Cocaine, the cold drug: Hello Narcissus, goodbye P...!
- Dr. Jessica Di Bella
- Jun 2
- 10 min read
Doctors, lawyers, architects – cocaine was long considered a lifestyle drug of the elite. However, it has now reached the mainstream and is gaining increasing popularity, especially among young people. There, it is often perceived as having relatively few side effects. A tragic misconception. In this article, I examine the causes as well as the long-term psychological and physical consequences of cocaine use and show how even occasional use can have a lasting impact on friendships, love, and sexuality.
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Cocaine – Elite drug or mainstream?
Cocaine use is no longer a fringe phenomenon. Approximately one in 18 adults in Germany uses cocaine or crack at least once in their lifetime (Federal Drug Commissioner, 2024). This lifetime prevalence has increased significantly over the last two decades: from 3 percent to almost 6 percent today (Rauschert et al., 2022). A similar trend is evident in the 12-month prevalence: the proportion of adults who used cocaine or crack within a year rose from 0.6 percent in 2015 to 1.6 percent in 2021.
The striking difference between the sexes is that cocaine use affects men more often . At 7.1 percent, the proportion of male consumers is almost twice as high as the proportion of female consumers, which is around 4.0 percent.
These figures align with my observations from psychotherapeutic practice. It is noteworthy, however, that it is largely not the users themselves – mostly male – who seek therapeutic help, but rather their partners or family members who suffer the consequences of drug use.
Is cocaine a "drug of the elites"?
The widespread impression that cocaine is primarily a drug of the upper classes cannot be empirically confirmed. Studies show that cocaine use occurs in almost all social milieus (Federal Ministry of Health, 2022). Cocaine is not a fringe phenomenon, but is embedded in diverse social contexts – from classic drug scenes to student environments and performance- and status-oriented professional fields.
A characteristic of cocaine use in highly performance-oriented environments is that it does not occur exclusively in a leisure context, but increasingly also in everyday professional life. Whether in consulting, the financial sector, science, medicine, or architecture – in recent years, it has become apparent in various professional fields that the substance is being used deliberately to supposedly enhance performance during working hours.
Regarding recreational and party cocaine use, this also occurs more frequently in financially well-off groups (Prinzleve et al., 2004). Higher income facilitates access to this comparatively expensive substance . On the Berlin black market, a gram of cocaine costs between 60 and 120 euros, depending on the source and purity. Despite rising demand over the years, prices remain stable, which is interpreted as an indication of a large supply and well-functioning supply chains (Deutsche Welle, 2025).
Cocaine use is very expensive. If you consider not only the price of the drug itself, but also other expenses related to its use, such as club entry fees, alcohol, or taxi fares, monthly costs quickly add up to several hundred euros. Many users find themselves increasingly stressed by these financial burdens and develop significant money problems – which often further destabilizes them and thus triggers their use even more, instead of prompting them to question it.
Cocaine has established itself as a mainstream party drug.
Cocaine use among young people has increased significantly in recent years, and the substance has become firmly established as a party drug in nightlife (Deutsche Welle, 2025). Young adults today have more financial resources than previous generations, and obtaining the drug has become increasingly easier in recent years. The "coke taxi," which was considered a new phenomenon during the COVID-19 pandemic, has now become commonplace.
Mobile delivery services, where the drug is ordered via Telegram and delivered to a desired location, are firmly established in the black market.
In the party scene, cocaine is considered a guarantee for a good mood, self-confidence, and physical stamina. It is often combined with large amounts of alcohol to create disinhibition without exhibiting the typical alcohol-related impairments – at least on the surface.
How deceptive this image is is illustrated by a personal example: A few years ago, a young man from Berlin-Mitte lost his life. His snobbish demeanor, as was widely known, had substantial reasons. That night, too, he was under the influence of cocaine and alcohol and was run over in an accident he caused himself. He was not a "hopeless junkie." He was a young management consultant.
Cocaine and the psyche
A key effect of cocaine is an artificially inflated sense of self-worth . Cocaine acts like narcissism in powder form: those who don't already possess narcissistic traits develop them, at least for the duration of the high. To put it cautiously: cocaine doesn't necessarily bring out the most appealing aspects of a personality – and these changes don't necessarily disappear when the high wears off.
Well-documented psychosocial consequences include pronounced egocentrism and a significant reduction in social skills.
With some experience, people under the influence of cocaine are easy to recognize. During the high, their pupils are noticeably dilated (mydriasis). They themselves report heightened alertness and a feeling of clarity. To others, they often appear emotionally cold, superior, and arrogant. However, this emotional detachment can quickly turn into irritability or aggression.
A former colleague of mine once found herself in an unpleasant situation at Munich's Oktoberfest with an older, very well-known German director. He was clearly under the influence of cocaine – something she couldn't properly assess at the time. When she didn't behave as he expected, his mood changed within seconds. Jovial closeness turned into aggressive rejection , and at his request, she was summarily escorted out of the tent.
Why do people use cocaine?
Many people use cocaine to "feel good," to be more productive, or to cope with increasing pressure. This is a misconception. The more frequently cocaine is used, the more psychological resilience erodes —and the less able an individual is to actually manage stress.
