When a person takes certain drugs continuously, the person’s body becomes acclimated to the effects of the drug on the system. The individual’s body adjusts physiological functions accordingly and learns to function at a new set of homeostasis (internal balance) that is dependent on the drug being in the system. When that individual abruptly stops taking the drug or abruptly decreases the dosage, the body functions that were affected by the presence of the drug are thrown off balance. This results in predictable and unpredictable symptoms, both physical and emotional, known as a withdrawal syndrome.
Often, drugs that have a high potential to produce physical dependence (a syndrome that consists of both tolerance and withdrawal) will be associated with withdrawal symptoms that are opposed to their major psychoactive effects. For example, a drug that produces a very high euphoric feeling might be associated with severe feelings of depression during the withdrawal syndrome.
What Is the General Timeline for Cocaine Withdrawal?
Taking cocaine results in a very extreme sense of euphoria that is a result of a massive release of the neurotransmitter dopamine and, to a lesser extent, norepinephrine. When individuals stop using cocaine during a cocaine binge or discontinue use after a lengthy period of regular use, they will almost inevitably experience what many users refer to as “a crash.”
During the crash, individuals often experience an inability to feel pleasure, increased anxiety, increased sleepiness, periods of irritability, very strong cravings for more cocaine, and sometimes even suspiciousness or paranoia. Periods of depression and even the presence of suicidal thoughts are not uncommon following the discontinuation of cocaine use in chronic abusers. Cocaine withdrawal doesn’t involve intense physical symptoms, but the feelings of depression and cravings for the drug that do occur are extremely salient.
The most commonly cited description of the withdrawal process from cocaine uses a phase model with three major phases of cocaine withdrawal. Cocaine has a very short half-life in the system of about 60 minutes, so the initial phase can occur rather quickly:
- Phase I consists of the crash that occurs after stopping use of cocaine that can last for a day to a few days. In this phase, individuals typically demonstrate relatively strong feelings of depression and anxiety, an inability to feel pleasure, irritability, fatigue, an increased need for sleep, increased appetite, and strong cravings. Some cognitive symptoms can also occur, including a lack of concentration, periods of confusion, and mild memory issues. There is a potential for some physical symptoms to occur, including tachycardia arrhythmias, cardiac arrest, severe dehydration, trembling, and an increased potential to develop seizures, but these are rare.
- Phase II: Withdrawal can last up to 10 weeks and is characterized by increased cravings, irritability, periods of fatigue and lethargy, and some issues with attention and concentration.
- Phase III is known as the extinction phase where individuals still experience cravings, especially when exposed to certain environmental triggers that remind them of their previous cocaine use. There may be long-term issues with apathy, mood swings, irritability, and just feeling out of sync at times.
Later research suggested that these distinct phases are not quite as separate as originally conceptualized, and there is just a steady progression from the crash to extinction. The time period for this linear progression can vary greatly between individuals.
Despite the absence of serious physical withdrawal symptoms, medical detox may be recommended for cocaine withdrawal. Due to the acute crash that many individuals experience, serious symptoms of depression and the potential for suicidal thoughts and poor decision-making may be present. Moreover, individuals who relapse during a crash experience higher probabilities of overdosing as they tend to binge.
In general, individuals can expect to go through an acute period withdrawal for the first few days, followed by less intense symptoms occurring for weeks or even months.
What Factors Determine the Severity and Length of Withdrawal Syndromes?
There are several different factors that are involved in determining the length of the withdrawal process and the severity of symptoms that people experience:
- The type of drug a person is taking will influence any physical or psychological symptoms that occur once the person either stops or cuts down on using it. Some drugs are associated with a high risk for physical dependence, whereas other drugs produce mainly psychological symptoms associated with their discontinuation.
- The manner in which a person stops using the drug will influence the severity or length of any potential withdrawal symptoms. Individuals who just stopped taking the drug altogether will more often experience more severe and lengthy withdrawal symptoms than individuals who taper down the dosage they take over an extended period of time.
- The dose of the drug that the person was taking will affect the severity of the withdrawal symptoms and the length of time the withdrawal process takes. Typically, higher doses of the drug are associated with lengthy and severe withdrawal effects.
- How long the person was taking the drug is another factor that can determine the length and severity of withdrawal symptoms. Typically, the longer a person used or abused the drug, the more severe and lengthy withdrawal symptoms will be.
- Personal differences in physiology and emotional makeup also play a part in the length and severity of withdrawal symptoms.
Medications Used during Cocaine Withdrawal
There is no one medication that has been designed specifically to assist individuals during withdrawal from cocaine. Several medications can be useful. Medications that can reduce the severe cravings or other symptoms that individuals experience during withdrawal for cocaine include:
- Neurontin (gabapentin) is an anticonvulsant that has been found to reduce some of the symptoms that occur during cocaine withdrawal and assist in the reduction of cravings.
- Sabril (vigabatrin) is another anticonvulsant that is found to be useful in reducing cravings during the withdrawal period. It can only be obtained under very special circumstances in the United States.
- Topamax (topiramate) is another anticonvulsant medication that has been recently found to be useful in reducing cravings for cocaine.
- Gablofen, also known as Lioresal (baclofen), is a muscle relaxant that has been used to curb cravings and some withdrawal effects for cocaine.
- Antabuse (disulfiram), a drug commonly used to help prevent relapse in individuals with alcohol use disorders, can also be used to help reduce relapse in individuals going through cocaine withdrawal.
- Provigil (modafinil) is a mild stimulant that can reduce the lethargy and sleepiness that occurs during the early stages of withdrawal from cocaine.
- Other medications can be used for specific symptoms, such as antidepressants for individuals who become chronically depressed, antipsychotics for individuals who become seriously paranoid, and so forth.
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Getting through the withdrawal phase is only the first step of recovery from a cocaine use disorder. Individuals need therapy following detox to develop coping skills, understand the triggers that led to cocaine use, develop relapse prevention skills, and develop a long-term aftercare support program.
While going through withdrawal is a crucial time in recovery where there is a high probability of relapse, it is important to get professional help after the withdrawal process has been completed. If great care is not taken to anticipate all the potential issues that will occur in recovery, there is a higher potential for relapse after detox.
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