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Cocaine Withdrawal Timeline: Symptoms, Duration and Treatment

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Last Updated - 06/24/2024

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Key Takeaways

  • Cocaine withdrawal begins shortly after cessation, with symptoms like increased appetite, exhaustion and psychological distress.
  • The first 24 hours are marked by acute symptoms, including intense cravings, dysphoria and potentially suicidal thoughts.
  • Physical symptoms during the initial week can include fatigue, hunger and discomfort, while psychological symptoms may involve anxiety, depression and cravings.
  • Long-term withdrawal can last weeks or months, with mood swings, anhedonia and cravings as common symptoms.
  • Factors influencing withdrawal severity include usage frequency, dosage, administration method and individual health.
  • Medical supervision is recommended during detox to manage symptoms and reduce relapse risk.
  • While no FDA-approved medications for cocaine withdrawal exist, off-label medications may be used to treat specific symptoms.
  • Support networks and behavioral therapies are crucial for managing long-term withdrawal and aiding recovery.
  • Ongoing treatment and aftercare are essential for maintaining sobriety and preventing relapse.

The Causes and Effects of Cocaine Withdrawal

Cocaine withdrawal is a significant phase in the journey to recovery from addiction. It occurs when an individual who has been using cocaine consistently stops or drastically reduces their intake. Cocaine, a powerful stimulant, causes intense changes in the brain’s chemistry, particularly elevating the levels of dopamine, a neurotransmitter associated with pleasure and reward.

When use is discontinued, the brain struggles to regain balance, leading to a variety of withdrawal symptoms. These symptoms can be both physical and psychological, varying in severity based on factors such as the duration of cocaine use, the amount consumed and individual health conditions.

Due to the potential severity and risks associated with cocaine withdrawal, medical supervision during detoxification is highly recommended. This ensures a safe environment where symptoms can be managed, reducing the risk of relapse and providing support for the individual’s physical and psychological well-being.

Cocaine Withdrawal Effects in the First 24 Hours

The initial phase of cocaine withdrawal, known as the crash, typically begins within hours after the last dose. During this time, individuals may experience a range of symptoms that can affect both their physical and mental well-being.

The abrupt cessation of cocaine use leads to a sudden drop in dopamine levels, resulting in intense cravings and a profound sense of dysphoria. The severity and onset of these symptoms can vary widely among individuals, influenced by factors such as frequency of use, dosages and individual physiology.

Initial Physical Cocaine Withdrawal Symptoms

The initial 24-hour period following cessation of cocaine use is critical, marking the onset of withdrawal and presenting several physical symptoms. During this phase, individuals may experience a range of withdrawal symptoms as the body begins to adjust to the absence of the stimulant. 

Notable physical symptoms include:

  • Agitation and restlessness: A heightened unease often characterized by an inability to remain still or calm.
  • Fatigue: Intense tiredness and lack of energy are common as the stimulating effects of cocaine wear off.
  • Increased appetite: Cocaine suppresses appetite, so its discontinuation may lead to a sudden increase in hunger.
  • Physical cravings: A strong desire to use cocaine again to relieve withdrawal symptoms or to re-experience its effects.

It is vital to recognize that while these symptoms are uncomfortable, they are typically not life-threatening. However, they can be intense enough to encourage relapse, making medical supervision and support crucial during this period. Cocaine withdrawal is a complex process that requires comprehensive care for successful recovery.

Initial Psychological Cocaine Withdrawal Symptoms

Although cocaine withdrawal is not typically associated with severe physical symptoms like those seen with alcohol or opioid withdrawal, the psychological impact can be substantial and may necessitate medical attention. These symptoms are a direct result of the brain’s sudden deprivation of the drug’s stimulant effects.

Significant psychological symptoms during this period include:

  • Agitation: Anxiety, irritability and disordered thoughts are some of the most common symptoms.
  • Mood changes: Depressive moods characterized by profound sadness or hopelessness.
  • Self-harm: This dysphoric state can sometimes escalate to suicidal thoughts or behaviors.
  • Sleep disturbances: Insomnia is a common symptom, further exacerbating the psychological distress.

Despite the discomfort, these psychological symptoms are a normal part of the withdrawal process and signify the body’s attempt to readjust to the absence of the substance.

Days 2-7 of Ongoing Cocaine Withdrawal

While the physical and psychological symptoms may begin to subside after the first few days, cravings for cocaine can remain strong and present a significant risk for relapse. Withdrawal symptoms such as depression and insomnia may also persist. It is during this period that medical intervention and social support become paramount. Medical professionals may provide symptomatic relief to make the withdrawal period more bearable. 

Additionally, a safe detoxification setting can offer the necessary monitoring to manage symptoms and address relapses effectively, thereby enhancing the chances of a successful recovery. It is also during this time that individuals may benefit from outpatient therapies, which provide resources to manage withdrawal symptoms and reduce cravings, ultimately supporting the journey toward long-term recovery from cocaine dependence.

Physical Symptoms During First Week of Cocaine Detoxification

The physical withdrawal symptoms during this time may include extreme fatigue, increased appetite and physical discomfort. Some common physical symptoms reported during the first week of cocaine withdrawal include:

  • Exhaustion and lethargy, resulting in extended periods of sleep or difficulty waking.
  • Increased hunger, as the body seeks to replenish energy reserves.
  • Muscular aches and pains can be widespread and contribute to physical discomfort.
  • Chills and tremors reflect the body’s adjustment to the absence of stimulant effects.
  • Headaches can range from mild to severe in intensity.