Individual and social factors play a role in the question of the causes of cocaine use. At an individual level, loneliness and boredom are considered risk factors, as is fragile self-esteem . Cocaine use is associated with impulsivity, low frustration tolerance, emotional instability, impaired self-regulation, and a pronounced need for stimulation (Chamberlain et al., 2021; Richardson et al., 2013). Depressive disorders and anxiety disorders can also play a role.
However, social factors are often more decisive for first-time drug use. The social environment has a significant influence on drug exposure and the likelihood of use (Stritzel, 2021; Keyzers et al., 2020). One of the most fundamental human needs plays a role here: the need for belonging . If this need is met in an environment where the use of illegal substances on certain occasions is normalized, the likelihood of conforming and participating increases.
A decision against drug use therefore often goes hand in hand with the decision to build a new social network. This choice is uncomfortable – but it is open to everyone. Always.
Why not just try it out?
While cocaine does not lead to classic physical addiction, it quickly results in psychological dependence . Sigmund Freud also had to recognize this, as he experimented with the substance in his early years as a physician – both on himself and on others (Freud, 1884). Over time, he became aware of its addictive potential, as well as the personality changes that cocaine use brought about, changes which were also viewed critically in his personal life.
According to the International Classification of Diseases ICD-11 (WHO, 2019), psychological dependence on cocaine is present if at least two of three criteria are met over a period of at least twelve months:
Reduced control over consumption
Increasing prioritization of substance use over other areas of life
Continued use despite negative physical, psychological, or social consequences
Cocaine addiction is the result of a learning process.
Neuroscience research suggests that genetic predisposition plays a significant role in the development of psychological addictions – be it to drugs, alcohol, sex, or gambling (Borrego-Ruiz & Borrego, 2025; Vess, 2023). Genes influence how strongly certain brain regions react to stimuli – particularly those structures in the midbrain and forebrain where cocaine acts via increased dopamine release.
This dopamine produces euphoric feelings and forms the basis of the substance's addictive potential. The intensity with which the brain reacts to such stimuli is therefore also genetically determined. Nevertheless, we are not helplessly at the mercy of our genes: addiction is not fate, but a learned process : a stimulus-response chain that has become ingrained, but can also be unlearned.
Cocaine addiction is the result of conditioning: The user is initially "rewarded" with released dopamine and the associated positive feelings and experiences. However, after the effects wear off, the user is confronted all the more clearly with their own inner reality – for example, with low mood, loneliness, or lack of motivation.
Under the influence of the onset of a drug hangover, these states are often experienced more intensely than before consumption. The resulting feelings, characterized by inner emptiness, Despair and even suicidal thoughts can, in turn, increase the need to take the substance again. And that's where the cycle begins.
Cocaine in love and sexuality
Cocaine is known for its antisocial effects . Its use negatively impacts the quality of relationships – in partnerships, families, friendships, and professional contexts. This is compounded by loss of control and self-harming and harmful behavior towards others, particularly in sexual situations.
Cocaine use increasingly places the "self" at the center of attention, while empathy, compassion, and a sense of what is appropriate in personal and professional relationships recede into the background. As a result , emotional boundary violations towards people in one's immediate circle can become more frequent.
Short-term vs. long-term effects of cocaine on sexuality
The effects of cocaine on sexuality are systematically underestimated – perhaps because they don't fit the myth of performance, control, and strength that the drug promises. However, cocaine use has a significant long-term damaging effect on the central nervous system. Physical degeneration can become noticeable even after a relatively short period of drug use.
A client of mine, in her early twenties, struck up a conversation at a party with a young man who was only a few years older than her and about to graduate from university. During the evening, he told her that he occasionally used cocaine – and that without the drug, he could barely function sexually. Without cocaine, he said, he simply couldn't get an erection.
Cocaine use and erectile dysfunction are closely linked, a connection that is largely taboo. This is hardly surprising: cocaine significantly interferes with the neurobiological and vascular processes necessary for sexual arousal. The initially stimulating effect of cocaine can be reversed with frequent use.
Studies show that chronic cocaine use is associated with a decrease in natural excitability and consequently with reduced libido and sexual dysfunction ( Ghadigaonkar & Murthy, 2019; Zemishlany, 2010).
Goodbye, cocaine! – The path to a new future
In my psychotherapy practice, I repeatedly witness how severely cocaine use impairs the ability to experience genuine joy and love from within. This so-called "anhedonic symptomatology" is usually reversible with moderate duration and intensity of use. However, this requires patience and consistent, sustained abstinence .
The brain needs time to relearn how to naturally generate states of happiness. This process is a form of "psychological detoxification".
However, many drug users are in an internal state that makes change difficult: they have limited capacity for self-reflection, tend to externalize responsibility for their situation, and do not attribute their problems to drug use. Even when insight is present, they often lack the courage to consistently and sustainably change their own lives and social circles. In such cases , accompanying psychotherapy is not only helpful but often crucial for lasting change.
There are far more beautiful and sustainable ways to make your life exciting! Therefore, if this resonates with you, I encourage you to embark on a journey – a search for what truly fulfills you.
Are you planning to give up drugs and turn your life around?
Are you in a close relationship with someone who uses cocaine and would like psychological support? I'm happy to help. Schedule a free initial consultation in my online practice .
Psychologist M.Sc. & Coach Dr. rer. pol. Jessica Di Bella
Your contact: mail@jessicadibella.de More information: praxisdibella.de
Important: If you or another person requires urgent help, please contact the social psychiatric service in your region.
literature
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