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Cocaine Withdrawal and Detox

Cocaine inhibits the reuptake of the neurotransmitters serotonin, norepinephrine and dopamine. All of these neurotransmitters play important roles in brain activity, which is altered by chronic cocaine use. When cocaine intake is abruptly decreased or stopped, these neurotransmitter systems are forced into sudden states of dysfunction, causing physiological and psychological withdrawal symptoms. Cocaine withdrawal symptoms range in severity depending on the level of dependence prior to cessation or dose reduction. Long-term, heavy cocaine use is associated with severe withdrawal symptoms that may last for months after stopping use.1

Prolonged use of cocaine can result in “crashing” characterized by anxiety, depression, fatigue, irritability and thoughts of suicide. Other common cocaine withdrawal symptoms include restlessness, nightmares, a general feeling of discomfort and extremely strong cravings for the drug. Cocaine-dependent users have a statistically higher risk for other substance use disorders, as well as personality disorders, post-traumatic stress disorder and depressive disorders.2

People who suddenly stop using stimulant drugs such as cocaine often experience psychological symptoms of post-acute withdrawal syndrome (PAWS). While the physical cravings associated with chemical addiction begin to abate after the first few weeks, drug and alcohol abuse cause more than physical dependency. The post-acute stage of addiction is associated with overt emotional and psychological symptoms of withdrawal, taking recovering addicts on a roller coaster ride of thoughts, feelings and reactions. PAWS is experienced a little differently by every individual, although the following are commonly reported symptoms.3,4

  • Anxiety and panic attacks
  • Depression
  • Suicidal thoughts
  • Irritability
  • Sudden mood swings
  • Fatigue
  • Lack of motivation
  • Insomnia
  • Inability to concentrate
  • General cognitive impairment
  • Memory loss
  • Difficulty solving problems and thinking clearly
  • Obsessive thoughts
  • Fluctuating energy levels
  • Extreme drug cravings and obsessions
  • Anhedonia (the inability to feel pleasure from anything beyond use of the drug)3,4

Cocaine Detox Treatment

Cocaine addicts often use alcohol, sedatives, hypnotics or antianxiety medicines to treat withdrawal symptoms. This is not a solution because it simply shifts addiction from one substance to another. Currently, there is little evidence-based research on medication-managed withdrawal, although some studies have shown amantadine and bromocriptine may help reduce cravings, increase energy and normalize sleep.2 Most of the research has been on rats, and while some studies have been promising, clinical trials on humans are required to bring any treatment to market. A recent animal study analyzed an experimental cancer drug currently undergoing clinical trials. In rats, the drug showed potential for inhibiting memories responsible for cocaine cravings.5

The mental health aspects of cocaine withdrawal are particularly challenging and need to be incorporated into cocaine treatment strategies. Behavioral therapies are effective in patients affected by cocaine abuse and dependence. These include contingency management (CM), which was originally conceived specifically for the treatment of cocaine abuse. The premise behind CM is to systematically use reinforcement techniques, such as monetary vouchers, to modify behavior in a positive and supportive manner. Cognitive behavioral therapy (CBT) has also shown benefits for people undergoing cocaine rehab. CBT helps people recognize irrational and unhealthy thought patterns and behaviors, and teaches them how to replace them with healthy and empowering ones.6

  1. Cocaine Withdrawal Symptoms, Timeline, Causes and Treatment. Mental Help website. https://www.mentalhelp.net/articles/cocaine-withdrawal/ Updated November 25, 2015. Accessed January 10, 2017.
  2. Cocaine withdrawal. Medline Plus website. https://medlineplus.gov/ency/article/000947.htm Updated April 13, 2015. Accessed January 10, 2017.
  3. What Is Post-Acute Withdrawal Syndrome? Drug Abuse website. http://drugabuse.com/library/post-acute-withdrawal-syndrome/ Accessed January 10, 2017.
  4. Post-Acute Withdrawal Syndrome (PAWS). Semel Institute UCLA Dual Diagnosis Program website. https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS Accessed January 10, 2017.
  5. Potential new treatment for cocaine addiction. Science Daily website. https://www.sciencedaily.com/releases/2016/08/160831085622.htm Published August 31, 2016. Accessed January 10, 2017.
  6. Cocaine Abuse Treatment. Drug Abuse website. http://drugabuse.com/library/cocaine-abuse/#cocaine-abuse-treatment Accessed January 10, 2017.
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