Though cocaine withdrawal may not be as physically intense as withdrawal from other drugs, it does come with its own set of challenges.
Withdrawal from certain substances, like alcohol and benzodiazepines, can involve severe physical withdrawal symptoms; however, cocaine detox brings mostly psychological withdrawal symptoms. Symptoms of cocaine withdrawal include:
- Difficulty concentrating
- Slowed thinking
- Slowed activity or physical fatigue after activity
- Inability to experience sexual arousal
- Anhedonia, or the inability to feel pleasure
- Depression or anxiety
- Suicidal thoughts or actions
- Vivid, unpleasant dreams or nightmares
- Physical symptoms, such as chills, tremors, muscle aches, and nerve pain
- Increased craving for cocaine
- Increased appetite
When Is Medical Detox Necessary?
While cocaine detox may be completed on an outpatient basis, medical detox is recommended in some instances. For example, if a person has relapsed during past withdrawal attempts, the 24-hour supervision afforded by medical detox can prove invaluable. In addition, if the person suffers from any co-occurring mental health disorders, medical detox followed by comprehensive inpatient addiction treatment can effectively address both withdrawal management and mental health treatment needs.
One of the more problematic withdrawal effects associated with acute stimulant withdrawal is an increased risk of suicide. People who attempt to stop cocaine use after addiction has taken hold can suffer from severe depression and mood swings, including thoughts of suicide. With regular cocaine use, the brain adapts to the consistently elevated dopamine activity associated with the drug. Over time, the reward circuit is disrupted and becomes less sensitive to dopamine, per the National Institute on Drug Abuse. At this point, a person often needs increasingly large amounts of cocaine to feel good; without it, they may feel profoundly depressed and dissatisfied with life.
If a person has any history of depression or suicidal thoughts, medical detox is generally recommended to ensure safety throughout the withdrawal process.
The symptoms of acute cocaine withdrawal often resolve after about 7-10 days. However, like with many drugs, cravings for cocaine may persist for longer periods of time and could develop suddenly, years after individuals have gotten sober. Cocaine has a relatively short half-life and, in people with significant dependence, withdrawal symptoms can begin as soon as 90 minutes after the last dose. The timeline for withdrawal symptoms varies depending on the individual. Here are some factors that may influence the timeline for cocaine withdrawal:
- Length of use: For people who abuse cocaine for a short period of time, withdrawal symptoms may be relatively short in duration. People who have used cocaine for years may continue to suffer lingering withdrawal symptoms for weeks, perhaps in part due to a buildup of the drug in their bodies.
- Average dose used: People who’ve used very large amounts may experience more intense withdrawal symptoms than someone who used lower doses.
- Polysubstance dependence: Someone who has developed physiological dependence to 2 or more drugs may experience withdrawal symptoms related to both, potentially complicating the course of withdrawal and worsening the experience for the detoxing person.
- Environment: If cocaine was used a means of escape from a stressful environment, stress may trigger the urge to use again. As a result, environmental factors that lead to stress – such as relationship issues, work troubles, or other factors – may lead to intense cravings for cocaine, complicating the psychological withdrawal process.
- Co-occurring medical or mental health issues: If an individual suffers from any co-occurring medical conditions such as cardiovascular disease or mental health issues, such as depression, anxiety, an eating disorder, or personality disorder, the withdrawal process from cocaine could be more complicated. The same is true for those suffering from polydrug addictions.
Medications and Treatments for Cocaine Withdrawal
Unlike some drugs, such as opioids, there are no FDA-approved medications that specifically treat cocaine withdrawal. However, there are some promising medications that may help individuals overcome cocaine addiction and work through withdrawal symptoms.Some medical research on animals has shown that both buprenorphine and naltrexone may offer some assistance for people in cocaine withdrawal. Both of these medications are approved to treat other types of addictions, but findings relevant to cocaine abuse and addiction are in the very early stages.
Another study suggested that propranolol might have a beneficial, stabilizing effect for those suffering from cocaine withdrawal. This beta blocker has been approved to treat hypertension and angina, and it is often prescribed to treat anxiety and related psychological problems. One of the major concerns with cocaine withdrawal is the risk of a person developing serious anxiety, depression, or suicidal thoughts. If anxiety and restlessness are reduced, other symptoms of withdrawal may be easier to manage and the entire withdrawal experience will be less unpleasant.
Other medications to treat depression and anxiety could be useful for people undergoing cocaine withdrawal, as it could stabilize their moods and reduce depression. They could be particularly helpful for people whose withdrawal symptoms last longer than 7-10 days. However, medical professionals should consider these cases individually and carefully monitor patients for side effects, further addictive behaviors, and psychological changes that are detrimental to the overall goal of managing the addiction.