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 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 addictive properties of cocaine. However, cocaine is addictive when addiction is defined as a desire for more of the drug, despite negative consequences.

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

See also:

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

Primary symptoms may include:

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

The craving and depression can last for months following cessation of long-term heavy use (particularly daily). Withdrawal symptoms can 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. Just the same, the cravings may remain powerful.

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

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 completely over time. People experiencing cocaine withdrawal often attempt to self-medicate with alcohol, sedatives, hypnotics, or antianxiety medications, such as diazepam (Valium). Self-medication or replacement is not advised, because each simply shifts addiction from one substance to another.

Because at least 50% of people addicted to cocaine have a co-existing mental disorder (particularly depression and attention-deficit disorder), these conditions must be considered and treated aggressively.

Relapse rates are dramatically reduced when these conditions are treated appropriately. All prescription drugs 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 for most people addicted to cocaine, according to the research.

Presently there are no effective medications for reducing craving, though 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 serious problems.

• 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 extreme joy produced by cocaine, force yourself to think of the negative consequences that follow use. Seek support if you find it helpful.