Jodi*, a 33-year-old woman, has just finished her reformer Pilates session in Double Bay. As she sips on her almond milk matcha latte, she juggles the rapid fire of emails demanding her attention on her phone.
Sporting a full set of Alo activewear, her appearance is pristine with freshly styled hair and skin radiating the kind of glow that speaks of regular facials, collagen supplements, and a collection of wellness products designed to soothe the nervous system.
Earlier that morning, during her drive to Bondi, Jodi absorbed a podcast about managing cortisol levels and female hormones, all while planning a high-protein, low-carb dinner for herself that evening.
At first glance, Jodi appears to epitomize contemporary wellness culture. However, when Monday morning arrives, she’s likely to awaken around 3 a.m., her heart pounding, anxiety surging, and a troubling sensation of being unable to unwind.
This feeling isn’t solely due to burnout, perimenopause, or the general stress of life—although these factors may lurk beneath the surface. Rather, it’s linked to the ‘cheeky lines’ of cocaine she indulged in at a friend’s birthday gathering on Saturday night. Among her peers, this is often dismissed as mere ‘weekend fun.’
Increasingly, I find myself questioning whether we’re missing the mark in our discussions about cocaine. Public discourse typically centers on addiction, illegality, and overdose. Yet, what I observe among well-off women is a nuanced and intricate psychological terrain that extends beyond these familiar narratives.
There is a growing culture of recreational cocaine use among women who remain highly functional on the surface, while destabilising nearly every biological system responsible for keeping them emotionally resilient, hormonally balanced and metabolically healthy.
While the side effects of cocaine are well-documented, because these women still appear polished, productive and outwardly in control, the damage often goes unnoticed until their bodies begin struggling in ways they no longer understand.
Nutritionist Faye James (pictured) deep dives into so-called ‘casual’ cocaine use and explains the side-effects impacting women who are outwardly polished, productive and in control
The wellness culture contradiction
One of the most striking things about modern cocaine culture is how seamlessly it now co-exists alongside wellness culture itself.
The women using it are often the same women spending fortunes on organic groceries, magnesium supplements, infrared saunas and anti-inflammatory meal plans. They understand the language of cortisol, nervous system regulation and gut health intimately. Many track their sleep scores obsessively and speak fluently about blood sugar balance and longevity.
Yet every weekend they are placing enormous physiological strain on the very systems they are trying so desperately to optimise.
The ‘cheeky line’ snorted during a long lunch, the ‘nose powder’ discreetly passed around in restaurant bathrooms after too many spicy margaritas, or the tiny bumps taken at girls’ weekends away or lavish birthday dinners that stretch late into the evening.
Not every day; sometimes not even every weekend. This sporadic pattern is precisely why so many women convince themselves it is harmless. But the female body does not experience cocaine casually simply because the user emotionally categorises it that way.
What cocaine does to the female stress response
One of the most damaging physiological effects of cocaine is the way it activates the body’s stress response system.
‘The women using it are often the same women spending fortunes on organic groceries, magnesium supplements, infrared saunas and anti-inflammatory meal plans,’ says nutritionist Faye James (stock image posed by model)
‘One of the most striking things about modern cocaine culture is how seamlessly it now co-exists alongside wellness culture itself,’ writes James (stock image posed by model)
Cocaine sharply increases cortisol and adrenaline production, pushing the nervous system into an exaggerated fight-or-flight state. Heart rate rises, blood pressure increases, blood vessels constrict and the brain becomes hyper-alert.
Socially, this can initially feel energising and women often describe feeling more confident, more charismatic and emotionally invincible for a few hours.
Physiologically, however, the body experiences cocaine as a significant stress event.
The problem is that many modern women are already living with chronically elevated cortisol levels long before cocaine even enters the picture.
Poor sleep, overtraining, emotional stress, excessive caffeine intake, under-eating and regular alcohol consumption already place enormous strain on the hypothalamic-pituitary-adrenal axis, the system responsible for regulating stress hormones throughout the body.
Repeated cocaine use essentially traps the nervous system in a cycle of hyperstimulation followed by depletion.
Over time, this begins impairing sleep architecture itself, particularly deep sleep and REM sleep, which are essential for hormonal repair, emotional processing, metabolic regulation and cognitive recovery.
