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Addiction and Substance Abuse

Long Term Brain Damage from Cocaine Use



Hello, My boyfriend abused cocaine for a period of his life, probably several years, and has been relatively clean for at least 2 years, but still an occasional user when he gets stressed. He is somewhat moody and emotional by nature (I think) but we have had a prolonged period of frequent fighting where it seems he is absolutely off his rocker! I am 40 years old and have been in other relationships. I have a PhD and I know I`m not crazy but some of the things that upset him make no sense at all to me or any of the other rational people I know. He seems to have issues bordering on paranoia and cognitive problems (i.e. relating one situation to another where there are parallel trends/events, reasoning/judgement based on parallel events). I am wondering what types of behavioral or emotional alterations might arise as long-term consequences of cocaine use and, if some of his behaviour is the result of brain damage, can I expect it to ever get better the longer he stays clean?


The long-term consequences of cocaine use vary greatly depending on many factors, including an individual's genetic vulnerability, the amount and duration of drug use, co-occurring mental illness, and so on.

In general, I would say that some of the behavior you described should improve with continuous abstinence. However, I did note that you said that he occasionally uses under stress. Each time he uses again, he is exposing his brain to a powerful relapse trigger.

The paranoia you describe could indeed be an effect of cocaine use, but it could also be a part of a personality disorder or of a major mental illness (such as bipolar disorder or schizophrenia). If the paranoia and cognitive symptoms persist despite continuous abstinence, then it's likely that something else is the cause of it.

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Response by:

Christina M Delos Reyes, MD Christina M Delos Reyes, MD
Assistant Professor of Psychiatry
School of Medicine
Case Western Reserve University