Cocaine Withdrawal: Stages, Manifestation, and Treatment

Last Updated: December 17, 2020

Authored by Isaak Stotts, LP

Reviewed by Michael Espelin APRN

Cocaine, a stimulant, known by many names such as joy powder and others, acts on the brain in peculiar ways to create tolerance and dependence, making it difficult for the individual to quit this habit even if they want to. And then there are the cocaine withdrawal symptoms! It is vital to know what the joy powder does to one’s body. Cocaine withdrawal symptoms range from the unpleasant and inconvenient to the terrifying, morbid, and life-threatening. It is the desire to avoid these symptoms and get a grip on their sanity that makes people seek refuge in coke once more. The result is a relapse. While there are therapies to combat the symptoms of cocaine withdrawal, awareness helps one to be prepared; that in turn empowers the individual to battle their addiction and prevent cocaine drug from taking over their lives once more.

Why Learn About Cocaine Withdrawal?

The menace of the stimulant in society has been ever-present and has contributed to the loss of lives over the year. The study of cocaine withdrawal is essential to understand its occurrence and phases better and for users to realize its dangers to health and seek medical help for the substance immediately. Cocaine withdrawal, unlike other substances such as alcohol or heroin, often has no physically visible effect like tremors, vomiting, and others; rather, side effects of cocaine usually include severe cravings, paranoia, anxiety, suicidal thoughts, and others. Despite the efforts made by the government and various medical groups, the prevalence of coke use is still on the rise.

Upset depressed girl sit near bed.

The National Youth Risk Behavior Survey is carried out amongst 9th through 12th-grade students in public and private school students across the country during the spring semester every two years. According to the CDC report, the incidence of substance use amongst this population has decreased to 5.5 percent in 2013 from 6.8 percent in 2011.

These statistics are truly encouraging, but, on the other hand, there are also numbers that provide a reality check and remind us that the war against coke is not yet over.

According to the NSDUH, the incidence of coke powder use amongst adults aged between 18 and 25 years is the highest amongst all groups. This is the time when they define their purpose and goals in life, search for meaningful vocations, choose careers, and nurture dreams of owning their first homes and raising happy families.

The NIH report also mentions that there are still 913,000 Americans whom the Diagnostic and Statistical Manual of Mental Disorders guidelines classify as being dependent on the stimulant or who abuse the drug.

Cocaine overdose deaths in the U.S. increased by 27% per year between 2013 and 2018, according to a report by the National Center for Health Statistics (NCHS). The likelihood of a joy powder overdose is directly linked to the abuser’s tolerance level.

Cocaine Withdrawal Symptoms

Cocaine withdrawal symptoms can be defined as the negative signs that occur when a user of the substance either cuts down on the amount of substance used regularly or quits using the drugs. Quitting the drug abruptly is a major cause of extreme cocaine withdrawal symptoms. The negative signs of abuse can occur even if the user isn’t off the drug yet and still has a significant amount of the drugs in their system.

Cocaine withdrawal symptoms are caused by staying off the drug for a period of time. A certain substance such as benzos and others may come with severe physical signs but cocaine withdrawal symptoms are mostly psychological.

Some Cocaine Withdrawal Symptoms include:

  • Anxiety
  • Restlessness
  • Irritability
  • Extreme fatigue
  • Increased appetite
  • Drowsiness
  • Lack of pleasure
  • Nervousness
  • Panic
  • Impaired verbal fluency and memory
  • Lack of concentration
  • Depression
  • Vivid, unpleasant dreams
  • Erratic sleep patterns
  • Dysphoria
  • Psychomotor agitation

Stages Of Cocaine Withdrawal

Cocaine withdrawal happens in three stages:

  • The crash stage begins immediately after the last stimulant dose.
  • The lethargy stage begins after the crash stage and can last for up to 10 weeks.
  • The extinction stage causes the user to experience dysphoria and can last for up to six months.

