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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.
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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:
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.
There are several different factors that are involved in determining the length of the withdrawal process and the severity of symptoms that people experience:
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:
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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