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Cocaine Withdrawal & Detox Guide

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/15/2020

Number of References: 8 Sources

Cocaine is widely known as a “fun” party drug, but the experience of cocaine addiction is anything but glamorous. Cocaine withdrawal, while only producing psychological symptoms, can be extremely uncomfortable and long-lasting; sometimes taking many months for someone to fully recover. Additionally, cocaine addiction is capable of producing long term changes in the brain which may result in cognitive or emotional issues. Depending on the person and their using habits these may resolve after some time but in some cases may be permanent. Here we will look at the symptoms, timeline, severity, and treatments for cocaine withdrawal in great detail.

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Symptoms of Cocaine Withdrawal

Cocaine withdrawal does not produce physical symptoms, but this does not mean that it isn’t dangerous. Profound depression and anxiety are common symptoms of cocaine withdrawal, and suicide during this experience is not unheard of. Great care must be taken when cocaine withdrawal is concerned, and a better understanding of the symptoms may help someone to better gauge their needs during this time. If someone is able, entering a cocaine detox center is the best and most effective option.

Cocaine produces its effects primarily through increasing levels of dopamine in the brain. The neurotransmitters serotonin, norepinephrine, glutamate, and others are also affected, but dopamine is the major player regarding cocaine highs and cocaine withdrawal. Dopamine is an excitatory neurotransmitter and is in part responsible for mood, memory, concentration, learning, sleep, motor control, and feeling of reward and pleasure. When cocaine is used for long periods the brain adapts to these increased levels of dopamine through a process called downregulation. This means that the brain reduces its sensitivity to dopamine to compensate for the increased levels.

The process of downregulation is initially responsible for tolerance, and once cocaine use is suddenly stopped, it is the cause of the withdrawal symptoms that someone experiences. The cessation of cocaine use coupled with the brain’s reduced sensitivity to dopamine means that dopamine is present in much lower levels as well as having a reduced effect. The brain is capable of increasing dopamine sensitivity again, but this process takes time. During this process is where the experience of cocaine withdrawal lives.

Cocaine withdrawal can be a protracted experience but is commonly divided into 2 phases: acute and post-acute. While the symptoms during each phase are very similar, the distinction is mainly related to the intensity of the symptoms. To get the most well-rounded picture possible, let’s take a look at each phase in turn:

Acute Withdrawal Symptoms

Acute withdrawal is the time immediately after ceasing cocaine use. This begins with a “crash” which can begin only hours after the last time someone used cocaine and is commonly described as a rapid plunge into depression and fatigue. Characteristic symptoms of the acute withdrawal phase include:

  • Deep Depression (possibly with suicidal thoughts)
  • Intense Cravings for Cocaine
  • Fatigue and Lethargy (very low energy and a profound lack of motivation)
  • Anhedonia (inability to feel pleasure)
  • Inability to Focus
  • Cognitive Impairment (memory, reasoning, and perceptual deficiencies)
  • Sleep Disturbances (insomnia or hypersomnia with vivid dreams or nightmares)
  • Increased Appetite (and subsequent weight gain)

The acute phase of cocaine withdrawal may last several days, maybe a little over a week. Cocaine withdrawal is relatively short compared to withdrawal from other drugs. The most intense symptoms such as depression and anhedonia may begin to resolve first, followed by the cognitive impairments and sleep disturbances. The sleeping issues may begin as insomnia, but typically change to hypersomnia within the first week or so. Fatigue and lethargy may be present for some time along with increased appetite in general. After between 7 to 10 days, these symptoms should be much improved, and this usually marks the end of acute withdrawal and the transition into the post-acute withdrawal phase.

Post-Acute Withdrawal Symptoms

Post-acute withdrawal symptoms may persist for many months after cocaine use has been stopped and is characterized by depressive symptoms and intermittent cravings for cocaine. During post-acute withdrawal, the brain has often restored dopamine levels to normalcy, but subsequent neurological changes due to chronic cocaine use and behaviors may take time to normalize. The symptoms are much less severe than during acute withdrawal but are still present nonetheless.

This phase is different for everyone, and the length is dependent upon many variables and contributing factors. Some of the most common symptoms of post-acute withdrawal syndrome include:

  • Depression
  • Cravings for Cocaine
  • Sleep Disturbances (typically hypersomnia with vivid dreams or nightmares)
  • Fatigue
  • Anhedonia (less than during acute withdrawal but still present to some degree)

Post-acute withdrawal from cocaine can last around 6-7 months on average but has been known to persist for years in rare cases. The length of time as well as the amounts of cocaine that someone used will certainly play a role in the duration of post-acute withdrawal symptoms. This means that the more and longer someone uses, the longer the withdrawal symptoms will persist. That being said, the symptoms will not disappear all at once. There is a tendency for the symptoms to lessen over these months until they have completely resolved.