Because cocaine withdrawals tend to manifest over an extended time period of several months, many researchers divide the process into three distinct phases. Before delving into their details, it is important to note that these stages may set in early or late, overlap, or manifest in varying degrees depending on the severity of the addiction, the way in which the individual’s body metabolizes the drug, and the peculiar genetic makeup that may predispose him to certain psychiatric disorders.

Man suffering from cocaine withdrawals.

What Is The First Phase of Cocaine Withdrawal?

The first phase is the crash stage that manifests almost immediately after the last dose of taking the stimulant. The symptoms include:

  • Extreme fatigue
  • Drowsiness
  • Anxiety
  • Exhaustion
  • Irritability
  • Increased appetite
  • Intense lack of pleasure

Users may also develop depressive tendencies that are caused by a severe drop in the levels of serotonin and norepinephrine, the mood regulators in the brain. Some patients may also exhibit symptoms like paranoia.

Scientists have also discovered that early in the abstinence period, the user tends to exhibit impaired cognitive skills. It was found in a study that users in the early phase of withdrawal faltered on cognitive flexibility tasks and had impaired verbal fluency and verbal memory.

Contrary to popular notion, cocaine withdrawals can occur even when the user has traces of the substance in his body. He need not be entirely off the drug for the first phase of cocaine comedown to manifest.

What Is The Second Phase of Cocaine Withdrawals?

The lethargy manifested during the “crash” phase can continue for up to 10 weeks, which is well into the second phase of cocaine withdrawals. This phase is characterized by:

  • Irritability
  • Lack of concentration
  • Depression
  • Vivid dreams
  • Erratic sleep patterns that compound fatigue

This cocaine comedown phase may begin a week after taking the last dose of the substance and last for up to 10 weeks.

The risk of overdosing oneself is also high during this period. After a chronic period of abuse, coke users usually develop tolerance towards the drug. This increases the chance of an overdose.

What Is The Third Phase of Cocaine Withdrawal?

The third phase of cocaine withdrawal is known as “extinction.” It is marked by:

  • A profound sense of dissatisfaction with life (dysphoria)
  • Feeling of uneasiness
  • Episodic cravings for cocaine
  • Erratic sleep pattern
  • Psychomotor agitation
  • Unpleasant dreams

This stage may last for up to 28 weeks after taking the last dose of the stimulant.

It is interesting to note that withdrawal symptoms like dysphoria, erratic sleep pattern (insomnia/hypersomnia), psychomotor agitation (inability to control physical movements), and vivid and unpleasant dreams tend to manifest more in joy powder users who have a history of depression.

Heroin or oxycodone withdrawal periods are marked by signs like muscle aches, spasm, severe stomach cramps, diarrhea, vomiting, nausea, and dizziness that are hard to miss. On the other hand, symptoms of cocaine withdrawal are mostly emotional and psychological, which makes them more dangerous. Yet some effects like depression and dysphoria, if not managed, can trigger a relapse or, worse, drive ex-cocaine users to commit suicide.

Cocaine Detox

Cocaine detox is a treatment and recovery measure used to reverse the effect of cocaine dependency. Over the years, various medications have been experimented with to tackle cocaine dependency. Several medications have shown great promise in the field of medical health and have been fairly consistent in clinical trials, especially with patients suffering from severe addiction.

Wife Visits Her Recovering Husband.

The medications for detox work in two different ways. Some medications promote a stable period of abstinence, such as propranolol, while other drugs such as baclofen, tiagabine, topiramate, disulfiram, and others work to prevent relapse. This is done by reducing the craving for the drug or blocking the euphoria created by the medication.

