Cocaine withdrawal

**Cocaine withdrawal** happens when a person who uses a lot of cocaine stops using cocaine.  It can also happen when a person who uses a lot of cocaine starts using less cocaine than they did before.

Cocaine (also called **coke**) is a powerful stimulant.  It is an illegal drug outside of hospital usage.  It makes people feel very happy, talkative, energetic, and not want to eat as much food.

## Side effects of cocaine
Cocaine's most dangerous side effects include:
* Increased body temperature (high fever)
* Irregular heart rate or rapid heart rate
* High blood pressure
* Increased risk of heart attack
* Strokes
* Sudden death from cardiac arrest
* Sudden aggression
* Sudden very bad paranoia
* Feeling, seeing, or hearing things that are not really there (hallucinations), including feeling like there are insects under the skin (this is called *formication* or *coke bugs*)

## Withdrawal effects of cocaine
After using cocaine regularly, some users will become addicted.  When a person who is used to using cocaine stops right away, they will go through what is called a "crash" along with many of other cocaine withdrawal symptoms, like:

* Paranoia
* Depression
* Exhaustion (feeling very tired)
* Anxiety
* Itching
* Mood swings (quick changes in emotions)
* Irritability (feeling easily annoyed)
* Fatigue (feeling tired), sleeping many hours
* Insomnia (trouble sleeping)
* A very strong craving for more cocaine
* Nausea and vomiting.

Some cocaine users also report having similar symptoms to schizophrenia patients and feel that their mind is lost. Some users also report formication: feeling like things are crawling on the skin (also called, "coke bugs" or "spiders").  These symptoms can last for weeks or, in some cases, months.

Even after many withdrawal symptoms go away, most users feel like they need to keep using cocaine. This feeling can last for years and may get worse during times of stress.  About 30-40% of cocaine addicts start using other kinds of drugs or alcohol after they stop using cocaine.

## Treatment
### Therapy
*Twelve-step programs* like Cocaine Anonymous (modeled on Alcoholics Anonymous and Narcotics Anonymous) have been widely used to help people addicted to cocaine.  Cognitive Behavioral Therapy (CBT) and Motivational Therapy (MT) have proven to be more helpful than 12-step programs in treating cocaine dependency. However, both of these approaches have a fairly low success rate.

Ibogaine has been researched a treatment for cocaine dependency.  It is used in clinics in Mexico, the Netherlands, and Canada, but it cannot be used legally in the United States.

Non-drug treatments like acupuncture and hypnosis have been studied.  However, these studies have not clearly shown that acupuncture or hypnosis helps with cocaine withdrawal.

Cocaine addiction continues to be the second-most difficult addiction to manage, behind heroin addiction.

### Medications
Medications that have been studied to treat cocaine withdrawal include acetylcysteine, baclofen, bupropion, vanoxerine,  and vigabatrin.

The anti-depressant desipramine, and the stimulants methylphenidate and pemoline, have been used to treat cocaine dependence in people who also have a mental illness.

Several drugs have been used to treat cocaine withdrawal and cravings:
* The anti-convulsant drug carbamazepine (Tegretol);
* Medicines which increase the amount of dopamine in the brain, like L-DOPA/carbidopa
* Amino acids
* Tyrosine

However, a more recent study looked at prize-based contingency management: a treatment method that offers addicts chances to win prizes if they do not use cocaine.  This study found that prize-based contingency management helped cocaine addicts stay off cocaine, whether or not they had gambled recently.  This suggests that it is the chance of a reward, not the gambling itself, that helps cocaine addicts stay off of cocaine.

## References