Cocaine deaths have spiked among middle-aged men. Here are the signs your husband is hiding a secret habit – and why I fear things are about to get worse: DR MAX PEMBERTON

The Christmas party season is still a few weeks off. But when the time comes, plenty of wives will lie awake wondering who their husbands are flirting with at the office do when they would do better to worry about how often he slips off to the gents.

Why? Because last week Office for National Statistics figures revealed that cocaine has overtaken heroin as the drug most often involved in deaths in England and Wales, for the first time since records began in 1993.

It was linked to 1,233 fatalities registered last year, compared with 1,210 involving heroin and morphine. Cocaine deaths are now about four times higher than a decade ago.

What struck me most about this alarming statistic is who is dying. We tend to picture drug deaths as teenagers collapsing at festivals. Yet in England more than a third of those whose deaths involved cocaine were in their 40s, and another third were aged between 50 and 69. Only 136 were in their 20s. Most were men – in fact the typical victim is a middle-aged man, often in a rewarding career, with a family who have no idea about his drug habit. I see these men in my clinic.

One I treated, whom I’ll call James, was in his mid-40s and by any outward measure a success, with a senior job, a lovely home, a wife and two children.

His GP referred him to me with depression and for the first couple of appointments that’s what we talked about: his low mood, his irritability, the way he felt listless and had lost interest in everything.

It was only when I pushed him on whether he was using drugs that he paused for a long time before telling me everything.

He’d used cocaine occasionally for years, at weddings or on big nights out, without thinking much of it.

Then he was promoted and with the new job came long evenings at the office and the pressure to stay sharp late into the night. He started using it to keep himself alert and was soon getting through several bags a day, sneaking off to the toilets at work to take it.

He’d run up thousands of pounds of debt that his wife knew nothing about and he confessed he had even seen an ear, nose and throat doctor privately because he’d developed a hole in his nasal septum caused by excessive usage.

Despite all that, he continued to take cocaine daily. Those around him were oblivious. He told me he’d long since stopped taking it for pleasure and now needed it simply to function.

Much of the depression he’d been referred for was the crash that followed each binge.

James is far from unusual. Cocaine has become cheaper and stronger. The charity WithYou estimates that the price of a gram has fallen by about 40 per cent in six years while purity has risen, so people are often taking a more potent drug than they realise.

Middle-aged men are especially vulnerable because of what cocaine does to the heart. It narrows the arteries, drives up blood pressure and heart rate and can trigger heart attacks and strokes.

When it’s mixed with alcohol, as it almost always is at a party, the liver produces a compound called cocaethylene, which is more toxic to the heart than either substance alone.

Add the furred arteries that come with age, and a man of 48 is far more at risk than he was at 25.

So how can you tell if someone you love is ‘using’? The most obvious clue is frequent trips to the loo, particularly at social events, with the person returning more animated, talkative and confident.

Look out for constant sniffing, a permanently runny or blocked nose and nosebleeds, often blamed on a cold that never clears up.

Cocaine makes people clench their jaw and grind their teeth, so a sore jaw or morning headaches can be telling. Many users can drink far more than usual without seeming drunk, because the stimulant masks the effects of alcohol.

Then there’s the comedown, a day or two of irritability, exhaustion and low mood that’s easily passed off as a hangover or work stress. If your partner is reliably snappy and flat midweek after a big weekend, that pattern deserves attention.

Money is also often a giveaway, whether it’s regular cash withdrawals, debts you can’t account for, or sudden secrecy about bank statements.

So is your partner guarding their phone more closely, because many drug users arrange their supply by text.

Of course, none of these signs prove anything on their own and a runny nose in November is usually just a cold. It’s the cluster of signs, and the change from how someone used to be, that should prompt a conversation.

If you’re worried, pick a calm, sober moment to talk – avoid confronting him at 2am after a party. Be specific about what you’ve noticed and why it frightens you, and avoid accusations, because shame drives this habit further underground.

His GP is a good first step, and Frank (talktofrank.com, 0300 123 6600) and WithYou offer confidential advice to users and their families.

Cocaine addiction is treatable and James did recover but it began with someone asking the question.

Zoe’s midlife anxiety

Zoe Ball has revealed that her panic attacks have returned after a long absence. On Dig It, the podcast she hosts with Jo Whiley, she said her anxiety had been ‘terrible recently’ and she had replaced her afternoon coffee with decaf, which helped. Zoe, 55, also wondered whether it might be hormonal, because nothing in her life had changed. Frightening as it is, a panic attack isn’t dangerous. Her instinct about coffee is a good one, caffeine stimulates the same system that drives anxiety, producing a racing heart and jitteriness that the brain can misread as the start of a panic attack. Her hunch about hormones is also worth taking seriously. Anxiety is one of the most common symptoms of perimenopause and menopause. Regular exercise, decent sleep and going easy on alcohol can all help alleviate the problem.

Dr Max prescribes… potassium salt

Ditching ordinary table salt for a potassium-enriched alternative such as LoSalt is one of the cheapest ways to protect your heart. Researchers estimate that switching all salt could prevent almost 13,000 deaths a year in the UK, and a large trial found it cut the risk of stroke by 14 per cent. Anyone with kidney disease or taking blood pressure drugs should check with their pharmacist.