- Cocaine Withdrawal Symptoms
- Withdrawal Timeline
- Post-Acute Withdrawal Syndrome (PAWS)
- Medical Complications
- Cocaine Treatment Programs
- Cocaine Therapy Options
- Lifestyle Adjustments
- Cocaine Withdrawal Resources
Cocaine is one of the most widely abused recreational stimulants in the U.S. It is extremely addictive, and accounts for a large number of drug overdoses in the country every year. Cocaine primarily affects the central nervous system, triggering dopamine production in the brain that can cause extensive damage to the body over time.
Despite the intense impact that cocaine has on the body, it produces less severe physical withdrawal symptoms than alcohol or opioids. While withdrawing from cocaine presents its own challenges, the process is predominantly uncomfortable because of the psychological and emotional symptoms.
Luckily, options are abundant when it comes to recovering from cocaine addiction. Here we will review the symptoms and approximate timeline for cocaine withdrawal, as well as the range of treatment options available.
Eliminating an addiction to cocaine consists of multiple stages of rehab that target the physical, psychological, and emotional causes of addiction. However, the first stage is to detox from the drug itself. This requires an individual to stop taking cocaine, and this is best done through medically supervised detox.
During detox, an individual will experience withdrawal symptoms, which can vary between each person. Their severity is also dependent on several factors, such as:
- Individual physiology
- Duration of their addiction
- Quantities used
- “Poly-drug use” (using multiple drugs concurrently)
- Co-occurring condition or mental health issues
Cocaine Withdrawal Symptoms
Because cocaine alters the functioning of neurotransmitters in the brain, sudden discontinuation can create several symptoms. Generally, these consist of cravings, fatigue, and mood disturbances. The symptoms are usually predictable, and can include the following:
- Difficulty concentrating
- Slowed thinking
- Slowed activity or physical fatigue after activity
- Inability to experience sexual arousal
- Anhedonia (the inability to feel pleasure)
- Depression or anxiety
- Suicidal thoughts
- Vivid, unpleasant dreams or nightmares
- Physical symptoms (chills, tremors, muscle aches, and nerve pain)
- Increased craving for cocaine
- Increased appetite
The presence of these symptoms will depend on the stage of withdrawal. The early stages typically start with cravings and increased appetite, followed by anxiety, psychosis, and depression.
Like other stimulants, cocaine withdrawal symptoms start appearing within the first 24 hours. In general, symptoms reach their peak within 7 to 10 days of discontinuation, and then steadily decline thereafter. While the duration will vary from person to person, an approximate general timeline can look like the following:
First Phase (24 Hours)
The first phase occurs within 24 hours, but it can take place as early as a few hours after the last dose. During this time, individuals may experience food cravings, anxiety, and a depressed mood as the drug wears off.
Second Phase (1-3 Days)
Phase two is considered the onset of the serious withdrawal period, and takes place 1 to 3 days after the last dose. At this stage, individuals enter the period known as “the crash”. This occurs when dopamine levels drop in the brain and an individual experiences lethargy, persistent anxiety, irritability, erratic sleep, strong cravings, depression, and poor concentration.
Third Phase (3-14 Days)
The third phase occurs on days 3 to 14 and consists of more extreme symptoms, such as paranoia, anhedonia (inability to feel pleasure), and decreased sexual interest and ability. Symptoms will gradually start to decrease within this period.
Fourth Phase (Up to 28 Weeks)
The fourth phase is referred to as the “extinction” phase and may last up to 28 weeks. This period is characterized by sporadic cravings and dysphoria.
Post-Acute Withdrawal Syndrome (PAWS)
If withdrawal symptoms last longer than the 14-day period, this is referred to as “post-acute withdrawal syndrome” (PAWS). During this phase, symptoms include ongoing fatigue, depression, cravings, and long periods of sleep.
While the PAWS period is not physically dangerous, the psychological effects can lead to risky behavior. Also, due to the damaging effects on the body’s nervous system, working memory, attention, planning, problem-solving, and other cognitive tasks can be impaired long after the withdrawal period has passed. This includes mood disturbances, such as depression and psychosis, which may last up to a year.
As physical withdrawal from cocaine is milder in comparison to opioids or alcohol, the primary concern when it comes to detoxing are relapses, overdoses, and depression. While there is still discomfort when withdrawing from cocaine, it is relatively bearable and typically poses a low risk —especially if the individual detoxes in a medically supervised environment.