Cocaine Withdrawal Timeline

Since cocaine withdrawal does not produce physical or objectively measurable symptoms, the exact timeline is difficult to describe in a concrete manner. That being said, there are serious and intense psychological symptoms that are common among cocaine users in the period immediately after cocaine use has ceased. This varies between people, and some people may experience mild symptoms while others experience very intense symptoms. Additionally, the timeline for cocaine withdrawal will vary, sometimes greatly, between people depending on a variety of different criteria.

Here we will take a look at the average timeline for cocaine withdrawal to get a clearer picture of what someone could expect:

First Week

The first symptom is typically intense cravings and an increase in anxiety. This may be most intense in a day or two immediately after cocaine use has stopped and will decrease gradually over the first week. Sleep disturbances are common as it typically takes a very long time to get to sleep. Additionally, the time spent in REM sleep is much reduced compared to normal, meaning that the sleep that one does manage to get is less restful and is usually of poor quality. Aside from increased time to fall asleep, there may be a protracted period of grogginess or disorganized thinking upon awakening in the morning. This is in addition to the already clouded thinking which is common in cocaine withdrawal. Depression will typically begin within a day of the last time cocaine was used and may intensify over the first week. Life, and the world in general, may seem bleak, hopeless, and futile. Fatigue and lethargy will grow alongside depression and anhedonia, or an inability to feel pleasure or joy will become apparent during the first week.

Second Week

The intense cravings for cocaine have faded somewhat by now, but are still present. Sleep may be easier to achieve but the quality is still quite poor as REM sleep remains elusive. Cognitive deficits may begin to resolve as thinking becomes clearer and less chaotic. Depression is still present but may be reduced slightly. Fatigue may begin to lessen, with dopamine levels beginning to return to somewhat normal levels. Anhedonia will still be present and at similar levels than during the first week. Early in the second week, appetite may begin to return somewhat, and eating more may help the other symptoms resolve a little quicker.

Third Week

Cocaine cravings may begin to come and go and are no longer a constant presence. Getting to sleep may still be more difficult than normal, but the quality of sleep should begin to improve somewhat. Depression may be reduced in the third week, but is still an issue. Anhedonia is likewise still present but may begin to lessen. Appetite should be near normal levels now, and fatigue and lethargy may be mostly resolved by the end of week three. Cognitive problems such as clouded thinking and poor memory may begin to lessen during the third week as well.

Fourth Week and Onwards

Cravings will still be present but will be transient for the most part. Depression may lessen to a fairly stable level around week four but may persist in some capacity for several more months. Anhedonia may begin to disappear completely and cognitive issues will be much reduced by now. Confused thinking and memory problems are normally much improved by the fourth week, but may remain for another few months to some degree. Sleep may have returned to normal by, or shortly after, week four as getting to sleep becomes easier and the quality of sleep that is achieved improves. Fatigue and lethargy may be almost completely absent by now as well.

The Importance Of Cocaine Detox

The symptoms of cocaine withdrawal can be very emotionally uncomfortable, and getting help to manage them is critical. Entering a cocaine detox center can provide medical supervision, medications, and therapies that may both reduce the discomfort and improve someone’s chances of successful recovery from cocaine addiction. In addition to direct benefits, these centers may provide resources for continuing care after detox and help someone build a comprehensive foundation in recovery.

Cocaine Detox Centers

Physical Effects of Cocaine Withdrawal

While cocaine withdrawal does not produce physical symptoms per se, it can have a profound effect on someone’s energy levels. Due to the powerful disruptions that cocaine addiction produces in the natural dopamine and norepinephrine systems in the brain, the experience of withdrawal can be characterized by physical exhaustion and total lack of energy or motivation. These symptoms will decrease with time, but it may be several weeks before the brain is able to stabilize these neurotransmitter levels enough for someone to regain a feeling of physical normalcy.

Psychological Effects of Cocaine Withdrawal

The main impact of cocaine withdrawal is felt psychologically rather than physically. The levels of the neurotransmitters dopamine and serotonin are extremely low during withdrawal. The neurotransmitters are in part responsible for positive mood, memory, and reward (dopamine) as well as mood regulation and mood elevation (serotonin). The disruption in these systems can produce a general negative affect in the months after ceasing cocaine use. Negative affect is a general state of emotional distress that is characterized by negative emotions including sadness, anxiety, shame, irritability, fear, and other negative emotions.

