Cocaine Detox and Withdrawal
Cocaine Detox and Withdrawal
Cocaine is a
powerfully addictive stimulant drug. The powdered, hydrochloride
salt form of cocaine can be snorted or dissolved in water and
injected. Crack is cocaine that has not been neutralized by an
acid to make the hydrochloride salt. This form of cocaine comes
in a rock crystal that can be heated and its vapors smoked. The
term "crack" refers to the crackling sound heard when it is
Regardless of how cocaine is used or how frequently, a user can
experience acute cardiovascular or cerebrovascular emergencies,
such as a heart attack or stroke, which could result in sudden
death. Cocaine-related deaths are often a result of cardiac
arrest or seizure followed by respiratory arrest.
Cocaine is a strong central nervous system stimulant
that interferes with the reabsorption process of
dopamine, a chemical messenger associated with pleasure
and movement. The buildup of dopamine causes continuous
stimulation of “receiving” neurons, which is associated
with the euphoria commonly reported by cocaine abusers.
Physical effects of cocaine use include constricted
blood vessels, dilated pupils, and increased
temperature, heart rate, and blood pressure. The
duration of cocaine's immediate euphoric effects, which
include hyperstimulation, reduced fatigue, and mental
clarity, depends on the route of administration. The
faster the absorption, the more intense the high. On the
other hand, the faster the absorption, the shorter the
duration of action. The high from snorting may last 15
to 30 minutes, while that from smoking may last 5 to 10
minutes. Increased use can reduce the period of time a
user feels high and increases the risk of addiction.
Some users of cocaine report feelings of restlessness,
irritability, and anxiety. A tolerance to the "high" may
develop—many addicts report that they seek but fail to
achieve as much pleasure as they did from their first
exposure. Some users will increase their doses to
intensify and prolong the euphoric effects. While
tolerance to the high can occur, users can also become
more sensitive to cocaine's anesthetic and convulsant
effects without increasing the dose taken. This
increased sensitivity may explain some deaths occurring
after apparently low doses of cocaine.
Use of cocaine in a binge, during which the drug is
taken repeatedly and at increasingly high doses, may
lead to a state of increasing irritability,
restlessness, and paranoia. This can result in a period
of full-blown paranoid psychosis, in which the user
loses touch with reality and experiences auditory
Other complications associated with cocaine use include
disturbances in hearth rhythm and heart attacks, chest
pain and respiratory failure, strokes, seizures and
headaches, and gastrointestinal complications such as
abdominal pain and nausea. Because cocaine has a
tendency to decrease appetite, many chronic users can
Different means of taking cocaine can produce different
adverse effects. Regularly snorting cocaine, for
example, can lead to loss of sense of smell, nosebleeds,
problems with swallowing, hoarseness, and a chronically
runny nose. Ingesting cocaine can cause severe bowel
gangrene due to reduced blood flow. People who inject
cocaine can experience severe allergic reactions and, as
with any injecting drug user, are at increased risk for
contracting HIV and other blood-borne diseases.
Cocaine withdrawal occurs when
a heavy cocaine user cuts down or quits taking the drug.
Cocaine produces a sense of extreme joy by causing the
brain to release higher than normal amounts of some
biochemicals. However, cocaine's effects on the body can
be very serious or even deadly.
When cocaine use is stopped or when a binge ends, a
crash follows almost immediately. This is accompanied by
a strong craving for more cocaine, fatigue, lack of
pleasure, anxiety, irritability, sleepiness, and
sometimes agitation or extreme suspicion.
Cocaine withdrawal often has no visible physical
symptoms like the vomiting and shaking that accompanies
the withdrawal from heroin or alcohol.
In the past, people underestimated the addictive
properties of cocaine. However, cocaine is addictive
when addiction is viewed as a condition involving desire
for more of the drug despite negative consequences.
The level of craving, lack of pleasure, and
depression produced by cocaine withdrawal rivals or
exceeds that felt with other withdrawal symptoms.
Primary symptoms may include
depressed mood, fatigue, generalized malaise, vivid and
unpleasant dreams, agitation and restless behavior,
slowing of activity or increased appetite.
and depression can last for months following cessation
of long-term heavy (particularly daily) use. Withdrawal
symptoms can also be associated with suicidal thoughts
in some people.
During withdrawal, there can be powerful, intense
cravings for cocaine. However, the "high" associated
with ongoing use becomes less and less pleasant, and can
produce fear and extreme suspicion rather than joy. Just
the same, the cravings may remain powerful.
Signs and tests
A physical examination and history of cocaine use are
sufficient to diagnose this condition.
The withdrawal from cocaine may not be as unstable as
withdrawal from alochol. However, the withdrawal from
any chronic substance abuse is very serious. There is a
risk of suicide or compensatory overdose.
Symptoms usually resolve completely over time. People
experiencing cocaine withdrawal often attempt to
self-medicate with alcohol, sedatives, hypnotics, or
antianxiety agents, such as diazepam (Valium).
Self-medication or replacement is not advised, because
each simply shifts addiction from one substance to
Because at least 50% of cocaine addicts have a
co-existing mental disorder (particularly depression and
attention-deficit disorder), these conditions must be
considered and treated aggressively.
Relapse rates are dramatically reduced when these
conditions are treated appropriately. All prescription
drugs should be monitored carefully in patients who
Information from this page comes from both NIDA and