Dr Sylvie Stacy’s patient seemed like the model employee.
Working in white collar corporate America, he was outgoing and personable with his clients, always willing to meet their needs at a moment’s notice.
His to-do lists finished themselves in no time, and his coworkers envied his impeccable time management skills.
But over the next several months, the man’s colleagues caught onto a more concerning pattern. He started rambling and stumbling over his words, bouncing between calm and increasingly paranoid. For long stretches of the day, he seemed to disappear.
The man’s work performance was still stellar, but in the background, his sleep, finances and relationships were eroding.
Stacy, an addiction specialist and medical officer at Rehab.com, remembered this patient as part of an increasingly common picture in America: a high-performing worker whose personal life was imploding due to a secret addiction.
He was addicted to cocaine, the second-most common illegal drug in the US, rivaled only by cannabis.
A highly addictive stimulant, cocaine gives users a razor-sharp sense of awareness, bursts of energy and intense rushes of euphoria. But over time, the high comes crashing down and morphs into impulsivity, rage and violence.
Cocaine, the second-most popular illegal drug in the US, is linked to more than one million addictions nationwide
About 1.2 million Americans are addicted to cocaine, the National Survey on Drug Use and Health suggests, and the latest data shows the drug was responsible for 30,000 overdose deaths in 2023.
This is more than one in four of all US overdose deaths and nearly double the rate compared to five years ago.
Stacy – who has spent the last decade treating addicts, including cocaine users – told the Daily Mail that a familiar theme among cocaine abusers today is that they are usually ‘young adults, professionals, people who work long hours, and people who abuse other substances.’
She said cocaine causes ‘behavioral effects because it increases dopamine and other stimulating chemicals in the brain,’ creating ‘short bursts of energy, alertness, confidence and euphoria.’
However, she added, ‘there is a crash afterward that can be just as noticeable. People often become irritable or exhausted once the drug wears off.’
‘Someone using cocaine might suddenly sleep very little or become unusually impulsive,’ Stacy continued. ‘They might get defensive when you ask simple questions, like where they were or what they were doing.’
This was the case with her high-flying office-worker patient.
Other cocaine addicts, though, cling to the idea of being the life of the party.
Justin Gurland, a licensed medical social worker and founder of The Maze NYC, told the Daily Mail he had a friend admit to a cocaine problem, but had had no idea it was at the level of an addiction.
‘What made it difficult to recognize at first was that he was still functioning socially,’ Gurland explained. ‘He was the life of the party, funny, charismatic and outwardly social, so the consequences didn’t immediately look dramatic from the outside.
‘But underneath it all, there was this subtle “failure to launch” pattern – an inability to progress, build stability or fully step into adulthood while the people around him were moving forward with their lives.’
About 1.2 million Americans are addicted to cocaine, the National Survey on Drug Use and Health suggests (stock image)
Gurland, who works with drug and alcohol addicts and is 18 years sober himself, remembered the friend called him one morning and said ‘he was finally ready to get sober and clean.’
‘At that point,’ he said, ‘he felt stuck in life – unable to move forward, get organized or fully grow into adulthood.’
Gurland told the Daily Mail that cocaine use in a friend or coworker ‘is especially easy to miss in high-functioning environments like finance, entrepreneurship, nightlife or among young adults where long hours, heavy socializing and high stress are normalized.’
‘Behaviors that may actually be warning signs can get mistaken for ambition, charisma or simply “working hard,”‘ he added.
However, there are subtle behavioral signs of potential cocaine abuse to be on the look out for, Gurland said, including sudden increases in confidence and talkativeness, restlessness, irritability, impulsivity, mood swings and secrecy.
Dr Sylvie Stacy, an addiction specialist and medical officer at Rehab.com, has had patients get addicted to cocaine after trying to be more productive at work, cure headaches and stop constipation
Physically, users may appear to rub their nose or sniffle often, as well as deal with frequent nosebleeds – snorting cocaine can damage tissue inside the nasal passages over time.
Difficulty sleeping and weight loss may also occur due to the increased energy and appetite-suppressing effects of the drug.
Someone who is more than just an occasional social user may also have creative excuses to try and explain their chronic use.
One of Stacy’s patients claimed he initially started using cocaine socially to get high with friends, but around the same time, he was prescribed opioid pain pills after a dental procedure, which he became dependent on.
‘Those pills caused constipation, and he noticed that this got somewhat better when he used cocaine,’ Stacy said.
There is no clinical evidence suggesting cocaine can ease constipation, and instead it carries severe digestive risks such as bowel decay by cutting off blood flow to the cells lining the intestines.
The patient has since gotten clean from both opioids and cocaine, and manages his constipation with fiber-rich foods and stool softeners.
One of Stacy’s other patients was introduced to the drug after developing cluster headaches, a severe form of headaches that can drag on for weeks or months at a time causing pain so debilitating they have been nicknamed ‘suicide headaches.’
Like many of the one in 1,000 Americans with cluster headaches, the patient had little relief with conventional medications and turned to cocaine to get high, realizing the drug helped relieve his headache pain.
While cocaine can block nerve impulses and constrict blood vessels in the brain, reducing pain, it can also trigger severe bleeding and strokes.
For a concerned loved one looking to help a suspected addict, Gurland said people who notice signs of potential addiction should focus on specific changes they have observed rather than immediately confronting the person aggressively.
‘It can also help to encourage the person to speak with a mental health or addiction professional rather than trying to diagnose them yourself,’ he suggested.
‘Many people become defensive or minimize their use initially, so keeping the conversation supportive, calm and nonjudgmental increases the likelihood that they will actually hear the concern.’
