- Crack Withdrawal Symptoms
- Crack Withdrawal Timeline
- Post-Acute Withdrawal Syndrome (PAWS)
- Medical Complications of Crack Withdrawal
- Crack Withdrawal Treatment Programs
- Crack Withdrawal Therapy Options
- Crack Withdrawal Resources
Crack is a crystallized, free base form of cocaine that is incredibly potent and addictive. Affecting the central nervous system, crack smoking triggers an immediate dopamine response in the brain and produces an intense, euphoric high.
However, people who use crack also quickly develop a tolerance, which means they not only need higher amounts to feel the effects, but their bodies begin to depend on the drug to function normally.
Due to crack’s potency, it is more difficult to withdraw from than powder cocaine. While physical withdrawal is not as intense as heroin or alcohol, crack detox can be incredibly difficult, especially when it comes to the psychological and emotional symptoms.
Luckily, there are plenty of options when it comes to recovering from crack addiction. In this article, we cover the typical symptoms encountered during crack withdrawal and the timelines for recovery. We also address the range of treatment options available.
Eliminating an addiction to crack 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 crack, and 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
- Other drugs that were taken
- The length of use
- The dose taken
- Co-occurring mental health issues (e.g. anxiety or depression)
- Co-occurring physical health conditions
Crack Withdrawal Symptoms
Because crack alters the functioning of neurotransmitters in the brain, sudden discontinuation can create uncomfortable symptoms. Generally, these consist of cravings, fatigue, mood disturbances, as well as the following:
- Difficulty concentrating
- 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 crack
- Increased appetite
Crack Withdrawal Timeline
Like other stimulants, crack 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 typically looks like the following.
First Phase (24 to 72 Hours)
The first phase occurs within 24 hours, but it can take place as early as a few hours after the last hit. During this time, individuals may experience irritability, food cravings, anxiety, and a depressed mood as the drug wears off.
Second Phase (Week 1)
Phase two is considered the onset of the serious withdrawal period and takes place 1 to 7 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 (Week 2)
The third phase occurs on days 3 to 14 and can consist of extreme symptoms, such as continuous cravings, paranoia, anhedonia, depression, and anxiety. Symptoms will gradually start to decrease within this period.
Fourth Phase (Weeks 3 to 4)
The fourth phase is referred to as the “extinction” phase and may last up to 28 days. While physical cravings are mainly gone by then, the psychological ones remain. This period is characterized by depression, anxiety, and dysphoria.
Post-Acute Withdrawal Syndrome (PAWS)
If withdrawal symptoms last longer than the 3 or 4 weeks, 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. Some of the symptoms during this period can include:
- Difficulty with short-term memory
- Mood changes, including depression or anxiety
- Difficulty sleeping
- Panic attacks
- An inability to experience pleasure (anhedonia)
Medical Complications of Crack Withdrawal
- Cardiovascular issues: this includes chest pain, elevated blood pressure, or increased heart rate.
- Pulmonary disorders: this includes conditions such as difficulty breathing, shortness of breath, or coughing up blood (especially with crack pipe smoking).
- Neurological problems: these include headaches, seizures, or hallucinations.
- Cravings and overdose: cravings can lead to an overdose, especially if a person relapses during the detox period.
- Depression: this is especially common after crack use and leads to an inability to feel pleasure. This puts individuals at risk for developing clinical depression.
- Suicide: the long periods of depression and anhedonia can lead people to experience suicidal ideation or feelings of self-harm.
Additional long-term complications of crack are much more extensive and will depend on several factors, such as the duration and intensity of use.
Crack Withdrawal Treatment Programs
The good news is that treatment for crack addiction is 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 drug abuse treatment programs and what they entail.
Detox programs are available at certain clinics and 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. A detox center will place you in comfortable surroundings where you can be assured of 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 often led by a team of counselors, 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 varies in length but typically ranges 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 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 an opportunity for the individual to physically withdraw from crack 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 wish to receive intensive treatment while living off-site.
IOP 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 recommended. Crack is highly addictive and there are complications that can occur during withdrawal.
Intense cravings combined with depression may lead individuals to relapse or engage in dangerous behavior. Having medical support on hand can help ease the uncomfortable symptoms and prevent someone from relapsing.
Crack Withdrawal 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 crack addiction.
Rehab facilities that offer dual diagnosis are often staffed with psychiatrists or clinical therapists that can diagnose and/or treat co-occurring mental health conditions. This kind of treatment is especially useful for people who have underlying issues such as depression, anxiety, and post-traumatic stress disorder (PTSD). This allows clinicians to safely address these conditions alongside withdrawal from the drug itself.
Cognitive-Behavioral Therapy (CBT)
Due to the psychological effects of crack 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,” 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 crack again. This includes an understanding of how situations, people, or the environment can trigger an addictive desire to use crack, or how to introduce healthy behaviors that can steer them away from using. CBT is known to be effective and long-lasting as clients can continue utilizing these strategies once their therapy sessions have ended.
Dialectical-Behavior Therapy (DBT)
Dialectical-behavior therapy is a type of cognitive-behavioral therapy that focuses on mindfulness, how to live in the moment, cope with stress, and improve relationships. DBT also helps clients identify negative influences in their lives and learn how to develop healthy coping skills.
This kind of therapy is incredibly effective for addictions, especially those who have anxiety or depresssion. DBT is also effective for PTSD and for people who exhibit self-destructive behaviors.
The Matrix Model
The Matrix Model is another form of therapy that has shown to be effective in treating stimulant abuse. 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 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.
Unlike opioid addiction, which is treated using medications like Suboxone, there are currently no federally-approved medications used to treat crack withdrawal. 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 and crack. Some of the promising antispasmodics and anticonvulsants include Baclofen, Tiagabine, and Topiramate.
Beta-blockers such as Propranolol can reduce anxiety and restless symptoms that follow withdrawal from crack or 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 crack.
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.
Prescription sleep aids such as Trazodone and Seroquel are sometimes used to help with insomnia during cocaine or crack detox.
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.
Alternative or Holistic Therapies
Many rehab centers also provide holistic therapies. The purpose of these therapies is to treat the whole person and not just the symptoms. These can be incredibly beneficial for providing calmness, spiritual support, emotional expression, improving physical health, and teaching valuable skills. Some of the popular holistic therapies include:
- Nutritional therapy
- Animal-assisted therapy (e.g. emotional support dogs)
- Adventure therapy (e.g. hiking or rock climbing)
- Mindfulness and meditation
- Art therapy, Music therapy
- Equine-assisted therapy
Recovering from crack 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 substance 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, which is especially useful when recovering from stimulant addiction. Additionally, research has shown that meditation can be useful for easing tension and calming the nervous system.
Getting adequate nutrition after detoxing from substances is vitally important. The right diet can help repair any damage incurred following sustained drug use and lead to improved immunity, cognitive function, and energy. Nutritionists or doctors can provide tailored food plans specific to addiction recovery.
Learning to avoid 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.
Crack Withdrawal Resources
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