What Is Crack Withdrawal?
Crack is a form of cocaine that is processed and sold as a rock crystal. Users heat the crystals and then inhale the smoke or vapor.1
Crack cocaine is very addictive, and quitting is difficult due to withdrawal symptoms and cravings. Crack withdrawal is believed to be more severe and longer-lasting than withdrawal from powdered cocaine that is snorted.6
The most common symptoms of crack withdrawal include:
- Sleep disturbances.
- Increased appetite.
- Slow thinking.1
Crack withdrawal symptoms are not life-threatening in most cases. But they are difficult to deal with alone.
In addition, the longer a person has used crack, the more difficult the withdrawal process is likely to be. Further, any concurrent abuse of other drugs and the overall health and age of the crack user may affect the severity of withdrawal symptoms.
Risks of Withdrawal
- Depression. People going through crack withdrawal can experience severe depression. There is increased risk of suicide when someone is unable to stop using alone.2
- Cravings and relapse. The physical symptoms of crack withdrawal are often relatively mild, but a person in withdrawal often experiences intense cravings for crack. A rapid return to crack use, as well as an overdose, is possible with unmonitored detox. One of the most beneficial factors of treatment in a detox or treatment program is that the program prevents people from using crack.
- Medical complications. Some people in detox experience heart problems or seizures.3 Many withdrawing from crack also experience irritability, fatigue, and headaches.
Crack withdrawal may occur in the following stages:
- Stage 1: The crash as the person in withdrawal shows symptoms of irritability, agitation, increased appetite, insomnia, depressed feelings, and lethargy which may continue for several days.
- Stage 2: Withdrawal lasting up to about 10 weeks, with a person having continued lethargy, strong cravings, irritability, and poor concentration.
- Stage 3: Extinction in which a person may have intermittent cravings to use crack and ongoing issues with depressed moods.4
Symptoms can develop relatively quickly after the last dose. For most people in withdrawal from crack cocaine, the effects go away after a few days. However, in some people the symptoms can persist for 3 to 4 weeks.3
Some people in recovery from crack addiction experience longer-term problems in their ability to experience pleasure, which can persist for a long time after withdrawal is completed.3
Causes of Withdrawal
Crack use alters chemical behavior throughout the central nervous system. In particular, crack (as well as other forms of cocaine) increases the activity of dopamine, a chemical in the brain related to feelings of pleasure and a sense of reward. People who use crack experience increased energy, increased alertness, and feelings of elation.
The brains of those who frequently use crack adapt to the flood of dopamine produced by the drug, and they quickly require more and more of the drug to experience the same high as before. People who grow dependent on the drug may experience withdrawal symptoms when the drug wears off.
At this point, they may continue to take the drug to experience relief from these effects or to postpone their onset.1
Treatment for Withdrawal
Crack users are often more difficult to treat than cocaine users. Their addictions are usually severe by the time they enter a rehabilitation program, and they may have experienced problems with their work, their marriages, and their families.6
In addition, many people who are addicted to crack and other forms of cocaine have a co-morbid mental health issue, most often depression or attention-deficit disorder.2
For these reasons, someone seeking treatment for crack withdrawal should consider attending a comprehensive recovery program after detox. These programs can address the factors leading to crack addiction and/or factors that make recovery difficult, such as family conflict, underlying mental health disorders, and a lack of marketable job skills. By addressing a person’s daily needs, treatment can enable some recovering addicts to stay drug-free for a long time.5
Types of Recovery Programs
- Detox centers. A detox center gives a person addicted to crack an opportunity to be in a drug-free environment for several days to help them get over the worst of their withdrawal symptoms. These programs provide medical care and support. They may also provide some counseling and placement assistance to facilitate a seamless transition from detox to ongoing treatment.
- Inpatient is the next step after a detox program and typically provides assessments for any physical or mental health issues, access to health care, and a supportive environment designed to help a person through their program of recovery. Counseling is usually offered and may be individual- or group-based. Behavioral counseling services can help a person learn to avoid trigger situations, to manage stress, and to refuse crack when they leave inpatient treatment.
- Partial hospitalization. Some people may attend a partial hospitalization or day treatment program instead of being admitted to an inpatient program. Most partial programs are very similar to inpatient programs, but people who participate go home at night. Some of these programs are designed to function as a step-down from an inpatient program or a more intensive outpatient program. In some programs, a person may attend the program a few days per week for a few hours at a time.
- Outpatient therapy often follows a stay in an inpatient program or some type of partial hospitalization program. However, for some people, outpatient treatment may be their first treatment episode. Outpatient programs vary in terms of the hours and days required, with some programs meeting only once or twice per week for a few hours, while other programs require daily attendance.
- Cognitive behavioral therapy. Most treatment programs help participants address behaviors that lead to drug use and how to change them through the use of cognitive behavioral therapy (CBT) techniques. These techniques help the person in recovery learn new ways of thinking and acting that will enable them to stay drug-free. The recovering user learns how to recognize situations that are likely to trigger crack cocaine use, avoid those situations, and cope with other problems related to drug use.5
- Contingency management. Other programs use contingency management, which provides rewards to a person in exchange for not using crack or other drugs. The rewards can be as simple as a gym membership or tickets to events in the community. The incentives and rewards appear to have a positive impact on relapse and recovery.5
Medications for Crack Withdrawal
Medications are not a routine part of treatment for crack withdrawal. Medications for pain and sleep issues are usually administered on an as-needed basis. Any severe depression to arise in association with crack withdrawal may be treated with antidepressants.3
Current research is investigating the possible benefits of medications that affect the level of dopamine in the brain, as well as other chemicals in the brain. There is also research on a cocaine vaccine that would help the body not react to crack cocaine. However, the best current treatment for crack addiction is detox followed by a treatment program and aftercare to support a person in their quest for recovery.5
- National Institute on Drug Abuse (2016). Cocaine.
- Florida Agency for Healthcare Administration. (2015). Cocaine Withdrawal.
- Center for Substance Abuse Treatment. (2015). Detoxification and Substance Abuse Treatment. (Treatment Improvement Protocol (TIP) Series, No. 45.) 4 Physical Detoxification Services for Withdrawal From Specific Substances. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
- Australian Government. Department of Health. (2004). The cocaine withdrawal syndrome.
- National Institute on Drug Abuse. (2016). How is cocaine addiction treated?
- Wallace, B. (1991). Crack Cocaine: A Practical Treatment Approach for the Chemically Dependent. Routledge.