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.
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 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:
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.
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:
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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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.”