Cocaine Withdrawal

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Cocaine is a stimulant drug derived from the South American coca plant.1 It can be snorted, smoked, or injected.1 Cocaine is extremely addictive, and although it has limited medical purposes, it is most frequently used illegally, from occasional use to compulsive use.2

It’s possible to develop a cocaine addiction after a single use or after chronic, long-term use. Research suggests that up to one in six persons who use cocaine will develop a moderate or severe stimulant use disorder, which is the clinical term for cocaine addiction. Heavier users, and those who use cocaine via IV or smoke crack cocaine, are more likely to get addicted compared to lighter users who snort cocaine or use it orally.12

The dangers associated with using cocaine may make a person want to stop using, but uncomfortable psychological and physical withdrawal symptoms can make it difficult for someone with a stimulant use disorder to stop.1 Going to cocaine treatment can make it easier to manage cocaine withdrawal symptoms while helping a person learn skills to avoid relapse and maintain long-term sobriety.

If you or a loved one is ready to quit cocaine but has concerns about withdrawal symptoms, this article will help you understand:

  • Causes of cocaine withdrawal.
  • Cocaine withdrawal symptoms.
  • Effects of cocaine withdrawal.
  • How long cocaine withdrawal lasts.
  • Treatment for cocaine addiction.

What Is Cocaine Withdrawal?

If a person suddenly stops using cocaine or drastically reduces how much they take, they will experience withdrawal symptoms, which can be physical, psychological, or a combination of both.1, 3

Cocaine withdrawal symptoms are typically not as physically uncomfortable as other substances but can affect a person psychologically, leading to disordered thoughts, depression, and agitation.7, 8

Due to the potential for these effects, it can be unpleasant and unsafe to manage cocaine withdrawal alone. Seeking cocaine treatment can help a person safely manage withdrawal and be beneficial to the overall recovery process.


Causes of Withdrawal

Cocaine causes an excessive buildup of dopamine, norepinephrine, and serotonin in the brain.1 This excess dopamine in certain areas of the brain is primarily responsible for its reinforcing and addicting effects.

Over time, the brain becomes increasingly desensitized to the drug in a process known as tolerance.1, 2 Tolerance occurs as people use more cocaine to achieve the same “high.” Experiencing tolerance is one of the criteria of a stimulant use disorder.2, 4

To maintain balance (homeostasis), the brain adapts to the regular presence of cocaine and excess neurotransmitters.4 This adaptation is known as dependence, where the brain and body rely on continued use of cocaine to function as usual.4  

If someone dependent on cocaine stops taking it or significantly reduces their dose, they will experience withdrawal symptoms.1, 5 Experiencing withdrawal symptoms is a sign of dependence and is another one of the criteria of a stimulant use disorder.5


Symptoms of Cocaine Withdrawal

Although withdrawal from some substances can produce serious and even life-threatening symptoms, cocaine withdrawal symptoms tend to be less severe.5, 6 In general, withdrawal symptoms are the opposite of the drug’s effects.6 Symptoms of withdrawal typically begin within hours or days following prolonged use.11 Common cocaine withdrawal symptoms include:3, 6, 7, 8

  • Depressed mood.
  • Fatigue.
  • Having intense dreams or nightmares.
  • Trouble sleeping or sleeping much more than usual.
  • Increased hunger.
  • Sluggish thoughts and movements.
  • Anxiety.
  • Cravings for cocaine.
  • Increased irritability.
  • Loss of interest in things that you used to enjoy.
  • Agitation or restlessness.

Risks of Withdrawal

The initial period of withdrawal symptoms can be intense, but most symptoms of cocaine withdrawal are mild with few associated risks and resolve within 1-2 weeks. People who use cocaine heavily or more frequently, and for longer periods of time may experience more intense symptoms over a period of months. They may also be at increased risk for dangerous withdrawal symptoms.6, 7

Potential risks associated with cocaine withdrawal include:3, 6, 7, 11

  • Self-harm related to depression. This can be severe, especially in people who already have depression, and can lead to suicidal thoughts or behaviors. Cocaine-induced depression is usually resolved in a matter of hours or a few days. However, those with preexisting or undiagnosed depression are more likely to experience longer-lasting increases in paranoia and deeper depressed mood states.
  • Intense cravings during acute withdrawal and in the weeks following frequently lead to returning to cocaine use.
  • Brain issues. Seizures can occur during cocaine use and into the withdrawal process. Ongoing headaches can be a warning sign of bleeding in the brain. Those at increased risk for neurological complications include people with a history of seizures.
  • Heart issues. Cocaine has been linked to heart problems, which can continue even after cocaine use is stopped. People who are in withdrawal from cocaine may be at increased risk for abnormal heart rhythms, chest pain, and heart attacks. Those at increased risk for cardiac complications include people with preexisting or a history of heart and cardiovascular conditions.
  • Psychosis. This is more likely among people who regularly use high doses of cocaine and typically begins during intoxication, often related to sleeplessness. These symptoms may continue during the acute withdrawal phase and can involve feelings of paranoia, hallucinations, loss of touch with reality, agitation, disorganized thoughts, and the potential to harm oneself or others. A person who has experienced stimulant-induced psychosis while intoxicated is at risk of experiencing a recurrence of psychosis during withdrawal even months after stopping.

