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Cocaine Withdrawal

10 Minutes

Edited & medically reviewed by SENSES Team

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CONTENTS

Widely known for its high risk of abuse liability, cocaine is a powerful drug with strong euphoric effects. Native to South America, it is currently available in different formulations injected, smoked, or snorted by users across the globe. The immediate effects of cocaine, such as heightened alertness, increased energy, and a sense of euphoria, make it a highly sought-after substance. However, its impact on the reward system of the brain can easily trigger compulsive use, leading to psychological and physical dependence.

When a person develops cocaine dependence, stopping it can become a challenge. The process often triggers a series of symptoms, collectively known as cocaine withdrawal. [1] While not as intense and physically severe as withdrawal from other opioids, cocaine withdrawal can still pose a considerable risk for mental and physical health. It is crucial to prioritize and ensure recovery by understanding the phenomenon, including its symptoms, psychological and physiological effects, timeline, and treatment options.

Before understanding the specifics of cocaine withdrawal, it is crucial to know more about how cocaine targets the brain. Cocaine works by boosting the levels of a neurotransmitter called dopamine, which is typically associated with reward and pleasure. The substance increases dopamine concentration by blocking its reabsorption in the brain, ultimately leading to the intense excitement and euphoria most people seek. [2]

While cocaine-induced euphoria is highly enjoyable in the short term, its prolonged use forces the brain to adapt to the new normal. Consequently, users need higher concentrations of cocaine to achieve the same effects. This process is known as tolerance and acts as the first step toward attaining cocaine dependence. When an individual becomes cocaine-dependent, their body constantly relies on cocaine to maintain normal functions. Abruptly stopping it in such circumstances causes a sudden deficit in dopamine levels, triggering a withdrawal.

As mentioned before, cocaine primarily works by targeting the reward pathway in the brain and upping the levels of dopamine in the prefrontal cortex and nucleus accumbens. A withdrawal occurs when these dopamine levels plummet due to the unavailability of cocaine, leading to a dopamine crash. This dopamine crash leads to a host of symptoms, like intense cravings, anhedonia, and depression, collectively known as withdrawal.

In addition to dopamine, long-term cocaine use is also known to affect other neurotransmitter systems in the brain, such as norepinephrine and serotonin. These neurotransmitters also affect anxiety, mood, and stress responses, and any changes to their levels can further heighten the risk of withdrawal.

Cocaine withdrawal is slightly different from withdrawing from other opioids in a way that it may not manifest in the form of life-threatening symptoms. However, it can still lead to considerable emotional and psychological challenges that can be difficult to overcome. Given that cocaine’s half-life is around 90 minutes, its withdrawal symptoms may begin within a few hours, as soon as the effects of the last dose wear off.

Cocaine withdrawal can be broadly classified into acute and protracted withdrawal:

Acute Withdrawal: This phase begins shortly after stopping cocaine, usually within a few days to a few weeks. The symptoms are typically intense and may include intense cravings, anxiety, fatigue, depression, and irritability. Acute cocaine withdrawal can last up to 2 weeks.
Protracted Withdrawal: Also known as post-acute withdrawal syndrome (PAWS), some users continue to experience lingering symptoms of withdrawal for weeks or months following the acute phase. Some common symptoms of PAWS include poor concentration, sleep issues, mood swings, and ongoing drug cravings. The lingering symptoms, although mild, can significantly slow down recovery and increase the relapse risk.

The cocaine withdrawal experience may vary from one person to another, depending on several factors. These may include the following:

Method of Use: Certain methods deliver cocaine more quickly to the brain, such as injecting or smoking cocaine. Users opting for these methods typically have more intense withdrawal processes.
Intensity & Duration of Use: Long-term heavy use of cocaine typically leads to more intense withdrawal symptoms.
Polydrug Use: Individuals who regularly pair cocaine with other substances, such as opioids, marijuana, and alcohol, may experience a complicated withdrawal process that may be more intense or longer than expected.
Co-Occurring Mental Health Issues: Individuals with underlying mental health disorders, such as depression, bipolar disorder, and anxiety, may experience a more intense psychological withdrawal.

Cocaine withdrawal may present in different ways, and the symptoms can be classified into three categories. Remember that the combination of these symptoms and their severity may vary from one person to another.

Physical Symptoms

While the physical symptoms of cocaine are generally not dangerous, they may cause many uncomfortable physical symptoms, such as the following:

Increased appetite: Because cocaine suppresses appetite, its withdrawal may force individuals to experience a marked increase in hunger.
Exhaustion & Fatigue: As the stimulating effects of cocaine subside, the withdrawal may make users experience extreme tiredness and fatigue. This fatigue may last for days or weeks in many cases.
Sleep Disturbances: Many cocaine users who are actively withdrawing report experiencing insomnia or even hypersomnia as a part of the process. Other sleep-related issues encountered during the withdrawal include experiencing vivid dreams.
Muscle Aches: Generalized muscle tension and body aches are common for people who are withdrawing from cocaine after developing an addiction.