That said, there are always medical risks involved with any drug withdrawal process. When it comes to cocaine, these potential short-term complications include:
- Risk of overdose upon relapse
- Suicidal ideation or attempts
- Dangerous behavior (due to psychosis or paranoia)
- Driving impairment (due to psychomotor retardation or agitation)
The long-term complications of cocaine are much more extensive and will depend on several factors, such as the duration and intensity of use.
Cocaine Treatment Programs
The good news is that treatment for cocaine addiction is readily available. While every individual is unique and will have different needs, many centers provide tailored recovery plans. Below is a list of the most common forms of treatment programs, and what they entail.
Detox programs are available at certain clinics and specialized medical facilities, where they supervise a person’s drug withdrawal and provide supportive medications, where necessary. These clinics are usually staffed with a team of doctors and nurses who have experience with addiction and drug withdrawal.
The advantage of going to a detox center is that medical assistance is readily available. Detoxing from cocaine isn’t easy, even though the process carries fewer risks to physical health than withdrawal from opioids or alcohol. A detox center will place you in comfortable surroundings where you can be assured of receiving help in case of emergencies. These clinics also provide medications to ease some of the symptoms.
Short-Term Inpatient (Residential)
Short-term inpatient centers typically start with medical detox and are followed by a program of addiction treatment, such as therapy or counseling, for 30 to 90 days. These programs range from basic inpatient to luxury options, all varying in terms of their amenities and types of therapy. These facilities usually provide 24-hour medical support and are led by a team of clinicians and doctors. Short-term inpatient rehab is ideal for individuals who need detoxing and therapy, but who don’t require long-term treatment.
Long-term inpatient treatment programs vary in length, but typically range between 3 to 18 months. This type of rehab is best suited to individuals with long-term chronic addictions, especially those who have co-occurring conditions or mental health issues.
Depending on the severity of the addiction, long-term treatment may be a good option, especially as many programs address the underlying emotional causes of one’s drug abuse. Long-term treatment also provides ample time for the individual to physically withdraw from the drug while they focus on their mental and emotional rehabilitation. These centers also vary in terms of their provision of amenities, which range from basic to luxury options.
Partial Hospitalization Programs (PHP)
For individuals who are seeking intensive treatment but still prefer to live at home, partial hospitalization (PHP) or day treatment programs are also available. PHP typically consists of hospital treatment 5 to 7 days a week for 4 to 8 hours per day. Like inpatient treatment, clinical staff are on hand to assist with detox, medication management, and withdrawal symptoms. PHP also involves counseling and group therapy, as well as specialized services that focus on skill-building, relapse prevention, and employment assistance.
Intensive Outpatient Programs (IOP)
Intensive outpatient programs are less involved than partial hospitalization programs, and typically take place at a treatment center or outpatient clinic. Clients receiving intensive outpatient treatment will usually visit the center 2 to 5 days per week for 2 to 4 hours per day. IOP is well suited to clients who have just completed inpatient rehab and who wish to receive intense treatment while living off-site.
The programs vary between centers, but they often involve a mixture of individual and group therapy, case management, 12-Step programs, experiential therapies, cognitive-behavioral therapies (CBT), and services that cover topics like skill-building, goal setting, and relapse prevention.
Standard Outpatient Programs
Standard outpatient programs are suited to individuals who have just completed an inpatient program and want to continue some form of therapy. Standard outpatient is also ideal for people who may be juggling other responsibilities, such as work or school. Individuals typically report to a treatment center or clinic 1 or 2 days per week. These programs can include counseling, group therapy, 12-Step groups, skills development, goal setting, and relapse prevention training.
While cold turkey detoxing at home is an option, it is not the safest way to proceed. Intense cravings combined with depression can lead individuals to relapse or engage in dangerous behavior. While the physical effects of cocaine withdrawal are tolerable, having medical support on hand can help ease the uncomfortable symptoms and prevent someone from relapsing. Also, rare complications such as seizures can arise from suddenly stopping cocaine use, so it’s best to seek medical detox options where possible.
Cocaine Therapy Options
During rehab, centers and clinics will provide a range of treatments such as medications, counseling, and behavioral therapies. Below are some of the more effective therapy options for cocaine addiction.
