As with any substance use disorder it is important to realize that change doesn’t happen until one reaches the realization (often through the consequences of multiple unwanted outcomes) that he or she is physically and psychologically dependent on something that is rendering them virtually powerless. The ability to choose whether to continue to use or embark on the fearful but necessary path to recovery can feel like the most terrifying decision of their lives. The physical and psychological relationship with cocaine specifically is no different. It is often described as mimicking that of an unhealthy romantic relationship. All the false beliefs regarding the terms of the relationship, the eventual inability to navigate the demands of the relationship, and the betrayal after realizing that the partner is no longer an ally in many ways mirrors the painful physical and emotional outcomes of a substance use disorder.
Cocaine is a stimulant, one capable of producing extreme euphoria, heightened sexual appetite, and exaggerated perceptions of personal potential resulting in everything from high risk-taking behaviors to fantastic delusional perceptions depending on the amount ingested and the frequency of use. This highly addictive substance offers a great deal of enhanced perceptions, sensations, and beliefs while offering very little in the way of objectivity or opportunity for true personal connection. Ultimately, once a state of dependency is realized it has already become a physically demanding experience of chasing euphoric illusions while continuing to lose one’s ability to engage in the authentic world around them.
To consider “breaking up” with cocaine is to realize that one will be letting go of some potentially extreme highs, euphoric perceptions, and false confidence in order to embrace what turns out to be the rather humble circumstances of “daily life.” A life that the rest of the world seems to have learned to navigate through without all the artificial stimulation. It is also important to realize that asking someone to explore letting go of a relationship with cocaine is essentially asking them to hit a major reset on their perception of themselves and who they truly are as opposed to the fantasy that cocaine promises. It is, however a much easier proposition once someone is experiencing their own powerlessness over the substance, the physical toll on their bodies, and the ultimate realization that their chemical lover has turned on them and never truly delivered the intimacy that the initial euphoria might have seemed to promise.
Why Seek Medically Supervised Treatment?
Once an individual admits that they have lost their power to choose and is ready to take the next step toward breaking their cycle of using a whole new level of magical thinking may emerge. This is the notion that professional help may not be necessary and that going it alone to avoid the shame and disruption of treatment might be their best approach. Although some argue that it is possible to experience detox and recovery without professional help it would be highly unlikely that it would be safe or successful long-term depending on the level of use and the personal health of the individual. The withdrawal process alone can be very dangerous resulting in potential seizures, cardiac events, and possible death. Beyond the fact that medically supervised programs can offer medications that contribute to the comfort level of the individual experiencing detox, the patients can also be personally monitored for their safety. Medications over the course of an inpatient stay in a treatment facility can also allow for reduced cravings, mood stabilization, and even better general mental clarity to maximize the potential benefit of other therapies (CBT, group therapy, trauma therapy, 12-step groups, etc.) offered during their stay as well. Self-detoxification at home besides being medically unsafe rarely offers the opportunity to address the origins of the addictive behaviors themselves which is at the core of any effective relapse prevention program.
What to Anticipate During the Detox Process?
Depending on the level of physical dependency one can anticipate experiencing such acute withdrawal symptoms as anxiety, muscle aches, cocaine cravings, irritability, interrupted sleep (excessive sleeping to insomnia), depression, slower cognitive processing, poor concentration, and even paranoia. Depending on the metabolism and level of use of the individual this process could last a period of days to a few weeks. Additionally, post-acute withdrawal syndrome (PAWS) can show up off and on over months and even longer. These symptoms tend to be more short-lived and managed with good recovery support, however. Typically, a clinically supervised detox process can take around two weeks or less for cocaine. The inpatient treatment itself could be anywhere from a recommended thirty to ninety days.
Some recovery clinicians categorize the cocaine withdrawal experience in phases. The “crash phase” lasts anywhere from a few hours to a few days and is accompanied by symptoms such as severe anxiety and depression. The “craving phase” can begin after the first week and last up to ten weeks with symptoms of severe craving, irritability, and feeling lethargic. Less severe physical dependency will take less time to overcome. The “extinction phase” can show up after about thirty weeks and have less severe impulses, cravings, and preoccupying thoughts of using. It can often be managed with good recovery support and mindfulness exercises. It is important for those in early recovery to understand these experiences are common and not to judge themselves harshly for having these random interruptions in their mood or otherwise improved mental state.
What Medications Might Be Used in Treating Cocaine Addiction?
There are a few medications with various benefits that, according to the National Library of Medicine and a report by, Dr. Kyle Kampman, MD are now being introduced into the world of cocaine recovery treatment. Here are a few with their respective purposes and functions:
Propranolol (Inderal®, AstraZeneca) – As a beta-blocker, propranolol may be able to reduce the anxiety associated with cocaine withdrawal as well as reduce some of the more uncomfortable symptoms of cocaine craving. Beta-blockers may also be able to reduce some of the rewarding properties of cocaine.