Psychological Symptoms

The psychological symptoms of cocaine withdrawal can be highly distressing and often include the following:

Intense Cravings: The intense cocaine cravings can be extremely overwhelming, especially during the initial days of withdrawal. Some users continue to experience them even when the acute phase of withdrawal is over.
Depression: This symptom marks the hallmark symptoms of cocaine withdrawal and can vary in terms of severity. While some people experience mild sadness and low mood, others may develop suicidal thoughts.
Agitation & Anxiety: These symptoms are also reported by many cocaine users during the withdrawal phase. These feelings may persist for weeks or months, causing restlessness and constant irritability.

Behavioral Symptoms

Cocaine withdrawal can often cause a change in behavior, leading to the following symptoms:

Social Withdrawal: Withdrawing individuals commonly isolate themselves from family and friends, especially during the initial phases. This behavior is often fueled by factors like anxiety, depression, or embarrassment about their ongoing struggle.
Anhedonia: This term refers to the inability to experience joy and pleasure and is commonly seen as a part of cocaine withdrawal symptoms. Quitting cocaine abruptly decreases dopamine levels, which makes it difficult for people to engage and enjoy activities they once enjoyed.
Increased Sleep: Early days of cocaine withdrawal can make users struggle to stay awake. They may spend hours in bed, sometimes up to 16 hours per day, in an attempt to recuperate.

The cocaine withdrawal timeline can vary among users based on various factors like duration of use, individual health, the preferred method of ingestion, etc. Below is a generic timeline indicating how the process will likely proceed for most people.

Day One to Three: The Crash

Known as the first stage of cocaine withdrawal, the cocaine crash typically begins within hours to days from the last dose. The symptoms experienced during this phase usually include depression, fatigue, paranoia, increased appetite, and irritability. Many people report experiencing intense cravings during this time. [3]

Day Four to Ten: The Acute Withdrawal

Following the initial crash, most users progress to the acute withdrawal phase, where psychological symptoms like mood swings, anxiety, and depression set in. While the initially intense cocaine cravings become more manageable, some people continue to experience it for an additional few weeks. Sleep disturbances, such as unsettling dreams and insomnia, are other common symptoms users experience during this phase.

Week 2+: The Extinction

Many users are in a settled position by the end of the acute withdrawal phase. However, some may enter into a prolonged withdrawal phase, also known as extinction. During this time, the intense symptoms subside while others, such as sleep issues, intermittent cravings, and mood swings, continue. Depression and anhedonia may also persist in this phase for some users.

Cocaine withdrawal is not typically life-threatening but can be highly challenging to get through due to its psychological and emotional symptoms. A comprehensive treatment plan, including a combination of psychological support, medical strategies, and lifestyle tips, can be an excellent way to ensure recovery.

Cocaine withdrawal generally takes place in two different levels of care, including the following:

Inpatient Treatment: This level of care is appropriate for people with severe cocaine addiction or co-existing mental health illness. Inpatient treatment provides around-the-clock support and a supervised environment to overcome withdrawal.
Outpatient Treatment: This level of care is suitable for people with less severe addiction and robust support systems in the community. Outpatient programs allow them to continue living in their own space while participating in regular sessions.

The following are some essential components of a comprehensive treatment program for cocaine addiction:

Medical Treatment

Unfortunately, there is no approved medication to control cocaine withdrawal. However, certain drugs have been used, particularly in conjunction with therapy, with variable results. [4] [5] Some examples of medical treatments available to those with cocaine withdrawal symptoms include the following:

Anti-Anxiety Medications: In case of extreme anxiety, some people may benefit from short-term courses of anti-anxiety medications, such as benzodiazepines. However, their use must be very cautious due to their high abuse liability.
Antidepressants: Depression is one of the most common symptoms of cocaine withdrawal. Experts may prescribe SSRIs and other types of antidepressants to manage these feelings.
Sleep Aids: Melatonin supplements may help people actively withdraw from cocaine to manage their sleep cycle. In severe cases, prescription sleep aids may also be used.

