Cocaine Withdrawal Symptoms, Timeline, and Effects
Cocaine is a widely used and potent stimulant. It can be extremely addictive, and in 2015, more than 896,000 (or 0.3% of the population) suffered from a past-year cocaine use disorder.1 Cocaine withdrawal occurs when a heavy user cuts down or quits using the drug. Although withdrawal from cocaine rarely presents any immediate danger, a person may experience several uncomfortable signs and symptoms including depression, fatigue, and unpleasant dreams.
The timeline for withdrawal begins within a few hours to a few days after last use, and the effects can last for several weeks or even months. In the most extreme cases, there is a risk of suicide or overdose during cocaine withdrawal. Because of this, medical detox is the safest method to detox and recover from cocaine addiction.
Symptoms of Cocaine Withdrawal & Timeline
Symptoms can include cravings, depression, fatigue, and increased appetite. Other Signs and symptoms of cocaine withdrawal can include:2
- Increased appetite.
- Vivid and unpleasant dreams.
The severity of cocaine withdrawal effects will depend on:
- Length of cocaine use.
- Amount used.
- Abuse of other drugs, such as alcohol or heroin.
- Co-occurring mental health or medical conditions.
Substance use often co-occurs with mental health disorders such as depression, attention-deficit hyperactivity disorder (ADHD), or post-traumatic stress disorder (PTSD). In 2015, an estimated 8.1 million adults had a mental illness and a substance use disorder in the past year. 4, 1
When you stop using cocaine, you will likely experience an almost immediate crash. Cocaine has a short half-life, which means that after your last dose, withdrawal signs can take effect quickly. Below is a breakdown of the withdrawal timeline.
- Phase 1
- The “crash” may begin within a few hours to a few days. Symptoms may include exhaustion, irritability, anxiety, and increased appetite.
- Phase 2
- The second stage is referred to as the proper “withdrawal” period, with symptoms lasting up to 10 weeks. Symptoms include lethargy, persistent anxiety, persistent irritability, erratic sleep, strong cravings, depression, and poor concentration.
- Phase 3
- Also referred to as “extinction,” this phase may last up to 28 weeks and include sporadic cravings and dysphoria.5
Although cocaine withdrawal’s effects as rarely as severe as the withdrawal syndromes of heroin, prescription opioids, or alcohol (like vomiting and shaking), it does carry risks. One of the biggest risks is a relapse to avoid uncomfortable symptoms of withdrawal.Other serious complications of cocaine withdrawal include depression, suicidal ideation, cravings, overdose.6
Overdose can occur because withdrawal lowers a person’s tolerance. If the person relapses and uses the same dose they are accustomed to, it can overwhelm their system and lead to death.
Cocaine Withdrawal Help and Medication
Cocaine is a Schedule II stimulant that can be sniffed, smoked, injected, or taken orally. It is highly addictive, and users can develop a physical and psychological dependence on the drug. After consistently heavy use, many people will experience a withdrawal syndrome when they stop using the drug. Withdrawal can be safely and comfortably managed in a medical detox program – the first step in cocaine addiction treatment.
Types of detox programs include detox centers, inpatient rehab, intensive outpatient rehab, and partial hospitalization programs. No medications are approved to manage cocaine withdrawal, but a number are being tested. These are recommended as detoxing cold turkey can be extremely difficult. Many people relapse without professional help, and returning to cocaine use during withdrawal may lead to overdose.
Treatment Options for Cocaine Withdrawal
Inpatient programs may be better suited for people who have a more severe addiction to cocaine and require intense supervision. Many seek help for cocaine withdrawal from a treatment facility, where professionals can manage the side effects of withdrawal. As result, there are several varieties of treatment.
Cocaine withdrawal treatment options include:7
- Medical detox centers: These programs offer medical supervision as you withdraw. Medical professionals are available 24/7 to help you manage any distress or discomfort you may experience.