This is why so many women describe feeling ‘wired but exhausted’ after weekends involving cocaine. They may technically sleep, but the nervous system often remains physiologically activated long after the drug has left the bloodstream.
The body gradually loses its ability to properly switch off, and once deep sleep begins deteriorating consistently, almost every other biological system starts suffering too.
Why many women feel anxious, inflamed and emotionally depleted afterwards
One of the reasons recreational cocaine use becomes so physiologically confusing for women is because the symptoms rarely appear immediately or dramatically.
Instead, women slowly begin feeling emotionally flatter during the week while simultaneously becoming more anxious and overstimulated overall. Their resilience to stress weakens, sleep becomes lighter, their moods become less stable. They begin craving sugar, alcohol and stimulants more intensely while struggling with bloating, fatigue and low motivation.
Many assume this is burnout or hormones, but what they often fail to realise is that cocaine profoundly disrupts dopamine pathways, blood sugar regulation and cortisol rhythms simultaneously.
Initially, cocaine suppresses appetite through dopamine and adrenaline stimulation, which partly explains why some women associate it with thinness and social confidence. Afterwards, however, cortisol rises sharply, blood sugar becomes unstable and sleep deprivation worsens insulin sensitivity.
The body moves into a chronic physiological stress state and elevated cortisol encourages fat storage, particularly around the abdomen, while also increasing inflammation and muscle breakdown. Many women become trapped in a cycle where they appear outwardly healthy while privately struggling with bloating, weight fluctuations, exhaustion and intense cravings throughout the week.
Alcohol compounds the problem further by destabilising blood sugar and impairing liver detoxification pathways. Over time, the nervous system becomes increasingly dysregulated around both stress and appetite.
The gut-brain connection many women overlook
Perhaps one of the least discussed effects of cocaine is the impact it may have on gut health and the microbiome.
Cocaine constricts blood vessels throughout the body, including those supplying the gastrointestinal tract. Reduced blood flow can impair digestion, nutrient absorption and the integrity of the gut lining itself.
Emerging evidence also suggests stimulant use may negatively alter gut bacteria composition, increasing inflammation and disrupting communication along the gut-brain axis.
This matters enormously because the gut is intimately involved in neurotransmitter production, immune regulation and hormonal metabolism. About 90 per cent of serotonin is produced in the gut, which means disturbances to gut health can significantly affect mood, anxiety levels and emotional regulation.
When gut function deteriorates, women often experience worsening bloating, constipation, skin inflammation, low mood, fatigue and food intolerances, symptoms many simply attribute to stress or ageing.
What makes this particularly concerning is that many affluent women are spending thousands attempting to ‘heal’ symptoms they are unknowingly continuing to aggravate socially every weekend.
The cardiovascular risks women still underestimate
The cardiovascular risks associated with cocaine are well-established medically, yet many women still assume those dangers apply only to heavy or visibly chaotic users.
They do not. Cocaine increases heart rate, blood pressure and vascular constriction almost immediately after use, increasing the risk of arrhythmias, heart attack and stroke even in younger otherwise healthy individuals.
Women may actually be more vulnerable because hormonal fluctuations, smaller body size and differences in cardiovascular physiology can intensify the drug’s effects.
Alcohol magnifies the danger further. When cocaine and alcohol are consumed together, the liver produces a compound called cocaethylene, which is considered even more toxic to the cardiovascular system than cocaine alone and remains in the body longer.
Yet socially, this combination has become almost routine in many affluent environments, which is why the women most at risk often do not recognise themselves as being at risk at all. The consequences of recreational cocaine use rarely look like dramatic addiction in the beginning.
More often, they look like the woman who suddenly cannot cope with stress anymore. The woman waking every night with anxiety she cannot explain or whose nervous system feels permanently overstimulated despite all the supplements, Pilates classes and wellness rituals money can buy.
And because these women continue functioning professionally, parenting successfully and maintaining outward appearances, they often convince themselves everything is still under control long after their biology has begun telling a very different story.
Faye James is a Sydney-based accredited nutritionist and author of The Perimenopause Plan and The Menopause Diet.
*names have been changed