Psychological Therapy & Support

Psychotherapy remains an essential component of recovery when it comes to cocaine dependence and withdrawal. Some common approaches included in this therapy are explained below:

Contingency Management: This therapy provides tangible rewards to users for maintaining sobriety. These awards often serve as a powerful motivator for them to complete the withdrawal and sustain the recovery milestones.
Cognitive Behavioral Therapy: CBT can help individuals identify and replace negative behaviors and thoughts with positive ones. It can particularly help people manage specific cocaine withdrawal symptoms, such as cravings. [6]
Group Therapy: This therapy is available in community and rehabilitation centers and can be a great source to instill individuals with a sense of experience. Group therapy also provides them a platform to share experiences, essential for long-term recovery.

Relapse Prevention

Given the high intensity of cravings and other psychological symptoms that most users experience, relapse prevention remains an essential component of treatment. A good relapse prevention program may include the following:

Trigger Avoidance: This includes avoiding places, people, or situations associated with cocaine use.
Coping Skills Acquisition: This includes learning and using healthy ways to deal with anxiety, stress, and potential relapse triggers.
Ongoing Therapy: Both individual and group therapy can help cocaine users focus on their recovery goals and successfully overcome the ongoing withdrawal.

Cocaine withdrawal is a complicated, multifaceted process with various underlying psychological, behavioral, and physical symptoms. While the process may not be as dangerous as withdrawing from other substances, the mental and emotional turmoil it exerts can overwhelm anyone. Understanding cocaine withdrawal, along with its symptoms, timeline, and potential treatment strategies, can help individuals understand how to manage it successfully.

Remember that cocaine withdrawal is an aspect of cocaine addiction recovery. The recovery journey is long and requires a comprehensive approach, including therapy, medical support, and lifestyle changes. With the right resources and tools, individuals can navigate and overcome the challenges of cocaine withdrawal and achieve long-term sobriety.

[1] Gupta M, Gokarakonda SB, Attia FN. Withdrawal syndromes. InStatPearls [Internet] 2023 Apr 29. StatPearls Publishing.

[2] Nestler EJ. The neurobiology of cocaine addiction. Science & practice perspectives. 2005 Dec;3(1):4.

[3] Morton WA. Cocaine and psychiatric symptoms. Primary care companion to the Journal of clinical psychiatry. 1999 Aug;1(4):109.

[4] Carroll KM, Nich C, Rounsaville BJ. Differential symptom reduction in depressed cocaine abusers treated with psychotherapy and pharmacotherapy. The Journal of nervous and mental disease. 1995 Apr 1;183(4):251-9.

[5] Mendelson JH, Mello NK. Management of cocaine abuse and dependence. New England Journal of Medicine. 1996 Apr 11;334(15):965-72.

[6] Aharonovich E, Hasin DS, Nunes EV, Stohl M, Cannizzaro D, Sarvet A, Bolla K, Carroll KM, Genece KG. Modified cognitive behavioral therapy (M-CBT) for cocaine dependence: Development of treatment for cognitively impaired users and results from a Stage 1 tr

FAQs

Is cocaine withdrawal different from other drug withdrawals?

Cocaine withdrawal primarily includes emotional and psychological symptoms, whereas withdrawals from other substances like opioids and alcohol mainly revolve around intense physical symptoms, such as nausea, seizures, and tremors. However, the psychological challenges associated with cocaine withdrawal can be complex to manage and make recovery challenging in the absence of adequate support.

How long does cocaine withdrawal last?

The duration of cocaine withdrawal can vary based on various factors, such as the amount and duration of cocaine use, mode of ingestion, polydrug use, etc. The symptoms generally begin a few hours after the last dose and may last up to ten weeks. Cravings, anxiety, and depression usually peak within the first few weeks and subside, whereas the other psychological symptoms may linger for months.

How dangerous is cocaine withdrawal?

Unlike alcohol or opioid withdrawal, cocaine withdrawal is not generally life-threatening. However, it can pose a risk to health due to specific symptoms, like suicidal thoughts and severe depression. In cases where these symptoms become intense, seeking immediate medical attention is crucial to ensure safety and recovery.

Is it safe to go through cocaine withdrawal at home?

While some individuals can manage cocaine withdrawal at home, experts generally advise seeking professional help or remaining under medical supervision during the tenure of ongoing symptoms. Medical supervision is particularly recommended for individuals with a history of mental health disorders, heavy drug use, or other health complications. Individuals can seek medical attention as an inpatient or outpatient, according to their circumstances.

Can I use medication to support my withdrawal?

Unfortunately, the FDA has not approved any medication to manage cocaine withdrawal specifically. However, users can use certain drugs to manage specific symptoms. For instance, antidepressants can help them manage depression, whereas anxiolytics and sleep aids can help them manage insomnia and racing thoughts. Remember that these medications are only there for symptomatic relief and do not play a role in treating cocaine withdrawal directly.

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