A guide to the symptoms, timelines, and treatment for cocaine withdrawal

There’s no sugarcoating it.

Cocaine detox—and by extension, withdrawal—is uncomfortable in the extreme; however, it is also an essential early step in the journey from dependence to freedom from substance abuse. While cocaine withdrawal may not be as dangerous as opiate or alcohol withdrawal, heavy users seeking to end their abuse can still expect to face significant psychological and physical challenges over the coming days and weeks.

Understanding what’s to come allows cocaine rehab patients and their loved ones to prepare themselves and their environments, making the process as comfortable and pain-free as possible.

These overlapping factors mean that no two people experience the exact same withdrawal; however, most individuals ending cocaine abuse still follow a broadly predictable series of symptoms that present over 4 stages: the crash, early- and mid-withdrawal, and post-acute withdrawal.

A cocaine crash, also sometimes referred to as a cocaine comedown, may occur within hours to a day after last use, peaking within 48 to 72 hours. Common cocaine crash or comedown symptoms include:

• Severe fatigue
• Sleep disturbances and irregularities (both insomnia and hypersomnia may present)
• Intense cravings for cocaine
• Irritability and anxiety

Heavy users might experience the occasional cocaine crash when they lose access to the drug or are unable to take it for a day or two.

After around 4 days, the crash phase starts transitioning into early withdrawal. Over the next three days, the existing symptoms persist and may intensify. New symptoms that may emerge include:

• Mood fluctuations and emotional sensitivity, alternating between periods of anxiety and depression
• Mental fog and concentration issues
• Physical symptoms, such as headaches, tremors, hyperhidrosis (excessive sweating)
• Continued sleep disturbances with vivid dreams and nightmares

Cocaine withdrawal symptoms reach their peak intensity anywhere between 1 and 4 weeks since last use. Cravings, mood swings, restlessness, anxiety, depression, and physical discomfort intensify to their highest levels before slowly tapering off.

While some individuals see a marked improvement in their physical and psychological well-being after getting through peak withdrawal, some individuals experience post-acute withdrawal symptoms (PAWS) for up to several months after their last use.

• Low-intensity fatigue, depression, emotional sensitivity, and difficulty focusing.
• Occasional strong craving for cocaine

That said, treatments that help to stabilise the mood and manage triggers, anxiety, and insomnia can make detox and withdrawal significantly more comfortable, reducing the odds of relapse.

Effective cocaine detox and withdrawal treatment typically involves three key components: medical support, psychological therapy, and physical care.

There’s no medication for cocaine withdrawal like Librium for alcohol or methadone for opioids. Depending on their patients’ needs, doctors or psychiatrists prescribe specific medications to address specific symptoms. As they’re dealing with substance abuse patients, they will often prescribe short courses of non-habit-forming versions of medications to avoid further complications.

• Antidepressants to stabilise the mood
• Sleep aids to manage insomnia
• Anti-anxiety medication for panic attacks (if required)

If you or a loved one plans on ending cocaine abuse, please consult a physician for advice on medical treatments to ease the discomfort of withdrawal. While the medications above do help, they should only be taken as prescribed by a medical professional who is fully up to date with your substance abuse history. Antidepressants and anxiety medications may ease depression, irritability, and insomnia, but they carry their own risk of dependence and dangerous interactions with other substances.

Psychological therapy can significantly increase the chances of maintaining sobriety, especially within the first month after last use, when discomfort peaks. Whether as part of an intensive residential rehab programme for heavy users, day-to-day outpatient care for individuals in detox or post-detox, or as continued support for those experiencing prolonged withdrawals, psychological therapies play a critical role in understanding and addressing the root causes of addiction and developing personalised toolkits for dealing with stress and triggers.

Addiction specialists most commonly rely on a personalised mix of treatment, based on the patient’s needs, typically including:

• Cognitive Behavioural Therapies (CBT) – the backbone of substance abuse treatment worldwide, CBT is presented in a one-to-one format and helps individuals identify and change harmful thought patterns and behaviours.
• Dialectical Behavioural Therapies (DBT) – especially helpful for patients also suffering from mental health disorders, DBT helps individuals develop emotional resilience and regulation, critical skills for dealing with stress and triggers.
• Family therapies – More often than not, addiction will affect everyone in the family. Family therapy not only helps loved ones to address past conflicts and disappointments but also to move forward with a better understanding of addiction and how to create a recovery-friendly environment at home.
• Group therapies – when facilitated by a trained addiction specialist, group therapy helps individuals gain perspective on their own addiction, learn from others, and share accountability.

Of the almost 138,000 adults seeking treatment for all substance abuse treatment in the UK in 2022/23, including for cocaine, more than two-thirds (71%1) said that they required mental health treatment, highlighting both the psychological toll of addiction and the need for access to quality psychological treatment, even when going through detox and withdrawal at home.

An environment set up to deal with the requirements of an individual experiencing cocaine withdrawal can have a significant positive impact on their comfort and the likelihood of success. Key elements of supportive care and a recovery-friendly environment include:

• A clean, quiet, and restful space, removed from stressors, people, and places that trigger cravings or abuse.
• Ensure all access to cocaine is completely removed.
• Access to emotional support through a trained professional, friends, or family.
• Nutritious meals and proper hydration. Nutritional imbalances lead to mood disturbances and cravings—good food heals.
• A consistent and structured daily routine, ideally including some light exercise such as walking and activities that require creativity and/or mindfulness.

You can’t cure the symptoms of continued cocaine abuse overnight or with a pill. By the time an individual has used cocaine regularly enough to experience withdrawal and enter detox when quitting, cocaine has created a strong psychological dependency and neurochemical imbalances that will take time to recover. That said, a planned approach that integrates medical intervention, psychological support, and a recovery-friendly environment can dramatically ease the pain and discomfort, setting the stage for a successful detox and long-term recovery.