Cocaine Withdrawal: Symptoms, Timeline, & Treatment

What Is Cocaine Addiction?

Cocaine addiction (clinically known as cocaine use disorder) refers to a pattern of dependence on cocaine. It’s important to know the differences between physical dependence and addiction. Physical dependence refers to the body acquiring a tolerance to cocaine. When reducing or abstaining from use, the body then enters a state of withdrawal. Addiction refers to the behavioral patterns of using cocaine regardless of the consequences or desires to stop.

Cocaine is a psychostimulant that activates the nervous system. Most people experience a heightened sense of wakefulness and arousal when taking the drug. It also decreases the need for eating and sleeping. The most acute effects last about 20-30 minutes. People may be more prone to developing an addiction if they use cocaine in high doses, intravenously, or with other drugs.¹

What Causes Cocaine Withdrawal?

When someone frequently uses cocaine, their body habituates to the effects. Over time, they need to take more of the drug to feel the desired highs. Cocaine withdrawal happens when someone who frequently uses cocaine cuts down or stops using the drug abruptly. These symptoms can occur even if someone is using lower doses of the drug. People often binge on cocaine, which then results in an immediate crash.²

Cocaine Withdrawal Symptoms

Withdrawal symptoms of cocaine can range from mild to severe, and symptoms may occur at different times. Everyone responds to drug use and withdrawal patterns differently. People with a history of addiction, patterns of polysubstance use, or other health complications may face a greater risk for severe withdrawal symptoms. The more frequently someone uses- and the more they use- can also intensify withdrawal. Although it’s rare, cocaine withdrawal can lead to death.

Acute Cocaine Withdrawal Symptoms

Acute withdrawal refers to the primary symptoms experienced after stopping or reducing drug use. These symptoms can occur just a few hours after using cocaine. Cravings tend to be highest at this time, and these cravings can be so uncomfortable that they result in the person using cocaine or another drug to experience relief.

Acute cocaine withdrawal symptoms may include:³

• Anxiety
• Fatigue
• Paranoia
• Cravings
• Memory impairment
• Irritability
• Restlessness
• Aggressive behavior
• Vivid dreams
• Increased appetite

Protracted Cocaine Withdrawal Symptoms

Post-acute withdrawal symptoms (PAWS) refers to ongoing difficulties that arise after someone abstains from drug use. Also known as protracted withdrawal, symptoms last much longer than the conventional half-life associated with each substance. Symptoms may fluctuate in severity over time, but they can last for several months or years.⁴

Post-acute withdrawal symptoms may include:⁴

• Anxiety
• Sleep disturbances
• Depression
• Irritability
• Increased sensitivity to stress
• Appetite changes
• Apathy/anhedonia
• Obsessive-compulsive behaviors
• High cravings
• Relationship difficulties

Symptoms of Cocaine Withdrawal in Newborns

Neonatal abstinence syndrome refers to babies undergoing drug withdrawal after birth. This syndrome is often attributed to opioid use, but it can occur with any drug. If a woman uses cocaine during her pregnancy, it passes through the bloodstream through the placenta and exposes her unborn baby. Withdrawal symptoms can happen 1-2 days after birth.⁵

Signs of cocaine withdrawal in babies include:

• Excessive crying
• High-pitched crying
• Sleep problems
• Overactive reflexes
• Seizures
• Sweating
• Fever or rapidly-changing temperature
• Poor feeding
• Stuffy nose/sneezing
• Vomiting
• Diarrhea or constipation
• Tight muscle tone

How Long Does Cocaine Withdrawal Last?

The exact cocaine withdrawal timeline differs from person to person. The duration depends on numerous variables, including how long and often someone used cocaine and their general mental and physical health. Histories of previous detoxes can also affect how the body withdraws from cocaine. People without substance use disorders generally have less severe withdrawal symptoms.

Cocaine withdrawal is made up of three stages:

Stage 1: The Crash

The crash can occur just a few hours after a cocaine binge. Stage one occurs to every person with a substance use disorder for cocaine, even if they aren’t quitting. This phase tends to have some of the most obvious and heightened symptoms. People may have intense cocaine cravings, which can result in patterns of relapse. There are also physiological symptoms, such as fatigue, increased appetite, and aches/chills. Psychological symptoms may include irritability, panic, or a depressed mood. Detoxing from other drugs simultaneously may intensify certain symptoms.

Stage 2: Craving

Within a few days, the crash moves into the next phase, which is often known as the acute withdrawal or craving phase. Cravings happen to people as they try to quit using cocaine, but also for people who wait several days or more before using cocaine again. During this phase, the physiological and physical symptoms may become more pronounced. Cravings persist, and people may experience mood swings, problems with focus and concentration, sleep issues, depression, and ongoing fatigue. The risk of relapse is still high at this time.

