Cocaine is one of the most widely abused drugs in the United States for the energizing high it produces. Cocaine increases levels of dopamine in the brain, which is the neurotransmitter responsible for pleasure. After someone uses cocaine, the resulting high usually involves an intense sense of euphoria and a rush of energy.
People purchase cocaine on the streets as a fine, white powder under the names of “blow,” “coke,” “crack,” “rock,” and “snow,” among others. Cocaine use has become more dangerous recently, as street dealers commonly mix pure cocaine with other substances, such as amphetamine or synthetic opioids like fentanyl. People purchasing cocaine off the street are often unaware that they have bought a product laced with dangerous substances. An increasing number of deaths related to cocaine overdose have been linked to such altered cocaine.
The National Institute on Drug Abuse (NIDA) estimates that more than 1.5 million people in 2014 were active cocaine users. Of those people, more than 900,000 met the diagnostic criteria for a cocaine use disorder. Cocaine was also involved in more than 500,000 of 1.3 million emergency room visits related to drug abuse. Nearly 40 percent of drug-related emergency room visits involved cocaine.
Recreational cocaine use can lead to addiction and withdrawal symptoms when you stop using. NIDA explains that repeated use of cocaine causes chemical changes in the brain to take place. It blocks the reuptake of dopamine, which interferes with the reward circuit in the brain. Over time, the brain becomes less sensitive to the extra dopamine. As a result, it is also less sensitive to the effects of cocaine, so increasing dosages must be taken to achieve the same high as before or to prevent withdrawal symptoms.
Common cocaine withdrawal symptoms occur when someone with a history of regular cocaine use decides to cut back or stop their cocaine use entirely:
Cocaine withdrawal does not typically include physical symptoms, such as nausea, vomiting, or shaking, that are often seen in withdrawal from alcohol or heroin. Withdrawal is never an easy process to go through, even when there does not seem to be any physical symptoms, such as nausea and vomiting, someone experiences.
The U.S. National Library of Medicine’s MedlinePlus warns that complications from cocaine withdrawal can include serious depression, suicide, and intense cravings that lead to overdose. Cocaine withdrawal itself does not present physical symptoms severe enough to cause death. The greatest concern associated with cocaine withdrawal is the psychological challenges individuals must face.
Mental health concerns are some of the biggest dangers to individuals when withdrawing from cocaine. Depression and thoughts of suicide can so be strong that people engage in self-harm. Many people going through cocaine withdrawal have reported thoughts of suicide due to low mood and motivation for life.
In addition to depression, cocaine users frequently experience paranoia and aggression or violence. These mental states can threaten safety. Because of this risk, substance use professionals recommend detoxing under the care of medical professionals who can ensure your safety.
The other significant risk of death during cocaine withdrawal comes from the chance of overdose. When people are faced with intense cravings that they give into, they may have already lost some tolerance to cocaine during the period when they stopped using. When people impulsively start using again, they may not realize how much lower their tolerance is and accidentally use far too much cocaine, leading to a fatal overdose.
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Acute cocaine withdrawal symptoms usually resolve after a week or so, but symptoms such as depression and cravings can remain for months after use, particularly for people with an extended history of heavy use. Because of the short half-life of cocaine, withdrawal symptoms can be felt relatively quickly after the last use. Some people may begin to experience symptoms within one to two hours. Symptoms should peak around five to seven days and taper off after that point.
There are a number of factors that influence each individual’s withdrawal timeline. Factors that impact withdrawal from any substance include:
Substance abuse treatment professionals have recognized three main phases of cocaine withdrawal. Each person’s experience of these phases is unique, but they are likely to experience them to some degree.
The crash is the first phase of cocaine withdrawal, and it can last anywhere from a few hours to a few days. Withdrawal symptoms are likely to be the most severe during this phase. Feelings of depression and anxiety can be very intense, and people often want to sleep a lot. Cravings to use cocaine don’t necessarily occur during this phase. The crash phase is primarily characterized by exhaustion and low mood, which are the opposite of what a cocaine high typically produces.
The second phase of cocaine withdrawal is known as the craving phase. It can last anywhere from one to 10 weeks, depending on the individual. This period is marked by intense cravings to use cocaine. People report not being able to think about anything besides obtaining and using cocaine during this time. This period can also be accompanied by feelings of irritability, lethargy, and poor concentration. For people with a significant history of cocaine use, they can experience the craving phase for up to 10 weeks.
The final phase of cocaine withdrawal, referred to as the extinction phase, is marked by a decrease in cravings. Usually, after about 10 weeks, cravings begin to subside, though they can still last for more than 30 weeks. Over time, however, cravings become less intense and less frequent. As people work on their sobriety, changes in environment likely help to reduce cravings, as people no longer expose themselves to triggers that lead to cocaine use in the past. After 30 weeks or so, cravings usually go extinct.
The safest way to withdraw from any drug is to do it under medical supervision. Especially if you are experiencing severe psychological distress related to quitting cocaine, it is safest to do so under the watchful eyes of doctors and substance abuse counselors. They can help you manage withdrawal symptoms like anxiety and depression.
The most vulnerable period of withdrawal depends on the individual. Some people will be the most vulnerable during the crash phase when feelings of depression and irritability are at their highest. Depression, if left untreated, is very dangerous and can lead to suicidal ideation and attempts. Other people, however, may be most vulnerable during the cravings phase when they are completely overcome by cravings to use cocaine. Not everyone will experience such intense cravings, but for those who do, this period can put them at significant risk for relapse and overdose.
There are not currently any FDA-approved medications available to treat cocaine addiction and withdrawal. If detoxing under medical supervision, doctors may prescribe over-the-counter medicines to manage minor headaches, aches, and pains. In more severe cases, doctors may administer medicines to manage anxiety and depression during the withdrawal period. The goal of administering such medicines is to help individuals stabilize their moods so treatment can continue and participation in therapy can begin.
After you have safely made it through the acute phases of withdrawal, treatment programs provide many forms of therapy for participants in recovery to take advantage of. In the case of cocaine withdrawal, where symptoms such as cravings and depression can last for months, therapy can begin before these symptoms completely subside. Therapy can address depression and other symptoms of emotional distress people feel after going through withdrawal.
Cocaine is a highly addictive drug, but addiction treatment works. Going through detox and withdrawal are the first steps of addiction treatment, but they do little on their own to instill long-term sobriety. By participating in a holistic treatment program, you will gain an understanding of your addictive behaviors and learn the life skills necessary for maintaining a life free from substance use.
Cocaine Withdrawal Symptoms and Timeline. Mental Health Daily. Retrieved November 2018 from https://mentalhealthdaily.com/2014/04/22/cocaine-withdrawal-symptoms-timeline/
(March 2017). Cocaine Withdrawal. U.S. National Library of Medicine: MedlinePlus. Retrieved November 2018 from https://medlineplus.gov/ency/article/000947.htm
(July 2018). What Is Cocaine? National Institute on Drug Abuse. Retrieved November 2018 from https://www.drugabuse.gov/publications/drugfacts/cocaine
(May 2016). What is the Scope of Cocaine Use in the United States? National Institute on Drug Abuse. Retrieved November 2018 from https://www.drugabuse.gov/publications/research-reports/cocaine/what-scope-cocaine-use-in-united-states
(February 2018). What to Expect from Cocaine Withdrawal. Verywell Mind. Retrieved November 2018 from https://www.verywellmind.com/what-to-expect-from-cocaine-withdrawal-21990