Cocaine Withdrawal

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Cocaine falls under the category of stimulants, a class of drugs that act on the central nervous system. They speed up the normal activities of the brain, effectively making people feel more energetic and alert. They also produce an overabundance of dopamine, the pleasure-inducing chemical in the brain. CDC reports [1] that cocaine was involved in nearly 1 in 5 overdose deaths in 2019. In addition, over 5 million Americans reported current cocaine use in 2020, which is almost 2% of the population. Because of its powerful energizing effects, cocaine withdrawal can be extremely difficult.

What Are Cocaine Withdrawal Symptoms?

Cocaine withdrawals occur when someone who has become dependent on the drug reduces their intake of it or quits taking it completely. Cocaine addiction develops when someone uses cocaine over an extended period and the substance become necessary for them to simply feel “normal”. Individuals at this stage of addiction feel that cocaine is essential to their everyday functioning and cannot imagine their life without it. The authors of Cocaine: Pharmacology, Physiology, and Clinical Strategies, explain that “cocaine withdrawal is not a dramatic abstinence associated with opiates or sedatives”. This is because the neurochemical basis of cocaine withdrawal involves catecholamine depletion, which manifests as decreased energy (increased tiredness) rather than rebound hyperactivity, which can be more difficult to cope with.

The Diagnostic and Statistical Manual [2] of Mental Disorders sets out the following four criteria for cocaine withdrawal. An individual must meet all four criteria for it to be considered that they are experiencing withdrawal.

  • Cessation of (or reduction in) cocaine use that has been heavy and prolonged.
  • Dysphoric mood and two (or more) of the following physiological changes, developing within a few hours to several days after Criteria A
    (1) fatigue

     (2) vivid, unpleasant dreams

     (3) insomnia or hypersomnia

     (4) increased appetite

     (5) psychomotor retardation or agitation

  • Symptoms in Criteria B cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The symptoms are not due to a general medical condition and are not better accounted for by another medical disorder.

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Cocaine Withdrawal Symptoms Vary

Of course, the extent to which a person experiences withdrawal effects and the intensity of the effect will depend on factors such as how long a person has been using cocaine and the route of administration. Methods include swallowing, injecting, inhaling, smoking, or snorting. Some routes of administration will produce a quicker and more prolonged high than others, and crack cocaine use is associated with a relatively faster onset of coke withdrawal symptoms. Other factors include:

  • The frequency with which they have been taking the drug
  • The amount of cocaine used each time
  • Whether other substances were taken alongside the cocaine.

Dysphoric mood is a profound and debilitating state of dissatisfaction and unease. This manifests in depression, anxiety, irritability, and difficulty concentrating. In some cases, it can also be associated with suicidal thoughts or attempts.

When a person undergoes a cocaine withdrawal treatment program, the first stage is evaluation. This means that the healthcare professional will perform a thorough assessment of a patient’s current state of health to ascertain the nature of their addiction as well as the withdrawal symptoms that they may be more likely or less likely to face.

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How Does Withdrawal Work?

The authors of the book referenced above also explain that “since cocaine withdrawal is relatively mild, resolves quickly, and is not life-threatening, detoxification is not critical from a medical perspective. Pharmacological treatments that address craving and euphoria will therefore have a more important role than those that reverse the brief and often transient cocaine ‘crash’."

Thus while withdrawing from cocaine does involve detoxification in the sense of stopping using the drug and allowing the body to clear itself of it, tapering, which consists of weaning a person off a drug slowly in gradually decreasing doses, may not be necessary in the case of cocaine withdrawal. This is because the extreme low point that the patient will experience (the “crash”) is relatively short-lived compared to that involved in the withdrawal from other drugs, and does not usually involve severe physical symptoms or present immediate medical dangers to a patient.

How Long Does Cocaine Withdrawal Last?

In terms of the cocaine withdrawal timeline, in Substance Abuse: A Comprehensive Textbook, the author explains that “the crash is exhaustion lasting from hours to 4 days and is associated with intense depression, agitation, anxiety, hypersomnolence, hyperphagia and craving for cocaine. The withdrawal phase ranged from 1 to 10 weeks, with an absence of craving in the early weeks and a reemergence of craving in the middle weeks.”

The withdrawal phase begins when the cocaine leaves a person's system. To learn about cocaine's half-life read our online resource on this topic.

Withdrawal treatment for cocaine is more focused on addressing this longer withdrawal stage and the side effects that come along with it rather than the initial crash. Medical professionals monitor withdrawal progress to see whether everything is progressing as it should be or whether there are any departures from the norm and take any needed action to keep people safe and comfortable in the early stages of recovery. There are currently no medications specifically approved for cocaine withdrawal or treatment, but certain medications may be used during medical detox to help people manage troublesome cocaine withdrawal symptoms, such as insomnia.

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Cocaine Withdrawal Treatment

While the cocaine crash is transient, it is important that individuals don’t try to undergo drug detox treatment alone. Physical cocaine withdrawal symptoms can contribute to the perpetuation of drug addiction, if the individual finds the mental and physical symptoms (especially those of depression and anxiety) too difficult to withstand and ends up relapsing to relieve the symptoms they are experiencing.

In Kaplan & Sadock's Concise Textbook of Clinical Psychiatry, the authors explain that “persons experiencing cocaine withdrawal often attempt to self-medicate with alcohol, sedatives, hypnotics, or antianxiety agents such as diazepam (Valium)”. Part of the withdrawal stage consists of stabilization, where medical professionals help to ensure that patients can achieve a state of abstinence and medical stability, free from relapsing and self-medicating. This involves addressing what led the individual to turn to drugs in the first place as well as looking at what sort of social-support system they have access to.

There Is Help For Cocaine Withdrawal

Left untreated, cocaine addiction can have adverse effects on a person’s health and functioning, such as delirium, psychotic disorders, mood disorders, anxiety disorders, and sexual dysfunction. Tragically, cocaine addiction can also result in fatality. 

At Avenues Recovery, we provide a range of both inpatient and outpatient settings for cocaine withdrawal. Our team of expert specialists will be there to monitor your physical and mental well-being and guide you through each step of the way; no one is expected to go it alone. Don’t hesitate to contact Avenues Recovery today to discover what recovery options are available to you or your loved one, so you can enter the next phase of your life, a future free from the shackles of addiction.

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