Cocaine Withdrawal

Cocaine withdrawal usually begins with fatigue, anxiety, irritability, depression and slowed thinking. Other symptoms include bad dreams, increased appetite and intense cravings that can last for months.

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When a person snorts cocaine, the stimulant drug reaches the brain within minutes and causes an exhilarating, energizing rush. When someone inhales crack cocaine, it hits the brain in less than 10 seconds.

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The high doesn’t last long, though. The euphoric effects of powder cocaine wear off within a couple hours, and the typical crack high only lasts 10 to 20 minutes. Once the high subsides, many cocaine users are eager recapture that feeling, which can lead to a cycle of abuse and addiction.

With continued use, people can quickly build a tolerance to cocaine. Over time, it will take larger amounts of the drug for them to experience the same sort of high.

Up to one in six people who use cocaine will develop a dependence on the drug or a moderate to severe cocaine addiction. People who are dependent on cocaine experience withdrawal symptoms when they stop using it.

When cocaine levels in the body drop after a period of heavy use, or a binge, a person will feel a debilitating crash as the brain attempts to adjust to the absence of the drug. Fatigue, inability to focus and irritability are common signs of cocaine use.

This crash — which may include withdrawal symptoms such as severe fatigue, depression, irritability and sleep disturbances — can develop in as little as a few hours after last using cocaine.

Cocaine Withdrawal Symptoms

Cocaine withdrawal isn’t nearly as dramatic as withdrawal from alcohol or opioids, which can cause violent physical symptoms such as vomiting, shaking and sweating. But cocaine withdrawal is still distressing, and it can make people too weak to do normal daily activities.

Typical symptoms of cocaine withdrawal can include:

  • Agitation or restlessness
  • A general feeling of discomfort
  • Strong cocaine cravings
  • Irritability
  • Mental and physical exhaustion
  • Depression
  • Inability to feel pleasure or joy (anhedonia)
  • Vivid and upsetting dreams
  • Increased appetite
  • Slowed activity
  • Lack of motivation
  • Excessive sleepiness
  • Decreased sexual desire
  • Poor concentration

Some people may experience headaches, muscle aches and other uncomfortable physical symptoms. In severe cases, suicidal thoughts can occur. Researchers have also observed hostility and paranoia during cocaine withdrawal.

Cocaine Withdrawal Timeline

Because cocaine stays in the the system for a short amount of time, withdrawal symptoms can appear soon after someone stops using the drug. While there’s no scientific agreement on the typical timeline for cocaine withdrawal, the most commonly cited study on the phenomenon divides the withdrawal process into three distinct phases.

The phases of cocaine withdrawal include:

  • The Crash — The crash phase of cocaine withdrawal occurs between several hours and a few days of last use. It is characterized by severe depression, exhaustion, restlessness and irritability. Some people have suicidal thoughts during this phase.

  • Continued Withdrawal — While mood and functioning begin to improve, the person may feel bored or unable to feel pleasure. Increasing cocaine cravings, irritability and a lack of energy may occur during this stage, which lasts one to 10 weeks. Poor concentration and erratic sleep patterns are also common. The risk of relapse is particularly high during this phase.

  • Extinction — Intense cravings for cocaine that come and go are common during extinction. Mood swings can persist. This phase can last up to six months.

Generally, the most acute withdrawal symptoms will only last for between one and two weeks — but the length and intensity of cocaine withdrawal can vary widely from person to person. The severity depends on how heavily the person used cocaine.

For someone with a mild to moderate pattern of cocaine use, withdrawal symptoms will typically resolve in less than 18 hours. With heavy use, the symptoms usually peak within two to four days, but they may last up to a week. In some people, cravings, depression and other symptoms can linger for weeks or even months.

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Treatment for Cocaine Withdrawal

While cocaine withdrawal is not life-threatening and usually doesn’t require medical treatment, medically supervised detox is a necessity in some cases.

Some individuals going through cocaine withdrawal can experience strong suicidal urges, paranoid thoughts and even temporary psychosis. These patients will require inpatient cocaine rehab and detox.

About 24 percent of emergency department visits by people seeking detox or substance abuse treatment in 2011 involved cocaine use, according to the Substance Abuse and Mental Health Services Administration. And 6 percent of emergency department visits for drug-related suicide attempts that year involved cocaine.

Inpatient detox and treatment may also be necessary to prevent someone with a cocaine or crack addiction from compulsively using cocaine or other drugs to stave off withdrawal symptoms. Cocaine hotlines provide free information about treatment options and nearby support groups.

Removing people from the environment in which they were using cocaine or crack will give them the best chance to get through the worst stages of withdrawal without relapsing.

A dedicated cocaine addiction treatment can also provide people with the behavioral tools and coping strategies they need to break the cycle of addiction.

Most successful treatment programs for cocaine addiction provide a combination of cocaine-specific behavioral therapies and counseling aimed at preventing relapse. Counseling sessions are held in group and individual settings.

The Food and Drug Administration has not approved any medications for treating cocaine withdrawal or addiction — but several medications under investigation show promise.

Researchers at the University of Wisconsin-Milwaukee have found that Propranolol, a medication commonly used to treat high blood pressure and anxiety, may block memories that drive people to use cocaine again and again.

According to a study published in the American Journal of Psychiatry, Amantadine, an antiviral medication sometimes used to treat the flu and Parkinson’s disease, “may be an effective treatment for cocaine-dependent patients with severe cocaine withdrawal symptoms.”

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Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

Amy Keller, RN, BSN
Content Writer,
As a former journalist and a registered nurse, Amy draws on her clinical experience, compassion and storytelling skills to provide insight into the disease of addiction and treatment options. Amy has completed the American Psychiatric Nurses Association’s course on Effective Treatments for Opioid Use Disorder and continuing education on Screening, Brief Intervention and Referral to Treatment (SBIRT). Amy is an advocate for patient- and family-centered care. She previously participated in Moffitt Cancer Center’s patient and family advisory program and was a speaker at the Institute of Patient-and Family-Centered Care’s 2015 national conference.

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