Cocaine Detox: Managing Withdrawal Symptoms

Cocaine is a stimulant drug that occurs naturally in the coca plant, which has been used as a drug to improve mood, attention, and energy for thousands of years. However, cocaine in its modern form is extremely potent and addictive. While the Drug Enforcement Administration (DEA) lists cocaine as a Schedule II drug – it has some important local anesthetic properties for specific, difficult surgeries – it is predominantly abused for nonmedical reasons.

Cocaine abuse can quickly lead to addiction because the drug floods the brain with dopamine, increasing energy, attention, euphoria, paranoia, and delusions. The drug also increases blood pressure, heart rate, and body temperature, which can be very dangerous.

Withdrawing from cocaine requires medical supervision to prevent relapse. The body can develop a physical dependence on the drug; the brain requires the presence of cocaine to moderate brain chemistry, including the release and absorption of dopamine and serotonin. Withdrawal symptoms occur when the body does not get the drug it needs to maintain equilibrium. Some of the symptoms associated with cocaine withdrawal are uncomfortable, and if a person tries to overcome the addiction without help, they are more likely to relapse.

Withdrawing from Cocaine

Cocaine withdrawal is rarely physically dangerous, although withdrawal symptoms may be uncomfortable. The main withdrawal symptoms a person is likely to experience include:

• Restlessness
• Agitation
• Mood swings and irritability
• Fatigue
• Depression
• General feeling of discomfort
• Increased appetite
• Vivid, unpleasant dreams
• Insomnia
• Other sleep disturbances
• Slowed physical and mental activity
• Increased appetite

People withdrawing from cocaine abuse will also experience cravings for the drug. Since the brain is not producing dopamine in a healthy manner, the body will feel like it needs the drug to feel normal; this manifests as cravings, which, without medical supervision, can manifest in compulsive consumption of cocaine. When a person relapses back into cocaine abuse after being sober for some time, they are more likely to suffer an overdose.

Phases of Cocaine Withdrawal

By studying people overcoming cocaine addiction for several decades, medical researchers have identified three fundamental stages of withdrawing from cocaine.

1. Crash: Once cocaine processes out of the person’s body – usually within a day of the last dose – the crash occurs. During this phase, the person will be fatigued and exhausted. Initially, the individual will experience cravings for cocaine and also show signs of irritability, agitation, and dysphoria. The person will yearn for sleep and likely sleep a lot, especially in the latter part of the crash phase. Sometimes, people who try cocaine only once or twice will experience the crash as the drug metabolizes out of their body; this can lead to a cocaine binge, which can cause an overdose, trigger psychosis, or damage the body.
2. Depression: As the need for sleep gets worse and the person’s physical energy reduces, they will feel fewer cravings for the drug but lower mood, anhedonia, and hopelessness. They will not feel pleasure from activities they used to enjoy, and they may feel sad, alone, guilty, or angry. This second phase is an indication that withdrawal symptoms are easing. A doctor may consider prescribing antidepressants just before this stage to ease the transition.
3. Extinction: After two weeks, withdrawal eases. This is the extinction phase. While the person may still experience mood swings, depression, and cravings, they are less frequent, and physical symptoms will have cleared up.

Without therapy through this process, even at the third phase of withdrawal, the person is still at an elevated risk of relapse when they experience cravings for cocaine. In some cases, the ongoing psychological symptoms can induce post-acute withdrawal syndrome (PAWS).

Cocaine Withdrawal Syndrome

The post-acute withdrawal syndrome (PAWS) associated with cocaine addiction can last for longer than two weeks, keeping the person at risk of relapse. This condition is more likely to occur in those who have struggled with cocaine addiction for a long time, at high doses, or both. Psychological symptoms are the most likely to endure, although some physical symptoms may reappear. PAWS symptoms include:

• Insomnia
• Depression
• Anxiety
• Trouble sleeping
• Oversleeping
• Trouble with short-term memory

Like reducing the risk of relapse, medical supervision and therapy help to reduce the risk of PAWS and to manage symptoms of the condition if it occurs.

Cocaine Detox and Long-Term Treatment

A combination of medical interventions to ease withdrawal symptoms and psychotherapy is the best general treatment path for those overcoming any addiction, including one to cocaine. While there are no medications specifically prescribed to treat cocaine withdrawal symptoms, some drugs have shown effectiveness at preventing relapse and easing withdrawal:

• Disulfiram, which was developed to treat alcohol use disorder
• Modafinil, which is used to treat narcolepsy
• Lorcaserin, which was developed to treat obesity

Sometimes, an overseeing physician will prescribe small doses of psychiatric medications, like antidepressants or anti-anxiety drugs, to ease psychological symptoms like insomnia and depression. The doctor may also recommend over-the-counter medications to ease physical aches and pains or suggest herbal supplements like melatonin to help regulate sleep.

Treating cocaine addiction with therapy is the most effective way to overcome addiction. Cognitive Behavioral Therapy works well for most forms of substance abuse because this evidence-based form of therapy leads the client through an understanding of their emotional reactions to stress, triggers, personal history, and environment, and examines how behavioral reactions to those emotions have become self-destructive. Then, the therapist will help their client develop new, healthier behaviors.

Contingency Management and motivational incentives are forms of therapy that provide prizes or specific rewards when the client successfully changes their behavioral patterns. This short-term positive reinforcement works well with people who struggle with addiction to stimulants like meth and cocaine because it provides a quick stimulation to the reward center of the brain.

Therapeutic communities are a great long-term way for people to practice behavioral changes. Sober living homes, support groups, and drug-free residences all help to reinforce daily changes to life while maintaining a substance-free environment to reduce the risk of relapse. People who have struggled with addiction to cocaine and other drugs for a long time can benefit the most from living in these environments after they exit a residential treatment center.