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Cocaine withdrawal

Cocaine withdrawal occurs when someone who has used a lot of cocaine cuts down or quits taking the drug. Symptoms of withdrawal can occur even if the user is not completely off cocaine and still has some of the drug in their blood.

Causes

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 other parts of the body can be very serious, or even deadly.

When cocaine use is stopped or when a binge ends, a crash follows almost immediately. The cocaine user has a strong craving for more cocaine during a crash. Other symptoms include fatigue, lack of pleasure, anxiety, irritability, sleepiness, and sometimes agitation or extreme suspicion or paranoia.

Cocaine withdrawal often has no visible physical symptoms, such as the vomiting and shaking that accompany withdrawal from heroin or alcohol.

In the past, people underestimated how addictive cocaine can be. However, cocaine is addictive when addiction is defined as a desire for more of the drug, despite negative outcomes.

The level of craving, irritability, delayed depression, and other symptoms produced by cocaine withdrawal is as strong as other types of withdrawal, or even stronger.

See also:

Symptoms

Primary symptoms of cocaine withdrawal may include:

  • Agitation and restless behavior
  • Depressed mood
  • Fatigue
  • General feeling of discomfort
  • Increased appetite
  • Vivid and unpleasant dreams
  • Slowing of activity

The craving and depression can last for months after stopping long-term heavy use (particularly daily use). Withdrawal symptoms may 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. It can produce fear and extreme suspicion rather than joy (euphoria). Even so, the cravings may remain powerful.

Exams and Tests

A physical examination and history of cocaine use are often all that is needed to diagnose this condition. However, routine testing will likely be done. It may include:

  • Blood chemistries and liver function tests such as CHEM-20
  • Cardiac enzymes (to look for evidence of heart damage or heart attack)
  • CBC (complete blood count, measures red and white blood cells, and platelets)
  • Chest x-ray
  • EKG (electrocardiogram, to measure electrical activity in the heart)
  • Toxicology (poison and drug) screening
  • Urinalysis

Treatment

The withdrawal from cocaine may not be as unstable as withdrawal from alcohol. However, the withdrawal from any chronic substance abuse is very serious. There is a risk of suicide or overdose.

Symptoms usually disappear over time. People who have cocaine withdrawal will often use alcohol, sedatives, hypnotics, or anti-anxiety medicines to treat their symptoms. Long-term use of these drugs is not recommended because it simply shifts addiction from one substance to another. Under proper medical supervision, however, short-term use of these medicines may be helpful in recovery.

At least half of all people addicted to cocaine also have a mental disorder (particularly depression and attention-deficit disorder). These conditions should be suspected and treated, if present. When diagnosed and treated, relapse rates are dramatically reduced. All prescription drug use should be monitored carefully in patients who abuse substances.

Support Groups

The 12-step support groups, such as Cocaine Anonymous or Narcotics Anonymous, have helped many people addicted to cocaine. Other groups, such as SMART Recovery, may appeal to those who do not like the 12-step approach.

Outlook (Prognosis)

Cocaine addiction is difficult to treat, and relapse can occur. However, the rates of becoming stable are as good as those for other chronic illnesses, such as diabetes and asthma.

Treatment should start with the least restrictive option and move up if necessary. Outpatient care is as effective as inpatient care for most people addicted to cocaine, according to research.

Presently, there are no medicines for reducing craving, but testing is taking place. Some studies have shown that the drugs amantadine and bromocriptine may help to reduce craving, increase energy, and normalize sleep, particularly among those with the most serious addiction.

Possible Complications

  • Depression
  • Craving and overdose
  • Suicide

Because many users will abuse more than 1 drug, other withdrawal syndromes, such as alcohol withdrawal, need to be ruled out.

When to Contact a Medical Professional

Call your health care provider if you use cocaine and need help to stop using it.

Prevention

Avoid cocaine use. If you have used cocaine and wish to stop, try to avoid people, places, and things you associate with the drug. If you find yourself considering the euphoria produced by cocaine, force yourself to think of the negative outcomes that follow its use. Group participation is helpful for many people.

References

Doyon S. Opiods. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw-Hill; 2004:chap 167.

Rao RB, Hoffman RS. Cocaine and other sympathomimetics. In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 154.

Wax PM, Barrera, R. Drug withdrawal. In: Wolfson AB, Hendey GW, Ling LJ, et al, eds. Harwood-Nuss' Clinical Practice of Emergency Medicine. 5th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009:chap 337.

Review Date 4/13/2015

Updated by: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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