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DefinitionCocaine withdrawal describes the symptoms that develop when a heavy cocaine user cuts down or quits taking the drug.
Causes, incidence, and risk factors
Cocaine produces euphoria by causing the brain to release higher than normal amounts of dopamine, a neurotransmitter linked to excitement related to new experiences and pleasure. (A neurotransmitter is a chemical that sends signals from one nerve cell to another.) Dopamine signals the part of the brain that seems to say "do it again", and taking one dose often leads to the desire for another.
When cocaine use is stopped or when a binge ends, depression (crash) follows almost immediately. This is accompanied by a strong craving for more cocaine, fatigue, pleasurelessness, anxiety, irritability, sleepiness, and sometimes agitation or paranoia.
Cocaine withdrawal is not as dramatic as withdrawal from other highly addictive drugs: there are often no visible physical symptoms like the vomiting and shaking that accompanies heroin withdrawal or the seizures and delusions that can follow alcohol withdrawal.
In the past, people used this lack of physical symptoms to argue that cocaine was not addictive -- but since addiction is primarily a psychological condition involving desire for more of the drug despite negative consequences, this lack of physical symptoms is unimportant.
The level of craving, pleasurelessness, and depression produced by cocaine withdrawal rivals or exceeds that felt with other withdrawal symptoms.
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Primary symptoms include depressed mood, fatigue, generalized malaise, vivid and unpleasant dreams, agitation and restless behavior, or slowing of activity and increased appetite.
The craving and depression can last for months following cessation of long-term heavy (particularly daily) use. Withdrawal symptoms can also be associated with suicidal ideation in some people.
A person in the state of cocaine withdrawal will experience powerful and intense cravings for it, because he or she believes that taking cocaine will eliminate these symptoms.
Ironically, this is not true: once a person has become addicted to cocaine, the high becomes less pleasant and more likely to be an experience of fear and paranoia rather than joy. However, because of the drug's effect on the brain, the addict has a hard time learning this and craving remains powerful.
Signs and tests
A physical examination and history of cocaine use are sufficient to diagnose this condition.
Symptoms are treated as appropriate. Unlike other withdrawal syndromes (such as that associated with alcohol), cocaine withdrawal does not progress to serious or life-threatening complications, though there is a risk of suicide or compensatory overdose.
Symptoms usually resolve completely over time. People experiencing cocaine withdrawal often attempt to self-medicate with alcohol, sedatives, hypnotics, or antianxiety agents, such as diazepam (Valium). This should be discouraged as it is possible to simply shift the addiction from one drug to another.
Since at least 50% of cocaine addicts have a co-existing mental disorder (particularly depression and attention-deficit disorder), these conditions must be looked for and treated aggressively.
Relapse rates are dramatically reduced for people with these conditions who are treated appropriately. Stimulants (such as Ritalin) should not be withheld from people with ADD who have developed cocaine addiction, although use should be carefully monitored. Antidepressants should never be withheld.
Support GroupsThe 12-step support groups, such as Cocaine Anonymous or Narcotics Anonymous, have helped many cocaine addicts. 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 is to be expected. The failure rate at remaining abstinent from cocaine is estimated to be as high as 80% on the first try. However, rates of achieving stabilization are as good as those for other chronic illnesses like diabetes and asthma.
Treatment should start with the least intensive option and move up if necesssary. Outpatient care is as effective as inpatient for most cocaine addicts, 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, to increase energy, and normalize sleep -- particularly amongst those with the most serious problems.
Further studies are being conducted. A vaccine to prevent cocaine from acting if taken is currently in phase II (efficacy) trials in humans.
Because many users will abuse more than one drug, other potentially more serious withdrawal syndromes (e.g., alcohol) need to be ruled out.
Calling your health care provider
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 of cocaine, force yourself to think of the negative consequences that follow use. Seek support if you find it helpful.
Update Date: 5/13/2002Yvette Cruz, M.D., Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT