Cocaine and methamphetamine-induced paranoia

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Grim Reaper

Photo courtesy of Pixabay.

Stimulant-induced paranoia isn’t exactly a diagnosis.

Paranoia is common among drug users. It’s especially common among stimulant users. When crack cocaine users first began to show up in hospital emergency rooms, there was a lot of confusion between drug-induced psychosis and the onset of schizophrenia and other psychotic disorders. For a while, it looked like there was an epidemic of new cases of schizophrenia. Then the picture emerged, something was very different about these new cases of psychosis.

The key features of psychotic disorder, schizophrenia, and some other related disorders are delusions, hallucinations, disorganized thought and speech, and grossly disorganized or abnormal motor behaviors. Some loss of normal functioning called “negative symptoms” is also part of psychosis. People with drug-induced psychosis don’t show those same levels of “negative symptoms.”

What most of us think of as paranoia fits generally under a couple of types of delusions, persecutory delusions, and referential delusions. These are the beliefs that people are out to get them and that what others are saying and doing is directed at them. Researchers have discovered that symptoms of paranoid can fall on a continuum from some mild suspiciousness and trust issues to potentially dangerous psychotic paranoia.

Psychosis and presumably paranoia can occur at multiple points in the drug-using experience. For any drug of abuse, we expect to see one set of symptoms while the user is under the influence and another set of symptoms during withdrawal. Some conditions will persist, sometimes for years, even after the drugs have left the users system. These conditions are called drug-induced. It’s also possible that a drug user had a particular mental illness before they began using or had a risk factor for an illness and the drug use was enough of a stressor to result in the appearance of that illness.

I should also mention here all these descriptions are based on the idea that mental illnesses are categories. That’s the way the diagnostic manual is designed. You either have the illness, or you don’t. Increasingly research has been suggesting that most of the things we are calling symptoms are on a continuum. You can have more or less of a symptom such as paranoia. This implies that counseling and the ways people think can result in changes in symptoms of something like paranoia, regardless of whether the person with paranoia has a diagnosable mental illness or not.

Paranoia among cocaine users.

Cocaine-induced paranoia is primarily reported during cocaine intoxication. It involves extreme hypervigilance for possible danger in the environment. Up to 70 percent of cocaine users exhibit temporary paranoia even after ruling out mental health diagnoses which would include paranoia. Cocaine users on average report developing paranoid symptoms after about three years of using cocaine. The quantity that was used or the patterns of use do not seem to affect the onset of paranoia (Rosse, et al., 1994.)

Methamphetamine-induced paranoia.

Studies of paranoia among methamphetamine users are generally newer than the ones involving cocaine. One noteworthy difference was that methamphetamine users who became paranoid were more likely to get a weapon and to attack someone. Meth users had typically been awake for 48 hours or more when the paranoia began. The majority experienced auditory and visual hallucinations. Almost 40 percent of the methamphetamine users also reported tactile hallucinations. These results not only overwhelmingly reported paranoia but fit more closely with the diagnosis of psychosis in the studies I found of psychosis in cocaine users (Leamon, M., et al., 2010.)

Other drugs probably cause paranoia also.

Most of the early research on stimulant psychosis was done using patients who had been addicted to crack cocaine. In the years since that research, it has become clear that other stimulants, methamphetamine, and the so-called “bath salts,” also produce psychotic episodes and an increase in paranoia. Studies of paranoia among cocaine users were largely done in psychiatric settings while the studies of methamphetamine and paranoia were mainly done in outpatient drug treatment which leads me to believe that paranoia is probably much more common and more likely to lead to violence among those who develop severe methamphetamine use disorders.

Paranoia and hallucinations occur among users of dextromethorphan.

Since most drug users use multiple drugs as well as drink alcohol and many also have mental health issues, it’s hard to be sure about causes. One thing does seem certain almost all drugs of abuse and excess alcohol use result in an increased risk that you will develop some level of paranoia.

For more on this topic see:



Dextromethorphan and paranoia.

Staying connected with David Joel Miller

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3 thoughts on “Cocaine and methamphetamine-induced paranoia

  1. I can’t seem to unsubscribe from this blog. I attempted to log in and it doesn’t recognize either of my emails. Maybe because I un-subscribed awhile ago. Please take me off the list


    • Well sorry about this. This is a first for me. There should be an automatic remove link at the bottom of the email. I checked my list and do not see you or this email address on my list. Unless it is being forward from someone or somewhere else? The posts are also sent to twitter or facebook followers or could be included in feeds from someone else, but I do not show you on my email list. Would need some more information to track this down.


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