- Inpatient or residential program: These programs may be better suited for people who have a more severe addiction to cocaine and require intense supervision. The length of inpatient programs can vary, but they typically last 30 to 90 days. These facilities are staffed with physicians and nurses that provide care around the clock. Luxury and executive facilities offer extra amenities such as tennis, swimming, private rooms, and workrooms.
- Intensive outpatient program (IOP): Depending on your needs, IOPs can last for weeks to several months. These programs may offer detox for people with relatively less severe cocaine addiction. You do not live at an IOP, but instead visit the treatment facility on certain days of the week to attend individual and group therapy and meet with other treatment providers.
- Partial hospitalization (PHP): People usually enter these programs after being in an inpatient program or after they have relapsed. Treatment will include drug use education, therapy, medical care, and detox monitoring. PHPs do not provide care overnight, but individuals can spend up to 20 hours a week in the hospital to receive treatment.
Despite the fact that cocaine addiction is a widespread public health problem, the Food and Drug Administration (FDA) has not approved any cocaine withdrawal medications. However, researchers are investigating several different types of drugs to help treat cocaine abuse.
Some promising medications for cocaine dependence and withdrawal include: 9, 10, 14
- Amphetamines: In animal studies, certain amphetamines have been used to treat cocaine addiction. One study found that after amphetamine treatment, rhesus monkeys decreased the amount of cocaine they used. However, the use of amphetamine medications to treat cocaine addiction is not approved by the FDA because it is not accepted as a safe and effective option.
- Anticonvulsant drugs: Many studies have investigated the ability of antispasmodic/anticonvulsant drugs to treat cocaine dependence. The findings indicate that this group of drugs could be helpful in preventing relapse by blocking euphoria produced by cocaine and reduce cravings. Promising antispasmodic/anticonvulsants include baclofen, tiagabine, and topiramate. Unfortunately, most of the studies on the effects of these drugs are small, clinical trials and have not been replicated on a larger scale.
- Propranolol: This drug is a beta-blocker, and it may help reduce symptoms of anxiety and restlessness that a person may feel as they withdraw from cocaine. Propranolol may also help reduce the feelings of euphoria and pleasure that a person experiences when they use cocaine, discouraging use.
- Baclofen: This GABA B agonist is a skeletal muscle relaxant. The drug may reduce the amount of dopamine released in the brain due to cocaine stimulation or cocaine craving. In a clinical trial, researchers found that it can decrease cravings.
- Tiagabine: This is a GABAergic medication that is currently approved to treat certain seizures. In a study of cocaine users, the number of cocaine-free urine samples increased by 33% among people who were treated with the drug.
- Topiramate: This drug enhances GABA-activated chloride channels and shows promise in helping to prevent relapse among cocaine-dependent individuals.
- Disulfiram: This drug is currently approved to treat alcohol Additionally, it blocks the enzymatic breakdown of cocaine and dopamine—thereby increasing feelings of anxiety and ultimately making the “high” less pleasant. Studies have found that the feelings it produces in the user discourage cocaine use and help people to transition off of cocaine.
- Modafinil: This stimulant is used to treat narcolepsy, but it shows promise in treating cocaine addiction. Modafinil activates glutamatergic circuits, blocks the euphoric effects of cocaine, and possibly prevents relapse.
- TA-CD: This vaccine prevents cocaine from crossing the blood-brain barrier by producing antibodies. In animal studies, TA-CD helped reduce the amount of cocaine self-administered by rodents. Human studies have shown that the vaccine can reduce the pleasurable effects of cocaine.
