Will my saddle nose get worse over time if left untreated?I have a huge perforated septum and saddle nose. (Photos)

Tough problem caused by the cocaine that created the perforated septum. The 'saddle' nose can be reconstructed with cartilage grafts from the ear or rib cartilage.
The perforated septum is more complex. Sometimes, this can be left alone and the function can be ok.
Congratulations on your sobriety for 5 years! Keep it up and good luck! 

First and foremost congratulations on staying clean for over 5 years.  Since you have issues with both the septum and the outward appearance it's important to see a Facial Plastic Surgeon that may also be an Otolaryngologist (ENT). He or she will specialize in the face/head/neck and may be able to perform a septorhinoplasty to repair the inside and out.  You would need an examination to determine which approach would be best.  Be Well!

 A thorough internal and external examination the nose is required to determine how to proceed with repairing the saddle deformity and septal perforation.  Important to be off cocaine for at least 1 year before undergoing any surgical procedures on the nose.  The saddle deformity can be built up with a cartilage graft harvested the ear, and the dorsal hump can be shaved down.  For more information and many before and after rhinoplasty examples, please see the link and the video below

Great to hear that you have stayed clean for 5 years!. There is a chance that your saddle deformity will continue to become more significant as you age. As we age the intrinsic strength of the cartilage decreases and this is why elderly people have droopy noses.  Based on your photographs you look relatively young and I recommend that you have your nose fixed sooner than later so you can enjoy appearance that you want for the rest of your life, have normal breathing, and not be at risk for bloody noses. Your surgery would be a complex one because of the saddle deformity and the septal perforation. Based on the size of the septal perforation  it may be possible to repair that as well for you. I have videos posted on here of complex noses I have repaired. I recommend that you consult a board-certified facial plastic surgeon with excess extensive experience in the kind of rhinoplasty that you require. Please make sure that they show you their own before and after work.  I wish you the best and hope this helps, Dr. Ardeshirpour 

t can get worse but it could be fine as well, it depends on the perforated septum.
Either way it's fixable so don't worry as the 'saddle' nose can be reconstructed with cartilage grafts from the ear or even the rib cartilage if you had more than one surgery and the ear cartilage was used.
Pictures Before and After