At least three stages are typically described for cocaine withdrawal. According to the text “Drugs and Human Behavior,” the first stage is an intense “crash” that follows coming off the drug, which can last for up to four days. The second is a period of dysphoria and intense craving that can last for one to 10 weeks. Finally, the third has an indefinite duration, where cravings occur and gradually become extinct.
Stage 1: Crash
The crash refers to an intense worsening of mood and decrease in energy, according to the text “Drugs and Human Behavior.” According to the website Addiction Info, this period is one where the individual will likely sleep more and feel depressed, shameful, fearful, confused, self-doubting and anxious. Additionally during this stage, the urge to use cocaine is strong. Other symptoms include irritability, concentration difficulty, paranoia and difficulty coping with stress. One of the hallmarks of this stage is anhedonia, the inability to feel pleasure. This is due to the fact that the brain is in such desperate need of the chemicals it has become so accustomed to getting from cocaine that there is a dwarfing of the brain's natural ability to produce the chemical responses related to pleasure. It is during this stage, which can last up to four days, when suicide may be contemplated and attempted, according to MedHelp.
Stage 2: Withdrawal
This period is characterized by extreme dysphoria or malaise, loss of pleasure, lack of motivation and increased cravings, notes “Drugs and Human Behavior.” This stage, which can last up to 10 weeks, begins with a "honeymoon" period characterized by improving energy and optimism regarding recovery, notes Addiction Info. The National Institute on Drug Abuse, or NIDA, notes that after this honeymoon period individuals hit the wall, which is the major hurdle in recovery because during this time reduced physical and sexual energy, depression and anxiety, irritability, and strong cravings make relapse a very real possibility. This risk for relapse is high during this stage, notes “Drugs and Human Behavior,” because the "wall of anhedonia" seems insurmountable. However, if patients can pass this stage without relapsing, there is a reasonable chance of remaining abstinent.
Stage 3: Extinction
This last stage has an indefinite duration, according to “Drugs and Human Behavior.” This period, beginning somewhere after as little as two weeks post drug and as many as 10 weeks, can indeed continue for years, notes NIDA, but cravings occur less frequently and less intensely. During this stage mood improves and a sense of normalcy begins to return, although boredom and a sense of loneliness may be present. During this phase, environmental cues can trigger memories of "cocaine euphoria," which can activate drug seeking behavior, notes “Drugs and Human Behavior.” In order to maintain "the extinction," it is often necessary to remove the user from environments associated with drug use. “Drugs and Human Behavior” notes that statistics for relapse are varied, from as little as 20 percent up to 80 percent.
References
- The National Institute on Drug Addiction
- Addict Info
- "Drugs and Human Behavior"; Tibor Palfai and Henry Jankiewicz; 1997
- MedHelp: Cocaine Withdrawal
