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 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. This crash is accompanied by a strong craving for more cocaine. Additional symptoms include 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 how addictive cocaine can be. However, cocaine is addictive when addiction is defined as a desire for more of the drug, despite negative consequences.

The level of craving, irritability, delayed depression, and other symptoms produced by cocaine withdrawal rivals or exceeds that felt with other withdrawal syndromes.

See also:

• Drug abuse
• Drug abuse and dependence
• Stroke secondary to cocaine

Primary symptoms may include:

• Agitation and restless behavior
• Depressed mood
• Fatigue
• Generalized malaise
• Increased appetite
• Vivid and unpleasant dreams
• Slowing of activity

The craving and depression can last for months following cessation of long-term heavy use (particularly daily). 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, and can produce fear and extreme suspicion rather than joy (euphoria). Just the same, the cravings may remain powerful.

A physical examination and history of cocaine use are sufficient to diagnose this condition.

A toxicology (poison) screen may be performed to see if other drugs may have been taken.

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 antianxiety medications such as diazepam (Valium) to treat their symptoms. Use of these drugs is not recommended because it simply shifts addiction from one substance to another.

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. When diagnosed and treated, relapse rates are dramatically reduced. All prescription drug use should be monitored carefully in patients who abuse substances.

The 12-step support groups, such as Cocaine Anonymous or Narcotics Anonymous, have helped many people addicted to cocaine. Alternative groups such as SMART recovery should be recommended for those who do not like the 12-step approach.

Cocaine addiction is difficult to treat, and relapse can occur. However, the rates of achieving stabilization are as good as those for other chronic illnesses like 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 the research.

Presently there are no effective medications for reducing craving, although some are being tested. Some studies have reported that medications such as amantadine and bromocriptine may help to reduce patient's craving, increase energy, and normalize sleep, particularly among those with the most seriously addicted.

• Depression
• Craving and overdose
• Suicide

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

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

Avoid cocaine use. If you have previously 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 consequences that follow its use. Group participation is helpful for many people.

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.