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Cocaine Detox & Withdrawal Guide

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Symptoms, Timeline, and Effects

Cocaine is a substance derived from the leaves of the coca plant. Illicit forms of the substance include a white powder as well as a freebase, crystalline solid known as crack cocaine.1,2 The various forms of the drug can be smoked, snorted, and injected.1,2 Though pharmaceutical cocaine (cocaine hydrochloride solution) has historically been used as a local anesthetic and vasoconstrictor during certain surgical procedures, illicit supplies of the drug and its prevalent abuse far outweigh such legitimate medical uses.3 Since cocaine has a high abuse potential but some medical use, the substance is listed as a Schedule II controlled substance.1,3

At certain doses, cocaine use is associated with a pronounced sense of euphoria. It’s interaction with our brain’s reward system leads to a powerful reinforcement of use that contributes to its widespread abuse across a number of demographics.1,2 According to the 2016 national Survey on Drug Use and Health (NSDUH), roughly 1.9 million people aged 12 or older were current users of cocaine.The National Institute on Drug Abuse reports that 3.9% of 12th graders have abused cocaine at some point in their lives.2

Consistent use of this substance often leads to significant physiological dependence and addiction development.

Consistent use of this substance often leads to significant physiological dependence and addiction development.5 Someone addicted to cocaine is at risk of many unwanted physical and mental health effects and decreased well-being.1,2 As the negative health effects accumulate, the person may wish to quit using; however, the associated physiological cocaine dependence can make this process challenging. Not only will the individual likely encounter strong cravings for more cocaine, but they may also have to endure a period of discomfort and distress.3,4 Called acute cocaine withdrawal, the effects associated with abruptly quitting cocaine, though different for each person, can be quite unpleasant, especially without proper care.

What Are the Signs and Symptoms of Abuse?

Knowing the signs and symptoms of cocaine abuse can help you get your loved one quality detox and treatment. Potential, observable signs and symptoms of abuse include the following:1,2,3

Observable signs of cocaine abuse can include anxiety, depression, irritability, and even suicidal thoughts or behavior.

  • Euphoria
  • Irritability
  • Inappropriate anger
  • Paranoia
  • Impaired judgment
  • Restlessness
  • Inability to sleep
  • Hypersensitivity to sight, sound, touch
  • Dilated pupils
  • Gastrointestinal complications, including abdominal pain and nausea
  • Poor appetite and weight loss
  • Muscular weakness
  • Increased body temperature, heart rate, and blood pressure
  • Cardiovascular events, including arrhythmias, sudden cardiac arrest, and stroke
  • Neurological effects, including headache, tremor, seizures, and coma

Bursts of energy followed by “crashes” that include depression, anxiety, irritability, and other negative emotions may indicate cocaine abuse, especially when they occur together with the other symptoms. When coming down from a cocaine high, some users may experience suicidal thoughts or exhibit suicidal behaviors.6,7

Detox Symptoms

Though the acute cocaine withdrawal syndrome may present differently amongst individuals, many people experience more psychological or emotional issues rather than severe physical symptoms. During detoxification, someone may experience the following: 2,7

  • Strong cocaine cravings
  • Exhaustion and lethargy
  • Slowed movements and thoughts
  • Impaired memory
  • Low mood/depression
  • Anhedonia (diminished ability to derive pleasure from previously enjoyable activities)
  • Poor attention and concentration
  • Insomnia
  • Anxiety
  • Restlessness/agitation
  • Paranoia and confusion
  • Hallucinations
  • Vivid dreams
  • Irritability
  • Increased appetite
  • Dehydration
  • Chills

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doctor talking to patientSomeone who has regularly abused cocaine is at risk of experiencing these uncomfortable and potentially dangerous withdrawal symptoms. Read More

How Long Does Detox Last?