Baclofen (Lioresal®, Novartis) – Baclofen is GABA B agonist used as a muscle relaxant. As a GABA agonist, baclofen may reduce the amount of dopamine released into the nucleus accumbens as a result of cocaine stimulation or cocaine craving.
Topiramate (Topamax®, Ortho-McNeil Pharmaceutical) – Topiramate may be an excellent medication for relapse prevention based on its effects on both GABA neurotransmission and glutamate neurotransmission. Topiramate increases cerebral levels of GABA and facilitates GABA neurotransmission.
Disulfiram (Antabuse®, Odyssey Pharmaceuticals, Inc.) – Disulfiram is an established medicine used for the treatment of alcohol dependence. It causes a characteristic unpleasant reaction (extreme nausea and vomiting) when alcohol is ingested due to blockade of the enzyme aldehyde dehydrogenase and the subsequent build-up of acetaldehyde. In addition to its effects on alcohol metabolism, disulfiram also blocks the enzymatic degradation of cocaine and dopamine and leads to extremely high cocaine and dopamine levels when cocaine is ingested. This does not increase the cocaine-induced high, as one might expect, but rather it makes the high less pleasant by increasing the associated anxiety.
Modafinil (Provigil®, Cephelon) – Modafinil is a medication approved for the treatment of narcolepsy. Modafinil was found to block the euphoric effects of cocaine in two independent human laboratory studies. Thus, modafinil may be effective for relapse prevention due to several mechanisms of action.
What Daily Practices Are Necessary for Relapse Prevention?
While relapses in recovery are not uncommon, they are also not required. Developing new daily strategies that offer better opportunities for structure, activity, and connection are of upmost importance in the “re-entry” phase as part of a good relapse prevention plan. Remembering that the dependency on a substance like cocaine is often rooted in the pursuit of euphoric, adrenaline enhanced experiences is paramount to approaching a new normal with intentionality that limits the opportunity to romanticize the high-intensity life that is being left behind. In other words, leave room for one to grieve the absence of all the euphoric thrill-seeking in their early recovery.
Having a structured day planned is a way of limiting the opportunity to get caught with too much unaccounted-for time at first. Having a set bedtime, a set time to wake up daily (even if there is nowhere to be or no appointments on the calendar) allows for a rhythm for daily living to emerge as well as resetting one’s sleep architecture. Knowing there are set times to exercise, engage in contemplative practices, time allotted to prepare for healthy eating, and eventually what a healthy workday will look like is all part of managing ones mental and emotional well-being by creating opportunities to feel positively without the aid of a stimulant.
Something as simple as a good twenty-minute walk every day can stimulate the endorphins (nature’s own antidepressant) that allow the brain to function more clearly and optimally. Taking responsibility for rebuilding the body in recovery is another practice in intentional living. Daily exercise will not only contribute to good physical recovery but will also be empowering as it helps restore what the substance stole from them physically. Remember to incorporate fun into the process! The impact of experiencing joy on neurological health can’t be underestimated.
Connection is a three-pronged approach that involves connecting with a Higher Power (something greater than oneself), connecting with their true self (learning to embrace their truth and present reality), and connection with others (healthy relationships, friendships, recovery support, family, and any positive environment where one is happy to see people who are happy to see them). Connection is a vital and equally intentional exercise incorporating a trusted circle of solid relationships into one’s recovery journey. Isolating behaviors did not offer the opportunity for encouragement, feeling known and heard, or allowing for outside input.
Knowing the “Why” Behind the “What”
Given that the side effects of cocaine use include euphoria, exaggerated senses of confidence, and even feelings of invincibility it is important to explore why those enhanced experiences were so appealing and even felt necessary to be pursued in the past. Asking oneself what it is they were trying not to feel, or what it is they believed was lacking that the substance offered will reveal a great deal about the story one tells themselves about themselves. Continued recovery care with a trained recovery professional (certified recovery coach, LADAC, psychiatric practitioner) is very necessary in helping them explore what cocaine use was helping them avoid or trying to enhance. All the underlying messages that have been a part of the inner narrative over the years will begin to be uncovered as one explores why the relationship to a substance, particularly one like cocaine that offers to create a super-human persona, was so appealing. Dismantling the persona that cocaine helped to create in the mind of the user will be a critical part of helping them embrace the sober version of themselves complete with all their insecurities, anxiety, shame, and restlessness.
Having A Bigger “Why”
Knowing why one wants to embark on a sober life is a pivotal piece to experiencing long-term recovery. What did cocaine steal that must be reclaimed? What do they want their lives to look like from here? What goals and passions did cocaine interrupt and can they still be realized in their recovery? What relationships were jeopardized and nearly severed? Could those relationships be redeemed if intentional sobriety was being demonstrated? Exploring these questions and more helps the identified person embrace a bigger why for the purposeful work ahead. Recovery is a re-claiming of oneself, one’s personal life, and the potential for them to give themselves permission to embrace their truth and give it a voice. The integrated life of recovery makes room for the past and the lessons it teaches while encouraging those who may have lost hope to give themselves permission to embrace a future filled with anticipation, gratitude, joy, and limitless opportunities.