I've seen what cocaine is doing to middle-aged men. Most of my patients think an occasional line is harmless but this is what it does to your heart, brain and sex life... and why the impact is so much worse past this age

Most people think of cocaine as a young person’s drug. But as a consultant psychiatrist specialising in addictions treatment, I’m seeing more and more middle-aged men whose use has escalated over the years, with devastating consequences – for their health and their marriages.In fact, the most recent Office for National Statistics figures show that almost a third of those in treatment for addiction are aged 50 or over, compared to just 12 per cent in 2010.Many of these men tell themselves it’s ‘just’ something they do at weekends or on holiday, a way of recapturing the buzz of their younger years. They treat buying cocaine no differently than ordering a pizza – and rarely stop to think about the risks.But by the time these would-be Peter Pans reach their forties, fifties and beyond, the drug is taking a far greater toll than they realise: on their heart, their brain, their relationships and even their sex life.Because every time they take cocaine, they might as well be playing Russian Roulette. At 55, the heart is far less robust than it was at 25. Snorting a line is like putting a supercharger on a Ford Anglia. Even if your use is only occasional, the effect can be fatal. Those in their late forties are four times more likely to die from taking cocaine than those half their age.As a stimulant, cocaine speeds up the heart rate, constricts blood vessels and increases blood pressure. These factors can cause arrhythmias (irregular heart rhythms) and dramatically increase the risk of having a heart attack.Research published this year by the University of Cambridge also shows that using cocaine almost doubles your risk of having a stroke in later life. It can cause fits and increase an individual’s chances of suffering an aneurysm, because constricting the blood vessels over a long period may reduce the oxygen the brain receives. Dr Niall Campbell says that over time, repeated use of cocaine can make the brain produce less dopamine, which can leave users anxious, depressed and paranoidUnfortunately, I’ve seen a case where a group of middle-aged friends went to Ibiza to party like it’s 1999, but their bodies couldn’t cope any more – and one didn’t make it back alive.While the death rates from cocaine are almost ten times higher than in 2011, these figures are likely an underestimate, because deaths from drug-related causes are often not recorded as such.Then there’s the impact on men’s sexual performance. Erectile dysfunction is one of the side effects men are often least willing to discuss, but it’s a common one. Long-term cocaine use is also associated with diminished libido, loss of sensation during sex and premature ejaculation.Cocaine may make users feel less inhibited in the moment, but physiologically it has the opposite effect. It reduces blood flow throughout the body, including to the penis, making it harder to achieve or maintain an erection.In any case, desire is the furthest thing from the minds of most of my addiction patients at the Priory Hospital Roehampton, because the mental health effects of cocaine are severe.When someone takes cocaine, their brain is flooded with dopamine – the ‘feelgood’ neurotransmitter associated with pleasure – making them feel happy and energetic. But prolonged exposure to high levels of dopamine can desensitise the brain’s response to sexual stimulation.Once the initial high from the drug wears off, dopamine levels drop sharply, leaving the brain depleted. Over time, repeated use can make the brain produce less dopamine, which can leave people anxious, depressed and paranoid – none of which are conducive to intimacy. Instead, all they’re interested in is taking cocaine again to replicate the euphoric feeling they got the first time they tried it.It’s hardly surprising, then, that by the time they walk through my doors, they are often on the brink of losing their relationship – or have already done so. Cocaine has gradually stripped them of honesty, trust and closeness – and their partner has reached the end of her tether. Many men simply don’t feel as sharp as they once did, and that mental fog can linger long after the high of cocaine has worn offThese are men who began using the drug intermittently and thought they had a handle on it but found dependency creeping up on them.They’re lying to their partner and sneaking off to take more cocaine, convinced nobody has noticed. They think they’re keeping their secret effectively, but the women in their lives invariably know.It’s difficult to hide the side effects of frequent cocaine use – and not just the financial ones, which can be catastrophic, with some men spending thousands of pounds every month.Their performance at work also begins to suffer. They’re exhausted after nights spent taking the drug, and start calling in sick more often, making poor decisions and struggling to concentrate. Colleagues and employers usually spot the changes earlier than they do.Long-term cocaine use has been linked to problems with memory, attention and decision-making.Many men simply don’t feel as sharp as they once did, and that mental fog can linger long after the high has worn off. While middle-aged men may think cocaine helps recapture their youth, the reality is they’re just hastening the arrival of the health problems we associated with old age.I’ve also known patients to become stuck in a state of paranoid psychosis, suffering terrifying symptoms such as delusions and hallucinations – problems that are extremely resistant to drug treatment.The biggest misconception I encounter is that if someone only takes cocaine occasionally, they’re somehow protected from its effects. They’re not.By the time most of my patients seek help, the damage has already seeped into every corner of their lives.My simple advice to anyone taking cocaine in their forties or fifties would be to stop – and if it’s your partner you’re worried about, trust your instincts and talk to them about it.Don’t wait for the situation to reach crisis point to seek help – or you may not live to regret it.For free support visit Cocaine Anonymous (cocaineanonymous.org.uk)As told to Polly Dunbar