stimulant-induced psychosis. In some individuals symptoms persist outside intoxication episodes (Leung et al., 2023; Leclair et al., 2024). The severity of these problems is dose- and frequency-dependent. Heavier, more frequent use predicts worse psychiatric outcomes.

3. Cognitive impairment and accelerated brain ageing.Beheshti et al. (2023) used brain-age prediction methods and showed people with cocaine use disorder had greater brain-predicted age differences than matched controls. These findings are consistent with lasting cognitive effects that complicate engagement with therapy and daily functioning.

4. Infectious and local tissue harms.Route matters. Snorting damages nasal mucosa, smoking harms lungs, and injecting increases risks of blood-borne infection and soft tissue injury. Local patterns of harm such as venous disease and abscesses are well documented in clinical audits and local public-health surveillance (GM DARD reports).

Social, legal and quality-of-life harms (UK and local evidence)

Rising harms and deaths. Official statistics show cocaine-involved deaths in England and Wales rose markedly in recent years and contributed materially to the increase in drug-related fatalities (ONS, 2024). In Greater Manchester surveillance, drug-related death reviews and DARD data identify cocaine as a recurring component, often in polydrug deaths where opioids or novel psychoactive substances play roles (GM DARD, 2022).

Treatment demand and shifting profiles. National treatment datasets and academic analyses find growing numbers entering services for powder cocaine (not just crack), presenting with complex psychosocial needs (GM TRENDS, 2024; Howarth et al., 2010). The profile of users has broadened, including more working-age adults, polysubstance use, and presentations with co-existing mental health needs.

Quality of life and relapse link. Longitudinal clinical studies in cocaine-dependent samples show early measures of poor mental-health quality of life and social functioning predict early relapse. That connection matters for services. Improving life circumstances and social support reduces relapse risk.

Cheshire and Greater Manchester: What local data tells us

Greater Manchester: The GM TRENDS monitoring programme (MMU) and the Greater Manchester DARD surveillance system provide detailed regional data. The 2023-24 GM TRENDS report shows sustained treatment demand for stimulants and high local variability in hospital admissions, treatment completions and overdose presentations across boroughs (GM TRENDS, 2024). DARD surveillance highlights that cocaine features increasingly in toxicology of drug-related deaths and emergency admissions, frequently alongside opioids or other sedatives (GM DARD, 2022).

Cheshire: Academic and public-health work that examines Merseyside and Cheshire (Howarth et al., 2010) and local Joint Strategic Needs Assessments (JSNA) identify rising indicators of stimulant availability and treatment seeking. The Cheshire JSNA (Substance Misuse, 2023) notes increases in presentations for cocaine and polysubstance use in some localities and highlights the need for joined-up responses that combine clinical, psychosocial and community supports (Cheshire JSNA, 2023).

Together these local datasets show three practical points: (a) cocaine-related harms are increasing regionally; (b) many presentations are complex, involving polysubstance use, housing or employment instability, and mental-health comorbidity; and (c) services must be integrated, flexible and sustained to reduce harm and improve outcomes.

Why recovery from cocaine is often more difficult than people expect

1. No licensed, widely effective medication. Unlike opioid use disorder, where methadone or buprenorphine help, there is no routinely approved pharmacotherapy for cocaine dependence. Research trials are ongoing, but psychosocial approaches remain central (Leung et al., 2023).

   
   

2. High relapse risk tied to brain changes. Reward-circuit alterations, strong cue-reactivity and impaired executive control make craving and relapse likely in the early months of abstinence (Beheshti et al., 2023).

   
   

3. Polysubstance complexity. Many people use cocaine alongside alcohol, benzodiazepines or opioids. This increases medical risks and complicates detox and treatment planning (GM DARD, 2022).

   
   

4. Social determinants. Housing insecurity, debt, social isolation and criminal-justice involvement reduce capacity to engage with services and sustain recovery (GM TRENDS, 2024; Cheshire JSNA, 2023).

   
   

5. Cognitive and psychiatric comorbidity. Psychosis, depression and anxiety both contribute to and are worsened by cocaine use. Co-treating them is essential but resource-intensive (Leung et al., 2023; Leclair et al., 2024).

   
   

UK case studies from academic literature (summarised)

• Merseyside and Cheshire service case study: Howarth and colleagues (2010) analysed local treatment and availability indicators and highlighted how increases in powder cocaine availability translated into rising service demand and the need for targeted interventions in non-urban areas previously less affected.

  
  

• Patient journeys in clinical research: A qualitative study of people with cocaine use disorder (and their supporters) mapped the patient and supporter journey through healthcare and research settings. The findings emphasise periods of acute crisis such as hospitalisation and psychiatric episodes interleaved with long stretches of functional but precarious use. This pattern calls for flexible, long-term support models (Leclair et al., 2024).

  
  

• Regional surveillance (GM DARD): Annual surveillance reports from Greater Manchester document multiple cases where cocaine co-occurs with opioids or novel sedatives in fatalities. These findings demonstrate the local importance of polydrug risk management and the need for targeted harm-reduction outreach (GM DARD, 2022). Indeed, cocaine is second behind opiates in being implicated in the highest number of drugs related deaths.

  
  

What helps, evidence-informed practice

Academic and regional evaluations converge on the same themes: psychosocial interventions, integrated care for mental health and substance use, long-term follow-up, and addressing social determinants. Where medications are trialled, they are delivered alongside structured psychological therapy. Local surveillance and clinical cohorts suggest that services able to respond flexibly, providing both crisis care and longer-term recovery support, show better retention and outcomes (GM TRENDS, 2024; Leung et al., 2023).