Some of the most commonly experienced psychological symptoms of cocaine withdrawal include:

-Cravings For Cocaine

Cocaine cravings are absolutely the most commonly reported symptom experienced during withdrawal from cocaine. These cravings can begin mere hours after the last time someone used the drug, and frequently continue for several months afterward. This is primarily due to changes that occur in the brain due not only to increased levels of dopamine but also where these increases occur. Dopamine is used all throughout the brain, but consistently high levels in specific areas can cause changes in the dopamine signaling structure in these areas. In addition to neurological changes, cocaine use is often a coping mechanism, and a sudden lack of this mechanism can leave someone craving its return.

The areas which lead to increased or persistent cravings for cocaine are components of the limbic system or “reward center” of the brain. The particular areas which contribute most to cocaine cravings include the nucleus accumbens, hypothalamus, and amygdala. These areas are not only tied to feelings of reward and pleasure but also play important roles in tying these feelings to specific memories. Cocaine use can profoundly alter the function of these areas, leading to long-lasting or even permanent connections between any feeling of pleasure and vivid memories of using cocaine.

These cravings can last for many months, years, or even for the rest of someone’s life. They will certainly decrease in intensity and frequency as time goes by, but they will be present for months at the very least. There are currently no reliable treatments for cocaine cravings, although many medications used in treatment for other drug addictions are showing promise in reducing these cravings, but further study is needed before they will be FDA approved.

-Depression

A depressed mood and outlook is one of the most commonly reported symptoms of cocaine withdrawal. While cocaine use produces euphoria and a sense of pleasure through use, it also intensifies pleasure and excitement which are triggered by other stimuli. During cocaine withdrawal, the things that normally made someone feel good will cease to have this effect for a time, and this can compound the depression which directly results from cocaine withdrawal. This is all due to low levels of the neurotransmitter dopamine mainly, but also includes serotonin and norepinephrine and this will take some time to resolve.

A common description of this experience includes symptoms such as:

  • Feelings of hopelessness
  • A sense of futility in staying sober, or even life in general
  • Possible suicidal or homicidal thoughts
  • Very little or zero motivation
  • No interest in connecting with others
  • A sense of isolation and loneliness

While these symptoms will pass with time, the subjective experience can be extremely uncomfortable and painful. There is a high risk of relapse since the last time someone in this position can remember feeling ok was when they last used cocaine. Suicide is not unheard of due to the severe depression brought on by cocaine withdrawal so this can be fatal, albeit in an indirect manner. These symptoms will pass, but support and psychiatric help are often needed to help someone overcome these challenges.

-Cognitive Deficits

Cognitive deficits during cocaine withdrawal can include a variety of thought processes, memory, and awareness or perception. This is a very broad term, but regarding the cognitive deficits due to cocaine use and withdrawal, there is quite a narrow range of symptoms. These are commonly described as compromised executive functions and can include issues such as:

  • Short Attention Span
  • Trouble with Planning and Flexibility
  • Compromised Judgement
  • Poor Impulse Control
  • Reduced Problem Solving Ability

These symptoms typically resolve within the first week or two but can cause great distress during this period. It is often described by recovering addicts as if they have lost the ability to think. Thoughts are disorganized and cloudy, lines of thinking can stop abruptly or disappear in an instant, and planning becomes nearly impossible. This not only has to do with cocaine-induced issues in the limbic system, but it is also thought to involve cocaine-induced problems in the prefrontal cortex. This can be thought of as the “human” part of the brain, as it is much more developed in humans as it is in other primates and is the seat for many of our higher reasoning functions.

-Anxiety and Paranoia

Anxiety and paranoia are less frequently reported than the above symptoms but are still quite common symptoms of cocaine withdrawal. The exact mechanism that produces these symptoms is not clearly understood, but more than likely has to do with the loss of such a powerful, although unhealthy, coping mechanism in the form of cocaine use.

The anxiety experienced during withdrawal can best be characterized as a feeling of intense restlessness or constant anticipation. While this symptom typically resolves fairly quickly after cocaine use has ceased (typically in the first week), it is still a contributor to the unpleasant experience of cocaine withdrawal. Since this symptom is fairly short-lived, non-narcotic anti-anxiety medications may not have time to begin working before the symptom resolves on its own.

Cocaine-induced paranoia is both a symptom of excessive cocaine use as well as a symptom of cocaine withdrawal. Some chronic cocaine users can begin to view the world as hostile and perceive other people, or sometimes inanimate objects, as a threat. This tendency does not disappear overnight after someone stops using cocaine, but may persist for some days or weeks afterward. Psychiatric medications may be used if the symptoms are severe, but many cases will resolve before such medications would have time to work anyways.

