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Drugs of abuse can produce temporary and even more long-lasting psychotic symptoms, but whether affected individuals are more prone to psychosis in the absence of drugs is not known. To evaluate the hypothesis that those experiencing transient cocaine-induced paranoia are more vulnerable to psychosis, 20 cocaine-dependent men with at least three years of continuous use were studied. Subjects had used at least five grams of cocaine per week and were currently involved in a substance abuse treatment program. Half of these men reported episodes of paranoia that occurred only when they binged with cocaine. Subjects were evaluated with two scales: the Perceptual Aberration Scale and the Magical Ideation Scale, which measure perceptual distortions and abnormal beliefs in causation, respectively. The scores were strongly correlated with a history of cocaine-induced paranoia; the 10 men who had experienced paranoia had more abnormal scores than men who never had such experiences. Eighty percent of those identified as prone to psychosis were in the group that reported paranoia, and 90 percent of those who were not prone to paranoia were in the group that did not report having had these experiences. The probability scores derived from these data were well above 80 percent. This suggests that heavy cocaine users who experience paranoia may be more prone to psychosis than cocaine users who do not. (Consumer Summary produced by Reliance Medical Information, Inc.)