Cocaine is an intense stimulant that is mostly found on the streets and in black markets. It has few approved medical applications today, and it is a common recreational substance, though this use has been made illegal since the 1920s. The drug increases the amount of certain neurotransmitters in the brain, producing a burst of energy and good feelings followed by a “crash” consisting of fatigue and depressed mood.
Cocaine use in the United States is still fairly prevalent despite being on the decline in recent years. As of 2014, 14.8 percent of people age 12 and older in the US have used cocaine in their lifetimes, according to the National Institute on Drug Abuse.
This substance is well known for its addictive potential. The euphoric rush that results from the primary methods of intake – snorting, smoking, or injection – followed by the crash often result in long binges that cause the individual to quickly develop a tolerance to the drug. This means that higher and higher doses are needed to get the same effect, and before long, the brain has adjusted to the constant flood of dopamine and serotonin.
In order to deal with the unnatural changes created by cocaine, the human brain will reduce the number of receptors that neurotransmitters like dopamine and serotonin bind to, meaning that more must be used to achieve a high.
This is the hallmark of what is referred to as physical addiction. If intake of the drug then stops, uncomfortable symptoms are created due to the fact that the receptors for those neurotransmitters are still dulled or disabled. These symptoms, called withdrawal symptoms, will continue until the brain can readjust back to its original state.
When it comes to intoxicants like cocaine, withdrawal symptoms can be unpleasant – so much, in fact, that the symptoms themselves can act as a serious deterrent to even trying to quit for an addicted person.
Cocaine withdrawal symptoms include:
- Increase appetite
- Vivid dreams or nightmares
- Slowed activity
- General feelings of discomfort
The intensity of these symptoms and concurrent cravings depend largely on how intense the abuse of the drug was and how long the abuse lasted. Those who abuse cocaine for long enough have been known to have permanently altered brain chemistry that results in long term anhedonia, or the inability to feel pleasure.
There are different stages to withdrawal from any drug. Cocaine stays in the system for an average of six hours. Once the drug is flushed out, the user experiences the crash. These initial symptoms, which typically consist of strong feelings of fatigue, depression, and irritability, last for a few hours to a few days. The stage that people generally think of as “withdrawal” happens when the cravings begin. These can be very intense and difficult to resist, and they can contribute to the symptoms of restlessness and agitation. This stage lasts for 1-10 weeks, though the most intense cravings and symptoms tend to decline after 1-2 weeks.
In spite of what most people think, this is not considered to be the end of withdrawal. The last stage is often referred to as the “extinction” phase. During this period, which can last for 30 or more weeks, cravings tend to pop up intermittently, often fueled by certain triggers. Reminders of the drug, such as friends who also take cocaine and environments similar to that where the drug was normally taken, can make cravings reappear. This can happen for the rest of the addicted person’s life, but they are most common during the extinction phase.
Though unpleasant, withdrawal symptoms are a likely reality for those who find themselves addicted to cocaine. According to the National Survey on Drug Use and Health (NSDUH), this amounts to 1.4 million people in the US as of 2008. Although there are ways to reduce and treat these symptoms, withdrawal is a necessary step in the path to recovery, as the only way to recover from an addiction disorder is to stop taking the drug.
Detox vs. Tapering
There are generally two ways to get off a drug one is addicted to: stop taking the drug altogether or taper off it. Stopping all use of the drug at once is often referred to as quitting “cold turkey.” People often say they are quitting “cold turkey” when they are going to attempt this method on their own without any kind of medical or professional assistance. When it comes to a drug as addictive as cocaine, this can be unwise.
Luckily, the withdrawal symptoms from cocaine are not life-threatening, unlike those of other intoxicants like alcohol and certain prescription drugs. However, the intensity of the symptoms makes it very difficult to stick to a do-it-yourself detox plan. Few people are able to maintain the strong willpower necessary to get through the withdrawal symptoms and cravings on their own.
Plus, cold-turkey detox creates an increased risk of overdose that many people are unaware of. Going off a drug entirely, even for a day or two, can reduce a person’s tolerance to the substance. Not realizing this, many addicted individuals will return to use at the same dose they had become accustomed to prior to attempting to quit. Without that tolerance in place, an overdose can easily occur and potentially end in death. According to the Centers for Disease Control and Prevention, about 5,000 people died of cocaine overdose in the US in 2013.
To avoid this, many hospitals and treatment centers offer medically assisted detox. This is simply a process wherein the client stays in a hospital-like setting for the duration of the withdrawal. Medical staff members monitor the person’s vitals closely to ensure that no dangerous symptoms emerge. They can also use various medications to treat things like anxiety, depression, agitation, and nausea. Nonaddictive antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may be prescribed to treat or prevent the worst emotional symptoms.
The goal of medically assisted detox is to make the withdrawal process as easy and comfortable as possible. Signs of distress are taken as signs that the treatment is not ideal, and it will generally be adjusted accordingly.
As an alternative to a complete detox, a medical professional may recommend tapering off the drug. This is more likely to be used for prescription medications that have easily controlled doses and are not generally illegal. The tapering approach is not generally used in cases of cocaine detox.
Tapering off a drug means taking lower doses over time before stopping altogether. Most of the time, the addicted person will spend a week or two on each dose before moving to a lesser one. This will reduce the intensity of cravings and withdrawal symptoms, though it may not eliminate them altogether. Medications like SSRIs may be prescribed to help the individual through this process. The downside to tapering, unless done in a highly controlled environment, is the temptation to go back on a higher dose.
Quitting the use of a highly addictive drug like cocaine is never easy. Medical assistance can make withdrawal a lot easier to deal with, but cravings can still haunt the addicted person for years. However, it’s important to keep in mind that relapse isn’t a failure. Relapses are common enough that addiction specialists tell individuals to think of them as additional steps on the path to recovery. Treatment can always be accessed again, if needed. The important thing is to stay positive and keep accessing the necessary support.