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What Factors Influence The Intensity of Cocaine Withdrawal?

There is a great deal of uncertainty in the exact duration of cocaine withdrawal experienced between individuals. In part, this is due to the lack of a clear cut and distinct transition between the two phases as well as the great variation of cocaine withdrawal experiences between people. For some people, the experience is over in a month, whereas other people may experience intense symptoms for a year or more. While the exact reason for this is unknown, there are several factors that are known to play large roles in the intensity and duration of withdrawal symptoms.

Several factors which may impact the cocaine withdrawal intensity and timeline between individuals include:

  • Genetics (if addiction runs in the family, then cocaine withdrawal may last longer)
  • The amounts of cocaine someone did
  • The length of time that someone used cocaine
  • Co-Occurring mental health issues such as depression

The genetic predisposition for addiction is not well understood, but it certainly plays a role in how quickly someone may become addicted to a drug. It may also affect the intensity of their addictive behavior to some extent. The amounts of cocaine that someone used will directly impact the withdrawal intensity and timeline, as larger quantities of cocaine produce a greater amount of downregulation. This in turn requires longer for the brain to restore balance after cocaine use has ceased. This is the same reason that the length of time someone used cocaine will extend the cocaine withdrawal timeline.

Co-occurring mental health issues play some role as well, although the exact interplay between pre-existing mental health issues and cocaine use is not clear. What is known is that the depressive symptoms of cocaine withdrawal will be more intense if someone were to suffer from depression previously. The neurotransmitter deficiencies produced through cocaine withdrawal are in a way very similar to some of the causes of depression. In this manner, these separate issues can compound and amplify each other, leading to a more unpleasant experience. The same could be said for anxiety, and possibly even psychosis or paranoia.

Cocaine Withdrawal Treatment

The first step in treating cocaine withdrawal is to enter a detox program. There are several different types of detox that offer varying levels of care and supervision; all the way from minimal to intense. The type of detox someone may wish to enter is largely dependent upon the severity of their withdrawal symptoms as well as the presence of any co-occurring mental or physical health issues. With professional treatment, supervision, and support someone will have a much better chance of making it through cocaine withdrawal and into early recovery.

-Medications for Cocaine Withdrawal

While there are currently no FDA approved medications specifically for cocaine withdrawal, there are many medications that are used off label for this application. These can be used to reduce the symptoms of cocaine withdrawal and help accelerate the natural healing processes of the brain. Other than medications, there is a wide range of therapies that can be beneficial for someone who is trying to overcome cocaine addiction and withdrawal.

Many of these medications were originally used to treat withdrawal symptoms from other drugs or alcohol but are proving effective at treating cocaine withdrawal as well. While the efficacy of these medications may vary from person to person, they certainly provide hope that a truly effective treatment for cocaine withdrawal is coming soon.

There are several well known and commonly used medications for treating cocaine withdrawal. Some of these include:

  • Naltrexone: Commonly used to treat other drug or alcohol addiction, this medication is known to reduce cravings for both drugs and alcohol.
  • Antidepressants: Such as selective serotonin reuptake inhibitors (SSRIs), these medications may help reduce the depression and anxiety that typically accompany cocaine withdrawal.
  • Blood Pressure Medications: Such as β-blockers, these medications may help reduce the anxiety issues which result from cocaine withdrawal.
  • Anti-Anxiety Medications: Preferably of the non-benzodiazepine variety, an example of which is buspirone. These medications take some time to begin working but can relieve anxiety while having very little risk or potential for abuse.

-Therapies for Cocaine Withdrawal

Detox programs can act as an introduction to further treatment and counseling and are frequently the first step on the road to recovery. There are some common therapies used in many treatment programs as well as detox programs themselves. It can be extremely helpful for someone to know that they are not alone in their addiction, and they are likewise not alone in their recovery. Others have been there and others have recovered. Seeing that this is possible can be extremely encouraging and inspiring.

Helping someone to articulate their own desire for recovery can be extremely helpful. This could be another person in recovery or even a therapist or counselor. Many of the most effective therapeutic techniques involve relationship building, effective communication, and meaningful connection with others.

Some of the more frequently used therapies include:

  • Group or Individual Therapy
  • Fitness and Nutrition Therapy
  • Meditation or Mindfulness Exercises
  • Addiction Education

Some of these can be experienced at a detox center, but a specialty treatment center will provide the most comprehensive approach to cocaine addiction recovery. Entering a drug detox center is highly recommended, as most detox centers will have close ties with their local recovery community and can help clients develop effective aftercare plans for continuing treatment after detox has been completed.

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