How Cheshire Sobriety Clinic can help: RTT® and talking therapy

Given the complex mix of brain-based, psychological and social drivers of cocaine use, Cheshire Sobriety Clinic uses a combined approach of Rapid Transformational Therapy® (RTT®) and evidence-based talking therapies (CBT, motivational interviewing, relapse-prevention work). This model addresses three levels:

1. Subconscious drivers (RTT®): RTT® helps identify and reframe deep-held beliefs, trauma responses or learned associations that make cocaine seem like the default coping tool. By working at the level of subconscious beliefs, RTT® aims to reduce the emotional intensity of triggers and increase readiness for change.

   
   

2. Cognitive-behavioural work: CBT and motivational interviewing teach practical skills such as coping strategies for cravings, cognitive restructuring for distorted beliefs (“I cannot get through social life without it”), and planning for high-risk situations. These approaches are strongly supported by clinical evidence as central components of stimulant-use treatment (Leung et al., 2023).

   
   

3. Holistic, joined-up care: Cheshire Sobriety Clinic builds personalised care plans that include medical liaison (for cardiovascular or neurological issues), social support (housing, employment signposting), and relapse prevention. Flexible delivery (in person and online) helps engagement for people juggling work, family or legal issues. The clinic also recognises that for many local users, polysubstance use and mental-health comorbidity require coordinated care with NHS and third-sector services, and it actively works to link clients into those pathways.

   
   

This combined model maps directly onto academic recommendations: treat the whole person, combine subconscious and conscious-level interventions, and ensure social and medical needs are addressed alongside therapy (Beheshti et al., 2023; Leung et al., 2023; Leclair et al., 2024; GM TRENDS, 2024).

Final note

Cocaine use in the UK, and in Cheshire and Greater Manchester, has become a more complex public-health challenge in recent years. Higher availability and purity, more deaths involving cocaine, and growing treatment demand have all been documented. The good news from academic work and regional surveillance is that outcomes improve when interventions are integrated, long-term and tailored. If you or someone you care about is struggling with cocaine, early assessment and a joined-up treatment plan make a real difference. Cheshire Sobriety Clinic’s combined RTT® and talking-therapy approach is designed to meet that need: addressing deep drivers, building practical skills, and long-term self-mangement skills which increase the probability of successfully overcoming cocaine dependency. Read what Mr M had to say about his time with us to help him resolve a £1500 per week cocaine dependency, on our home page.

References

Beheshti, I., Sone, D., Maikusa, N., Nakata, Y., Kimura, Y., Matsuda, H. and Aoki, Y. (2023) ‘Greater brain-predicted age in cocaine use disorder’, Journal of Neural Transmission, 130, pp. 185–195. https://doi.org/10.1007/s00702-022-02582-3

Cheshire East Council (2023) Substance misuse: Joint Strategic Needs Assessment (JSNA). Cheshire: Cheshire East Council. Available at: https://www.cheshireeast.gov.uk/livewell/health-matters/jsna (Accessed: 25 September 2025).

Greater Manchester Combined Authority (GMCA) (2022) Drug Analysis and Related Deaths (DARD) report. Manchester: GMCA. Available at: https://www.greatermanchester-ca.gov.uk (Accessed: 25 September 2025).

GM TRENDS (2024) Greater Manchester Trends in Substance Misuse: 2023–24 report. Manchester: Manchester Metropolitan University and GMCA. Available at: https://www.gmmh.nhs.uk/research/gm-trends (Accessed: 25 September 2025).

Howarth, C., Carey, K., Cunliffe, J., Crome, I., Parrott, A.C., McGoldrick, T. and Ashton, C.H. (2010) ‘Merseyside and Cheshire: an emerging area for cocaine use’, Journal of Substance Use, 15(2), pp. 89–96. https://doi.org/10.3109/14659890903013436

Leclair, S., Blumberger, D.M., Daskalakis, Z.J., Vila-Rodriguez, F. and Downar, J. (2024) ‘Understanding the patient and supporter journey in cocaine use disorder: A qualitative study’, Frontiers in Psychiatry, 15, 1252071. https://doi.org/10.3389/fpsyt.2024.1252071

Leung, J., Chiu, C., Douglas, L. and Ling, W. (2023) ‘Psychiatric comorbidities of substance use disorders: Does dual diagnosis predict inpatient detoxification outcomes?’, International Journal of Mental Health and Addiction, 21, pp. 3785–3799. https://doi.org/10.1007/s11469-022-00869-5

NHS England (2024) Cocaine and crack cocaine: information and advice. London: NHS. Available at: https://www.nhs.uk/live-well/addiction/drugs/cocaine-crack-cocaine/ (Accessed: 25 September 2025).

Office for Health Improvement and Disparities (OHID) (2024) Adult substance misuse treatment statistics 2023 to 2024: Report. London: Department of Health and Social Care. Available at: https://www.gov.uk/government/statistics/substance-misuse-treatment-for-adults-statistics-2023-to-2024-report (Accessed: 25 September 2025).

Office for National Statistics (ONS) (2024) Deaths related to drug poisoning in England and Wales: 2023 registrations. Newport: ONS. Available at: https://www.ons.gov.uk/releases/deathsrelatedtodrugpoisoninginenglandandwales2023 (Accessed: 25 September 2025).

Public Health England (2021) Alcohol and drug misuse prevention and treatment guidance. London: PHE. Available at: https://www.gov.uk/government/collections/alcohol-and-drug-misuse-prevention-and-treatment-guidance (Accessed: 25 September 2025).

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