Cocaine users often self-medicate withdrawal symptoms with alcohol, benzodiazepines, or opioids. If used in high enough doses, the person may also experience withdrawal symptoms and risks associated with these substances in addition to cocaine withdrawal symptoms.11


Cocaine Withdrawal Timeline

Cocaine is a fast-acting drug that is processed and then eliminated from the body quickly.11 There are many factors that impact an individual’s withdrawal timeline including:

  • How long a person has been using cocaine.
  • Amount used.
  • Frequency of cocaine use.
  • The method used to take cocaine (snorting, smoking, or injecting).
  • Use of other substances.
  • Co-occurring physical or mental health conditions.

Symptoms of cocaine withdrawal typically start within 24 hours from the last time it was used, and the more acute symptoms fade after about 3 to 5 days.6, 7 However, lower intensity symptoms such as sleepiness, hunger, depression, and other mood changes can linger for weeks or months.7


Treatment for Cocaine Withdrawal

Unlike withdrawal from certain other substances, the Food and Drug Administration (FDA) has not approved any medications to treat withdrawal from cocaine.2, 6 Medication can be used to manage certain symptoms such as insomnia, depression, anxiety, or psychosis if needed.6

Rest, relaxation, exercise, and a healthy diet can also aid in the prevention or reduction of withdrawal symptoms. Subsequent treatment started during and following detox generally focuses on supporting abstinence.11

Various treatments can be used to treat cocaine withdrawal and addiction. It is important for cocaine treatment to be individualized so that it can meet the unique needs of each person.5

Effective treatment should address co-occurring conditions, social or family concerns, employment issues, housing stability, and legal challenges.2, 5 When choosing treatment, an individual’s personal wishes should be considered as well.5

Treatment options include: 5, 7, 8, 9

  • Detox. This is the process by which cocaine and any other substances a person is using are cleared from their system. Detox can take place in an inpatient or outpatient setting. Treatment staff monitor a person’s condition and provide support or assistance as needed. Detox alone is not typically sufficient treatment to support long-term abstinence, although it is an important first step towards recovery. Detox that’s followed by additional drug rehab treatment will better position a person for long-lasting recovery.
  • Inpatient or residential. This involves staying at a facility for the duration of treatment where staff is available around the clock. Treatment can last from a few weeks to several months depending on the level of care a person needs. Services can include detox, behavioral therapy, drug counseling, medication, and aftercare planning.
  • Outpatient. This involves living at home while visiting the facility for various treatment services. It allows a person to maintain a normal work, school, and home routine while they recover, and practice using the tools they learned in treatment. Treatment can vary in intensity ranging from highly intensive programs such as partial hospitalization programs (PHP) for people who need higher levels of supervision, to moderately intensive programs known as intensive outpatient programs (IOP), to lower levels of intensity known as standard outpatient programs.
  • Behavioral therapy. These techniques are designed to provide the skills needed to maintain sobriety. Behavioral therapy can be used to treat cocaine addiction by increasing motivation towards sobriety, learning to manage cravings, changing thoughts and expectations surrounding cocaine use, improving communication skills, and incorporating healthy activities to replace substance use.

Some of the more commonly used behavioral therapies for cocaine addiction include cognitive-behavioral therapy (CBT), contingency management (CM), and motivational incentives (MI). These therapies are typically provided in both group and individual counseling sessions as a part of both inpatient and outpatient drug treatment programs.10


If you or a loved one is struggling with cocaine addiction and is ready to quit, you don’t have to do it alone. American Addiction Centers is here to help. Call 1-888-319-2606 Helpline Information to speak with a caring admissions navigator who understands what you’re going through and can help you understand treatment options. We can also help you check insurance coverage so you can get started in recovery today.


Sources

  1. National Institute on Drug Abuse. (2021). Cocaine DrugFacts.
  2. National Institute on Drug Abuse. (2016). Cocaine research report.
  3. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  4. National Institute on Drug Abuse. (2017). Tolerance, dependence, addiction: What’s the difference?
  5. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (Third edition).
  6. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45.
  7. Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 4, Withdrawal Management.
  8. National Institute on Drug Abuse. (2020). Commonly used drugs charts.
  9. National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction DrugFacts.
  10. National Institute on Drug Abuse. (2020). How is cocaine addiction treated?
  11. Substance Abuse and Mental Health Services Administration. (2021). Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series, No. 33.
  12. Minogianis, E. A., Lévesque, D., & Samaha, A. N. (2013). The speed of cocaine delivery determines the subsequent motivation to self-administer the drugNeuropsychopharmacology: official publication of the American College of Neuropsychopharmacology38(13), 2644–2656.

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