Cocaine Detox Medications

Some of the medications used as a detox treatment for cocaine addiction include:

  • Propanolol. This detox treatment is a beta-blocker that is very effective for patients with severe cases of withdrawal symptoms. Propranolol, as a beta-blocker, works by mitigating some of the uncomfortable withdrawal effects such as anxiety, and a few of the rewarding effects associated with the drug, thereby aiding severely addicted users to achieve an initial period of abstinence.
  • Baclofen. The muscle relaxant, Baclofen, is a GABA agonist that functions by reducing cravings for the drug in users. It does so by decreasing the levels of dopamine released during drug stimulation, making the experience unremarkable.
  • Tiagabine. The GABAergic addiction drug is used in the treatment of relapse. It was seen to be very effective in maintaining abstinence from drug use.
  • Topiramate. Topiramate is considered as possibly one of the best relapse recovery drug due to its effect on GABA and glutamate neurotransmission. While increasing GABA  and facilitating GABA neurotransmission, it also blocks glutamate neurotransmission. This mechanism helps improve abstinence in users.
  • Disulfiram. It has been used successfully over the years for all forms of substance addiction and abuse, such as alcohol dependency. It causes unpleasant health conditions when alcohol is used. Similarly, in terms of cocaine use, it blocks the degradation of the substance, and the excess accumulation of the drug leads to increased negative mental effects such as anxiety and others, causing a very unpleasant experience rather than the euphoria.
  • Modafinil. Typically, Modafinil is approved for narcolepsy. It is also effective for the prevention of relapse through various inhibitory reactions, blocking the euphoric effects provided by the drug during use.

What Is The Outcome of Cocaine Withdrawal Treatment?

Symptoms of cocaine withdrawal should not be ignored either by the user or those who live and work with them. When withdrawal symptoms are detected early and managed promptly, the outcome of the dependence program improves considerably and the user has the greatest chance of being drug-free.

Recovery from addiction is possible with the right professional services. The first step to recovery is to enroll in a rehab program. This could be through sponsorship, insurance, or personal support. Insurance coverage can be useful, especially for low-income earners seeking adequate treatment for substance abuse.

There are different approaches offered by various mental health facilities.

These services May Include:

  • Medical detox
  • Therapy and counseling
  • Social support

There is a lot to benefit from an intensive addiction recovery program, whether it is family inclusive of personal.

The Treatment Services that One Could Benefit from Include:

  • Diverse treatment for underlying health issues
  • Peer group support programs
  • Assessment and medical evaluation
  • Physical and mental wellness programs

Page Sources

  1. T C Helmus, K K Downey, L M Wang, G L Rhodes, C R Schuster, The relationship between self-reported cocaine withdrawal symptoms and history of depression, 2001.\, http://www.ncbi.nlm.nih.gov/pubmed/11436938
  2. National Institute of Drug Abuse, What is the scope of cocaine use in the United States?, https://www.drugabuse.gov/publications/research-reports/cocaine/what-scope-cocaine-use-in-united-states
  3. SAMHSA, Elinore F. McCance-Katz MD, National Survey on Drug Use and Health: 2017, https://www.samhsa.gov/data/sites/default/files/nsduh-ppt-09-2018.pdf
  4. Holly Hedegaard, Merianne Rose Spencer, Matthew F. Garnett, Increase in Drug overdose deaths involving cocaine: United States. 2009 – 2018. https://www.cdc.gov/nchs/products/databriefs/db384.htm
  5. Center for Disease Control and Prevention, Trends in the Prevalence of Marijuana, Cocaine, and Other Illegal Drug Use National YRBS: 1991—2017, https://www.cdc.gov/healthyyouth/data/yrbs/factsheets/2017_drug_trend_yrbs.htm
  6. Brendan J. Kelley, Kenneth R. Yeager,Tom H. Pepper, David Q. Beversdorf, Cognitive Impairment in Acute Cocaine Withdrawal, 2005, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1237006/

Published on: July 28th, 2016

Updated on: December 17th, 2020

About Author

Isaak Stotts, LP

Isaak Stotts is an in-house medical writer in AddictionResource. Isaak learned addiction psychology at Aspen University and got a Master's Degree in Arts in Psychology and Addiction Counseling. After graduation, he became a substance abuse counselor, providing individual, group, and family counseling for those who strive to achieve and maintain sobriety and recovery goals.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.