Stage 3: Extinction

The extinction phase generally refers to the last part of withdrawal. At this time, the majority of symptoms pass, and the person enters more of a phase of sustained recovery. Cravings may still arise, and PAWS symptoms may still fluctuate at this time. There is still a risk of relapse, and it’s important for individuals to develop coping skills to use when they feel stressed or upset.

Stage 3 typically emerges within a few weeks after stopping cocaine use. This stage does not have a defined length of time, although it’s estimated that it can last up to six months. In general, someone in this phase feels more stable, but they often struggle with ongoing symptoms of irritability, cravings, depression, and anxiety.

Treatment for Cocaine Withdrawal

Cocaine withdrawal is generally treated as a comprehensive health issue. Depending on the specific situation, substance use disorders are often addressed using a variety of integrative treatments, including therapy, group programs, inpatient/outpatient care, detox support, and medication. Some doctors may prescribe a tapering plan using medications to avoid the impact of quitting cold turkey.

Resources that may be helpful for managing cocaine withdrawal include:

At-Home Care

Many people detox successfully at home, but it’s paramount to have a safe environment and a sense of accountability. Detoxing without supervision is inherently risky, and people may be more likely to relapse without structure or support. Likewise, certain medical complications can escalate quickly, which can be dangerous when someone is alone at home.

These coping strategies can help alleviate cocaine withdrawal symptoms:

1. Stay hydrated: Withdrawal can lead to dehydration due to excessive perspiration and diarrhea. Aim to consume 2-3 liters of water daily to restore fluids. Consider drinking electrolyte beverages as well.
2. Eat regularly: It’s important to consume enough calories during detox. Have a variety of foods on hand because your appetite may fluctuate.
3. Exercise for your mental health: Light exercise, such as taking a short walk or doing some stretches, can help you feel better during withdrawal. Pay attention to your body, and don’t overextend yourself.
4. Practice self-care: Journal, take warm baths, or do other feel-good activities during this vulnerable time.
5. Seek support: Don’t detox alone. Stay in touch with friends and family who support your recovery efforts.
6. Get plenty of rest: Allow your body ample time to sleep and relax.

Rehab & Detoxification Centers

Detox and rehabilitation centers offer ongoing structure and monitoring for people experiencing substance use disorders. Detox can last a few days (if it’s necessary), and it provides initial stabilization for the most acute withdrawal symptoms. After that, people may enroll in inpatient or outpatient care. Treatment for cocaine generally focuses on building healthier coping skills, managing cravings, and treating other co-occurring mental health problems.

Cocaine Withdrawal Treatment for Newborns

Cocaine withdrawal in newborns may be treated at the hospital within the neonatal intensive care unit. Treatment may also include taking medicines to manage severe withdrawal symptoms. Once symptoms are stabilized, the baby gets smaller doses over time. Newborns may also receive intravenous fluids and higher-calorie baby formula. Most babies with withdrawal symptoms improve within 5-30 days.⁶

Treatment for Cocaine Abuse & Addiction

After completing detox and becoming medically stable, someone who completes detox may benefit from more long-term treatment for cocaine addiction. It’s important to note that addiction is a chronic disease, which means that it’s typical for people to experience patterns of relapse with recovery. That said, it’s absolutely possible to achieve a sustainable recovery without ever using drugs again.

Intensive Outpatient Programs

Intensive outpatient programs (IOP) refers to a clinical schedule that generally consists of individual therapy, group therapy, and meeting with an assigned case manager several hours over the course of the week. Clients in these programs receive ongoing accountability and structure, but they can still attend work, go to school, and live at home.

Therapy & Support Groups

Therapy can provide relief for withdrawal symptoms and address underlying factors maintaining addiction. Group therapy or support groups offer a sense of camaraderie and accountability, which can lessen the shame and stigma of drug use. An individual therapist maintains a trusting relationship where you can work on problems affecting your current well-being.

Some therapies that can address addiction and withdrawal symptoms include:

• CBT: Cognitive behavior therapy (CBT) focuses on the relationship between feelings, thoughts, and behaviors. Addressing negative thoughts about yourself and others can change addictive patterns.
• DBT: Dialectical behavior therapy (DBT) implements concepts of mindfulness, distress tolerance, and emotional regulation, all of which can reduce addictive behaviors.
• Motivational interviewing: Motivational interviewing (MI) is helpful for addressing ambivalence about change, and it meets people where they are compassionately and non-judgmentally.

In My Experience

Living with addiction often makes people feel trapped and even hopeless. Withdrawal can feel highly distressing, and it’s often a vulnerable time for people. That said, change is always possible, and I have seen many people make remarkable changes in their recovery. Even if you feel afraid, you can change the course of your life. Reaching out for help can make an invaluable difference in how you feel.