Cognitive-Behavioral Therapy (CBT)
Due to the psychological effects of cocaine withdrawal, cognitive-behavioral therapy (CBT) is one of the most effective therapies. CBT helps individuals change negative cycles of thought and behavior into more positive ones. Clients receiving CBT for addiction often learn:
- how to recognize “automatic thoughts” (i.e., dysfunctional thinking patterns and their origins);
- how to understand the behavior and motivation of others;
- how to develop a greater sense of self-understanding and confidence.
In essence, CBT helps clients learn new, drug-free ways to cope with triggers that might encourage them to use cocaine again. This includes an understanding of how situations, people, or the environment can trigger an addictive desire to take cocaine, or how to introduce healthy behaviors that can steer them away from using.
The Matrix Model
The Matrix Model is another form of therapy that has been shown to be effective in treating addiction to stimulants, like cocaine and methamphetamines. This 16-week approach is comprehensive, and consists of a mixture of behavioral therapy, individual counseling, 12-Step support, family education, drug testing, and encouraging non-drug-related activities. Through guided therapy, patients learn about issues connected to addiction and relapse. These sessions are designed to promote self-esteem and self-worth while the patient and therapist work together to reinforce positive behavioral changes.
Contingency management is another effective treatment for cocaine addiction, and is based on a reward system. In most cases, the therapist provides incentives to the patient in exchange for ongoing abstinence and acceptance of treatment. One well-known contingency approach is Motivational Incentives for Enhancing Drug Abuse Recovery (MIEDAR), which is effective for teaching individuals that it is possible to achieve abstinence using self-control.
Participants who continue to abstain receive rewards, such as prize draws for money or in-demand objects. This tangible rewards system has been shown to be effective for individuals with stimulant addictions like cocaine.
Unlike opioid addiction, which is treated using medications like Suboxone, there are currently no federally-approved medications specifically for cocaine. However, research has shown that the medications below may reduce withdrawal symptoms.
While only small clinical trials have been done so far, these drugs may prove helpful in preventing relapse and cravings by blocking the euphoric effects of cocaine. Some of the promising antispasmodic/anticonvulsants include Baclofen, Tiagabine, and Topiramate.
Beta-blockers such as Propranolol can reduce anxiety and restless symptoms that follow withdrawal from cocaine. Propranolol may also reduce the euphoric effects of cocaine, which can discourage future use.
GABA-ergic medications are often used to prevent seizures. While studies are still ongoing, these drugs show potential for preventing relapses by inhibiting the euphoric effects of cocaine.
Currently approved to treat alcohol addiction, this drug blocks the enzymatic breakdown of cocaine and dopamine, resulting in increased anxiety and an unpleasant high. Studies have shown that these uncomfortable feelings can discourage cocaine use and prevent relapses.
Modafinil is a stimulant used to treat narcolepsy. However, it is showing potential for treatment as it also blocks the euphoric effects of cocaine.
During treatment at a detox center or inpatient facility, medical professionals may also prescribe additional medications to help manage symptoms. This includes over-the-counter medicines such as Benadryl or Trazodone for insomnia, or selective serotonin reuptake inhibitors (SSRI) for depression.
Recovering from cocaine addiction can be challenging, but there are ways to make this process easier. Along with treatment, lifestyle adjustments and self-care can ease the symptoms while transitioning to a new life.
Exercise is great for improving cardiovascular health, which is especially important following stimulant abuse. Exercise also stimulates endorphins which can help with depression and low mood. Good forms of exercise include a mix of low- and high-intensity exercises, such as walking, running, swimming, cycling, or yoga.
Meditation is known to help calm anxious or racing thoughts. Meditation can also stimulate the pleasure centers of the brain and improve cognitive function. Additionally, research has shown that meditation can be useful for easing tension and calming the nervous system.
Getting adequate nutrition after detoxing from cocaine is vitally important. The right diet can help repair any damage incurred following sustained drug use and lead to improved immunity, cognitive function, and a higher energy level. Nutritionists or doctors can provide tailored food plans specific to addiction recovery.
Learning to avoid cocaine triggers is vital during the recovery period. This can include people, situations, or circumstances that can prompt a desire to take drugs. Techniques such as CBT can help individuals learn to identify and avoid their triggers by developing alternative coping strategies.
While cravings can be difficult to manage, hobbies such as sports, art, music, or crafts can be useful distractions. These activities can help someone redirect their cravings and focus on something positive and fun.
Cocaine Withdrawal Resources
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