The first week of withdrawal is a pivotal time for individuals seeking to overcome cocaine dependence and appropriate care can significantly impact the success of long-term recovery efforts.

Psychological Symptoms During First Week of Cocaine Detoxification

This period is fraught with emotional turmoil as the brain adjusts to the absence of the drug’s stimulation. The cravings are often accompanied by a profound sense of dysphoria or depression, which, in severe cases, may lead to suicidal ideation or attempts.

Common psychological symptoms during the first week include:

  • Intense cravings for cocaine
  • Increased anxiety
  • Agitation and restlessness
  • Depression and dysphoria
  • Suicidal thoughts in severe cases
  • Difficulty concentrating
  • Exhaustion coupled with an inability to experience pleasure (anhedonia)

It’s crucial to have access to healthcare professionals who can monitor symptoms and provide immediate intervention if necessary. This not only ensures the safety and comfort of the individual but also provides support to mitigate the risk of relapse.

Navigating Cocaine Withdrawal Long-Term

The long-term phase of cocaine withdrawal, which extends from the second week onwards, can be characterized by a set of persistent symptoms that may continue for weeks, months, or even years after cessation of use.

During this phase, individuals may experience protracted withdrawal symptoms, also known as post-acute withdrawal syndrome (PAWS). These symptoms are particularly challenging because they can wax and wane over time, with varying intensity.

Long-Term Physical Symptoms

The long-term phase of cocaine withdrawal can extend for weeks or months, presenting persistent physical symptoms that vary in intensity. Common long-term physical symptoms include:

Common long-term physical symptoms include:

  • Physical discomfort such as chills, tremors, muscle aches and nerve pain.
  • Increased appetite, often following a period of decreased appetite during the acute withdrawal phase.
  • Continued cravings for cocaine where the body intensely craves for the drug again.

Although there are currently no FDA-approved medications specifically for treating cocaine withdrawal, certain medications may be used off-label to address specific symptoms such as depression or anxiety.

Long-Term Psychological Symptoms

The long-term phase of cocaine withdrawal, which can extend for weeks or even months, is characterized by persistent psychological challenges. Individuals may experience a range of symptoms that include: 

  • Depression, general irritability, anxiety and mood swings.
  • Anhedonia, the inability to feel any pleasure.
  • Suicidal thoughts, ideation or attempts.
  • Sleep disturbances, including erratic sleep patterns, vivid and unpleasant dreams.

Support networks and treatment services, such as those offered by the Substance Abuse and Mental Health Services Administration (SAMHSA), play a critical role in providing the necessary care and assistance during this challenging time.

Factors Influencing the Cocaine Withdrawal Timeline

The timeline and severity of cocaine withdrawal symptoms are influenced by several factors, which can vary significantly from one individual to another. These factors include the frequency and dosage of cocaine use, the method of administration, the duration of use and the presence of co-occurring mental health conditions.

For instance, individuals who have used cocaine more frequently and in higher doses are likely to experience more intense withdrawal symptoms. Similarly, the method of consumption, such as smoking crack cocaine, can lead to a more rapid onset of withdrawal compared to snorting powdered cocaine.

Medical conditions, psychological state and environmental factors, such as stress levels and support systems, also impact the withdrawal timeline. It’s crucial to recognize that managing withdrawal is just the first step in treatment and ongoing therapy is often necessary to address the underlying causes of addiction and prevent relapse.

Effective Treatment Strategies for Cocaine Withdrawal

Managing cocaine withdrawal is a critical step in the journey toward recovery and while the FDA has not approved any specific medications for cocaine withdrawal, several treatment strategies can provide relief and support. 

Medical Detoxification

Medical detoxification is a cornerstone of treatment, offering a safe environment where healthcare professionals monitor and manage withdrawal symptoms. This approach may include administering medications to alleviate symptoms like headache and insomnia, which can be essential for patient comfort during early recovery.


For severe cases, inpatient treatment programs offer structured care and round-the-clock monitoring, which is crucial for individuals at high risk of relapse or those with co-occurring mental health disorders.

Behavioral Therapy

Behavioral therapies, such as cognitive-behavioral therapy (CBT), are instrumental in helping individuals develop coping strategies to deal with cravings and avoid relapse. The combination of medical and psychological support ensures a comprehensive approach to managing withdrawal symptoms and reducing the risk of relapse.

Lifestyle Changes

Lifestyle interventions, including rest, relaxation, exercise and a nutritious diet, are also beneficial in reducing withdrawal symptoms. Support networks and group counseling can provide the necessary social support to navigate the challenges of withdrawal.

It is important to note that withdrawal management is the first step in a long-term recovery process. Ongoing treatment, including outpatient programs and aftercare planning, is vital for sustaining sobriety and preventing relapse. 

If you or a loved one struggles with drug or alcohol addiction, Orlando Recovery Center is here to help. Our physician-led, evidence-based rehab programs include medical detox, inpatient and outpatient rehab and a full continuum of care in between. Our compassionate team will help you start life fresh with the tools, coping strategies and resources you need to succeed. Don’t wait — contact a Recovery Advocate today to see how we can help.


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