The detoxification process and the precise timeline for accompanying withdrawal is somewhat unpredictable depending on many individual differences related to cocaine abuse.Cocaine withdrawal symptoms will often emerge within 24 hours after last use and continue for between 3 and 5 days, although some symptoms may persist for weeks.6,7

Three Phase Detox

One model of cocaine detox separates the process into three phases:10

  1. The crash: Cocaine’s effects are quite short acting. Following a period of heavy use, a “crash” may be experienced with symptoms of exhaustion, increased hunger, depression, anxiety, and irritability. This can last for a few days.
  2. Withdrawal: Following the crash, the withdrawal phase can last for 10 weeks and include symptoms like lethargy, cocaine cravings, poor concentration, mood swings, and irritability.
  3. Extinction: The final phase, extinction can last for 6 months after last use with low mood and some cravings.

Chronic cocaine users may also experience what’s known as a post-acute withdrawal syndrome (PAWS) that persists long after their last use. PAWS may include protracted withdrawal symptoms like poor impulse control and difficulty regulating emotions.11

What Are the Effects of Withdrawal?

Cocaine withdrawal presents serious hazards including cardiovascular issues like irregular heartbeat or heart attack.

Though cocaine withdrawal may not pose the same pronounced physical risks as acute alcohol or sedative withdrawal, there are some potential complications to be aware of. The most serious hazards of cocaine detox include the following:2,7

  • Cardiovascular issues: Any stimulant abuse puts additional strain on the heart. With heavy use, problems may arise during detox like heart attack, stroke, or irregular heartbeat.
  • Seizures may be a complication of active stimulant abuse but may continue throughout the withdrawal period.
  • Mental health risks: Perhaps the most significant health effects of cocaine detox involve the individual’s mental health.
    • Depression: The level of negative thoughts can be profound. Depression may lead to suicide, especially in an individual with established depressive disorders.
    • Violence: During the period of agitation, confusion, paranoia, and hallucinations, a person can lash out violently against strangers or loved ones.
  • Cravings: The strength of cocaine cravings throughout detox can result in relapse.

What Are the Different Types of Detox?

Treatment will focus on monitoring symptoms and providing a safe environment. To safely and comfortably detox and avoid the unwanted effects of cocaine withdrawal, professional detox options will be valuable tools. There are no medications specifically approved for the treatment of cocaine withdrawal, so treatment will focus on monitoring symptoms and providing a safe environment to limit harm to self and others.7

There are no medications specifically approved for the treatment of cocaine withdrawal, so treatment will focus on monitoring symptoms and providing a safe environment to limit harm to self and others.

Detox may take place in a variety of treatment settings including the following:10

  • Outpatient settings: For people with strong supports and limited risks, outpatient treatment allows the individual to go to work or school, attend treatment, and return home in their path to recovery. Outpatient treatment is available at doctor’s offices or community addiction treatment centers.
  • Inpatient settings: Perhaps the best fit for people at high risk of severe and/or complicated withdrawal and with fewer supports at home, inpatient detox programs provide 24-hour supervision, support, and, when needed, medical intervention while the recovering individual lives at the treatment center. Inpatient detox may be available in hospital-based or other residential treatment settings.

Detox provides a solid foundation for recovery, but it is not a substitute for substance abuse treatment.10 Those interested in long-term recovery and abstinence from cocaine abuse will benefit from some form of professional addiction treatment, whether it be an inpatient, luxury, executive, or outpatient program.

Sources

  1. U.S. Department of Justice Drug Enforcement Administration. (2017). Drug of Abuse: A DEA Resource Guide.
  2. The National Institute on Drug Abuse for Teens. (2019). Cocaine.
  3. National Institute on Drug Abuse. (2016). Cocaine.
  4. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  5. Substance Abuse and Mental Health Services Administration. (1999). TIP 33: Treatment for Stimulant Use Disorders.
  6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  7. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
  8. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition).
  9. World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.
  10. Karch, Steven B. (editor in chief). (2019). Drug Abuse Handbook. San Francisco: CRC Press.
  11. University of Wisconsin Health. (2018). Health Facts: Post-Acute Withdrawal Syndrome (PAWS).
  12. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction.

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