Cocaine is a potent stimulant derived from the coca plant. Leaves on the plant have been chewed for their stimulant properties for centuries, but cocaine wasn’t synthesized until the early 1900s. Originally, it was used as a medicine, and it is still a Schedule II medication, like other powerful prescription drugs like oxycodone. Cocaine is still sometimes used as a local anesthetic for some surgeries.
When most people think of cocaine, however, they do not think of the medicinal applications. Instead, they know cocaine as an illegal street drug, which can come either as a white powder or as the brownish or yellowish rocks called crack cocaine. The drug is typically snorted, mixed with water and injected intravenously, or smoked (as crack).
How Cocaine Becomes Addictive
This stimulant drug is highly addictive, and it can lead the person abusing it into binge use. Cocaine forces the brain to release large amounts of the neurotransmitter dopamine, which is associated with elevated mood and sensory perception. When the brain has more dopamine, the person feels better, happier, and more energized, and experiences touch, sight, and sound differently. Changes in these experiences can also lead to nervousness, anxiety, paranoia, delusions, hallucinations, and aggression.
Cocaine is extremely addictive, and its use can lead to overdose. People who struggle with cocaine addiction may have tried to stop taking the drug, but the rapid onset and comedown mean users can feel uncomfortable withdrawal symptoms when going without the drug.
Cocaine and the Brain: Dependence and Tolerance
Cocaine acts in two ways. First, it binds to dopamine reuptake transmitters, so they do not remove any of the excess neurotransmitter from the synapses. This means that neurons are constantly stimulated, leading to mental and emotional excitement. This leads to positive feelings and increased physical energy, but it can also cause negative excitement, paranoia, anxiety, delusions, and rapid heartbeat, especially if the drug is ingested multiple times over the course of a cocaine binge. A 2008 paper on the neurobiology of cocaine addiction noted that 47 percent of neuron-binding sites must be blocked by cocaine for the person to experience a high. In people who struggle with cocaine addiction, typically 60-77 percent of those sites were blocked.
Two other important neurotransmitters – serotonin and norepinephrine – are also affected by cocaine binding to the reuptake sites. Norepinephrine in particular is part of the body’s natural “fight-or-flight” response, so when more of that neurotransmitter is in the brain, the body’s temperature goes up, pupils dilate, heart rate increases, blood pressure goes up, and respiration increases. The person feels like they must flee or like there is something to fear nearby. This increases paranoid delusions and aggression.
As cocaine is metabolized and begins to leave the body, neurotransmitter levels do not return to normal, or pre-consumption levels; instead, they fall below those initial levels. Dopamine is particularly affected, so the person feels lethargic and extremely depressed. Avoiding these sensations is part of why people binge on cocaine, which leads to rapid addiction and a much greater risk of overdose. Long-term abuse of cocaine changes the brain to respond to above-normal neurotransmitter levels as though they are normal. People struggling with addiction don’t just need cocaine to feel good; they believe they need cocaine to feel normal.
When a person ingests cocaine, the onset of the drug begins anywhere from 10-30 minutes after ingestion, depending on how the person took it. Typically, the onset of euphoria occurs quickly. The faster the person becomes intoxicated and the higher they get, the worse the comedown is. The “hangover” phase after a cocaine rush generally lasts at least 30 minutes, although it can also last for a few days.
The body’s withdrawal from cocaine begins almost as soon as the drug is metabolized out of the body. Completing the cycle of withdrawal generally takes two weeks, but it can take months if the person develops protracted withdrawal syndrome (PWS).
The Cocaine Withdrawal Timeline
There are three phases of cocaine withdrawal, which can last for several days if the person does not develop PWS. If the person develops PWS, withdrawal can last for much longer.
- Crash or onset: This phase begins when the body metabolizes cocaine, and the brain becomes depleted of neurotransmitters. The condition starts within a few hours of the final cocaine dose, and it could last for six hours to 2-3 days. Symptoms of the first phase include:
- Hypersomnia (oversleeping)
- Exhaustion or fatigue
- Irritability or mood swings
- Increased appetite
The person does not, however, experience cravings for cocaine yet, unless they are trying to avoid the crash.
- Primary withdrawal phase: The second phase lasts about one week without PWS. Symptoms include:
- Emotional changes
- Erratic sleep or the inability to sleep well
- Irritability and mood swings
During this phase, the person develops strong cravings for the drug. With medical supervision to ease withdrawal symptoms and social support to encourage their recovery, a person can effectively make it through this phase; however, many people who attempt to quit cocaine without help relapse during this time. Their body’s sensitivity to the drug has decreased, so if they go on a cocaine binge, they may experience an overdose.
- Extinction: The final phase is more prominent in people who develop PWS, and it can last for several weeks after the body has overcome tolerance to, and physical dependence on, the drug. The main symptoms of this condition are intense cravings, which may appear suddenly and are not consistent, and continued depression. As long as the person maintains social and therapeutic support, which may include medications like antidepressants, then they can overcome this final step. However, if they do not have the support they need, they may suffer a relapse.
Detox from Cocaine with Medical Supervision
To safely overcome cocaine withdrawal symptoms and avoid developing protracted withdrawal syndrome, it is very important to work with medical professionals to detox from cocaine.
Cocaine is often abused as a social or “party” drug, so people who struggle with addiction to this substance often concurrently abuse other substances, including alcohol, benzodiazepines, narcotics, and other dangerous drugs. People who struggle with polydrug abuse need medical supervision to detox from multiple substances safely. They may have physical damage from long-term drug abuse, or they may struggle with mental health problems related to substance abuse.
Even if the person struggles with addiction to cocaine alone, medical supervision, especially from a doctor and mental health professional, can help the person to manage many of the associated withdrawal symptoms. A psychiatrist can prescribe antidepressants and anti-anxiety medications, which can help to stabilize mood. A mental health professional can also monitor clients for signs of potential addiction to, or abuse of, these substances, and begin tapering the use of the medications to avoid further addiction issues.
There are no medications specifically used to ease cocaine withdrawal symptoms. Because so many of these symptoms are psychological or mood-related, psychiatric medications can lessen many of the intense feelings.