Behavioral Treatment Approaches
In the absence of an approved medication to treat cocaine abuse, treatment facilities rely on behavioral interventions to help reinforce healthy behaviors. Approaches used in treatment may include: 11
- Matrix Model: The Matrix Model is commonly used for addiction to stimulants such as cocaine. Therapists work as both a coach and a teacher and focus on fostering an empowering environment that helps increase self-esteem. 15
- Contingency management (CM): This approach reinforces positive behaviors and sobriety. You earn rewards such as vouchers or prizes if you complete treatment-related goals. 16
- Cognitive-behavioral therapy (CBT): Cognitive behavioral therapy is a goal-oriented therapy that focuses on identifying thoughts, feelings, and behaviors that contribute to drug use. A therapist helps replace drug-related behaviors with new, healthier ones. They may also teach you how to identify your triggers to use cocaine and then how to cope with these triggers without drugs. 17
- Computer-based cognitive therapy (CBT4CBT): This type of approach makes it easier for people to access CBT using a computer. In a study of people receiving treatment at a methadone clinic, those given access to CBT4CBT were more likely to stay drug-free at follow-up. 18
Detoxing Cold Turkey at Home
Detoxing cold turkey can be very risky and challenging. Withdrawal from cocaine is not characterized by serious physical symptoms such as those experienced during opiate or benzodiazepine withdrawal. But it can cause irritability, extreme fatigue, restless sleep, and depression.13
The user may feel strong cravings to use cocaine, either to feel good again or to relieve the withdrawal symptoms. They may relapse, and in some cases, overdose. 12,13 Going cold turkey may also result in medical complications, such as: 13
- Depression: Many people who are addicted to cocaine also struggle with a mental health disorder – particularly depression. When a person withdraws abruptly from cocaine, it may cause depression to emerge or get worse.
- Overdose: In many cases, people who go cold turkey experience uncomfortable side effects and turn back to drug use. They may take the same dose of cocaine that they were used to taking before going cold turkey. Relapse can lead to overdose if your body has not had the drug in its system for a period of time.
- Suicide: Some people who become depressed may be at risk of suicide.
Detoxing in a treatment program is a safe and effective way to begin recovery. It allows you to take a much-needed pause from your cycle of drug abuse and address any other health concerns—such as any co-occurring mental health or medical conditions—you are facing.
. Center for Behavioral Health Statistics and Quality. (2016). Results from the 2015 National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville, MD.
. The New York Times. (2013). Cocaine Withdrawal.
. UCLA Dual Diagnosis Program. Post-Acute Withdrawal Syndrome (PAWS).
. Brady, K. T., & Sinha, R. (2005). Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. American Journal of Psychiatry, 162(8), 1483-1493.
. Australian Government Department of Health. (2004). The cocaine withdrawal syndrome.
. National Institutes of Health. (2017). Cocaine Withdrawal.
. Johns Hopkins Medicine. (n.d.). Treatment Settings.
. Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
. Negus, S. S., & Henningfield, J. (2015). Agonist medications for the treatment of cocaine use disorder. Neuropsychopharmacology, 40(8), 1815-1825.
[ 10]. Kampman, K. M. (2008). Antiepileptic Drugs in the Treatment of Drug Use Disorders. In S. L. McElroy, P. E. Keck, & R. M. Post (Eds.), Antiepileptic Drugs to Treat Psychiatric Disorders (pp. 263-270). CRC Press.
[ 11]. National Institute on Drug Abuse. (2016). How is cocaine addiction treated?
. Abadinsky, H. (2010). Drug use and abuse: A comprehensive introduction. Nelson Education.
. U.S. National Library of Medicine. (2015). Cocaine Withdrawal.
. Kampman, K. M. (2005). New medications for the treatment of cocaine dependence. Psychiatry (Edgmont), 2(12), 44.
. National Institute on Drug Abuse. (2012). The Matrix Model (Stimulants).
. National Institute on Drug Abuse. (2012). Contingency Management Interventions/Motivational Incentives (Alcohol, Stimulants, Opioids, Marijuana, Nicotine).
. National Institute on Drug Abuse. (2012). Cognitive-Behavioral Therapy (Alcohol, Marijuana, Cocaine, Methamphetamine, Nicotine).
. National Institute on Drug Abuse. (2014). Computer-Assisted Delivery of Cognitive-Behavioral Therapy: Efficacy and durability of CBT4CBT among cocaine-dependent individuals maintained on methadone.