Derived from the coca plant, cocaine is a powerful, addictive and dangerous stimulant drug that has been around for centuries. The National Alliance on Mental Illness (NAMI) estimates that around 14 million people worldwide abuse cocaine annually.
Stimulant drugs work on the central nervous system and increase energy levels and pleasure, and decrease appetite. Cocaine raises blood pressure and heart rate as well as the production of some chemical messengers in the brain, or neurotransmitters. Dopamine, norepinephrine, and serotonin, three of these neurotransmitters, are increased initially and then blocked from being reabsorbed into the brain. At first, this promotes the high feeling as well as increases the “fight-or-flight” response and inhibits mood regulation.
One of the dangers of cocaine is that as a stimulant it can lead to sudden cardiac death. Long-term abuse of cocaine can lead to a tolerance of the drug, and it can change the chemical makeup of the brain as well as the way the brain functions.
How Long Does Detox Take?
The detox process is the purging of toxins from the body and brain, and it is dependent on factors such as:
- Amount of drug taken
- Duration of abuse
- Type of drug or purity of drug
- Physiology of the abuser
There is no specific timeline that is consistent for each case of cocaine detox, but generally speaking, someone detoxing from cocaine will undergo three main phases: crash phase, craving phase, and extinction phase. Cocaine has a very short half-life, meaning that the drug generally leaves the body within 90 minutes, upon which withdrawal symptoms can start. The crash phase refers to the time a few hours or days after stopping taking cocaine and the crash that occurs after the high dissipates. During this phase, people usually experience low moods and energy levels and an increased appetite as the drug is no longer suppressing or stimulating these parts of the brain and body. Cravings can be very intense during the craving phase, which is also sometimes called the withdrawal phase; it can last up to 10 weeks for cocaine addicts.
After detoxing and being withdrawn from cocaine for over 10 weeks, the extinction phase starts. During this phase, cravings may be random and intermittent and often due to environmental triggers. After 28 to 30 weeks of being free from cocaine abuse, cravings generally cease. Drug dependence is different for everyone, however, and some people may experience a longer or shorter detox timeline.
Health Concerns During Detox
Withdrawal symptoms for cocaine usually don’t include the severe physical discomforts of other drugs, like vomiting and shaking, but they can be fairly emotionally intense. These symptoms can include:
- Agitation
- Anxiety
- Concentration issues
- Nightmares and/or vivid dreams
- Depression
- Fatigue
- Insomnia
- Mood swings
- Hostility
- Paranoia
- Irritability
- Restlessness
Some cocaine abusers do experience physical symptoms like body aches and chills, but they generally subside rather quickly. The psychological symptoms can be debilitating at their worst, and close medical supervision in a secure detox facility that offers comprehensive psychological care is recommended.
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Unfortunately, suicide can be a byproduct of cocaine abuse. The Primary Care Companion to the Journal of Clinical Psychiatry reports that cocaine was present in as many as 18 to 22 percent of suicide victims. The American Journal of Psychiatry published that 39 percent of a group of patients undergoing treatment for cocaine abuse admitted to attempting suicide at least once.
Cocaine abuse can also cause anhedonia, a state created by an extreme lack of dopamine in the system, which leads to the inability to feel any pleasure at all. Depression and cocaine abuse often go hand in hand as well. Whether this is a product of those suffering from depression seeking to self-medicate, or if depression is exacerbated by the abuse of cocaine making changes in the brain, is not often clear. The Australian Government’s Department of Health reports that in a sample of patients in a drug treatment program for cocaine abuse, 87 percent of them also met the diagnostic criteria for major lifetime depression.
Cocaine is also commonly mixed with other drugs or substances, making treatment and detox that much more difficult. Admission to a program that has the capability to treat multiple disorders concurrently may be the best hope for recovery.
Pharmaceutical Options
At this point, there are no medically accepted, or FDA-approved, pharmaceutical options for the treatment of cocaine addiction. Currently, tests and studies are being run to gauge the effectiveness of opioid receptor-blocking medications as well as different medications that are being used to treat dependence for other types of substance abuse with varying results.
That being said, there are several medications that can aid in the detox process to help manage the intense psychological withdrawal symptoms or secondary and co-occurring psychiatric disorders. For example, beta-blockers like propranolol can reduce anxiety and calm the fight-or-flight response stimulated by cocaine use. Propranolol may also effectively damper cravings and the euphoric effect of cocaine, working to promote cocaine abstinence. Amantadine, a drug primarily used to treat Parkinson’s disease, may help with cocaine withdrawal symptoms and cravings also.
One of the biggest issues during cocaine detox is the drop in dopamine levels in the brain. Dopamine is responsible for pleasure, and this significant drop is what leads to depressed moods. Many medications and antidepressants can be issued to help stabilize dopamine levels and balance moods. For example, bromocriptine is a dopamine stabilizer, while desipramine, phentermine, and fenfluramine are antidepressants meant to relieve depression and anxiety as well as stabilize moods. These type of medications are commonly used in cocaine detox protocols. Benzodiazepines like diazepam are sometimes used to relieve anxiety due to cocaine withdrawal; however, benzodiazepines are narcotics with high abuse potentials and should be closely monitored by a medical professional.
Aftercare
Since cocaine withdrawal symptoms are primarily psychological, rehabilitation needs to include emotional support as well as treatment for the physical dependence. Detox is a vital part of recovery – a building block in a larger process. Behavior modification therapies, like Cognitive Behavioral Therapy (CBT), can help to identify social and environmental triggers as well as assist in changing negative thought and behavior patterns. Motivational incentives may be effective in redirecting energies into more positive outlets.
Counseling, group and individual therapies coupled with ongoing support groups and family education can help prevent relapse. It is important to realize that you are not alone. Cocaine can draw you in and be difficult to break free from without help. In 2007, the National Institute on Drug Abuse estimated that as many as 13 percent of those admitted to drug abuse treatment programs suffered from cocaine abuse or dependency.
Due to the high comorbidity rate of cocaine abuse with poly-drug abuse and mental illness, a dual diagnosis treatment model is often the best rehabilitation option. Dual diagnosis treatment models understand the complex nature of co-occurring disorders, realizing the importance of integrated care. At FRN, we strive for the highest level of care and ensure that all staff members are expertly trained and educated in dual diagnosis treatment methods.
In addition to offering a controlled environment for detox, dual diagnosis treatment focuses on healing the mind, spirit and body. Alternative treatment methods are explored and a healthy lifestyle, including a nutritious diet plan, regulated sleep schedules, and exercise regimen, are included. Cocaine addiction and depression are highly treatable disorders with the right care. Call today to discover how a dual diagnosis treatment model can help.
Dr. Michael Miller, a clinical psychologist based in Salisbury, MD, received both his M.D. and Ph.D. from Stanford University in 1975. After ten years in clinical practice and the birth of his daughter, he serendipitously entered medical journalism. Combining his deep interest in health issues with his passion for writing, Dr. Miller has found the perfect synergy. His work spans a wide range of topics, including health policy and basic science, effectively bridging the gap between clinical practice and academic research. In addition to his professional accomplishments, Dr. Miller is a frequent speaker at academic and industry conferences, sharing valuable insights from his extensive career in psychology and health care. He lives with his daughter and their beloved pets in both Salisbury, MD and their country retreat.
