Cocaine has a half-life of only one hour. Half the dose has been metabolized in an hour, three-fourths in two hours and seven-eighths in three hours. Because of this, the initial effects of cocaine disappear rather quickly. Withdrawal can begin in as soon as 6 hours from the last dose.
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They are uncomfortable, and may be dangerous, but are not considered life threatening in most patients.
Because the physical withdrawal symptoms are less than for other addictive substances, before the 1970s there was some argument about whether cocaine was addictive at all. This changed when the idea of psychological addiction emerged.
Psychological addiction with cocaine is thought to be driven partly by actual physical changes in the neurotransmitters and neurons in the brain. Research continues in this area to elucidate the actual mechanism in the hopes that a medication can be found to combat symptoms.
The major symptom is a severe craving for the drug. This can lead to behavior that is at odds with reality (criminal risk, harmful effects) and seems to hijack the user's will. While cravings are associated with all addictive drugs, with cocaine the problem is so severe that the drug is considered by some to be the most addictive of all.
Major physical symptoms of cocaine addiction:
- Restless behavior and agitation
- An inability to sit still or ‘quiet the mind’.
- In some cases, especially after a binge, quite marked, with an extended period of sleep.
- Depressed mood
- This is augmented when addicts are confronted by the truth of their addiction as they undergo withdrawal.
- Increased appetite
- After a day or two without cocaine the appetite goes back to normal and hunger reappears.
- Vivid and unpleasant dreams
- These sometime prevent those in withdrawal from getting the ‘good’ sleep that their body needs to recover. Many in withdrawal will seek out medications or use marijuana to help them sleep.
Because the relapse rate is so high, addicts are at risk when they withdraw and then relapse. The risk is overdose when someone who has been clean for weeks or months goes back to the drug and overestimates the amount they can handle. The slide back into use isn’t as slow or as carefully done as the initial addiction process. An addict returning to the drug will quickly regain their previous use pattern.
Another risk comes from the depression during withdrawal. In some cases, it may be serious enough that suicidal thoughts emerge. Addicts who first started cocaine use to combat depression (self medicate) are even more at risk. Not only does the original depression come back, but it is magnified by the depression associated with withdrawal.
Finally, there is a little understood phenomenon where users who have undergone physical withdrawal return to the drug and have a severe reaction. In these cases, even a small dose of cocaine will act as if it were an overdose – putting them at risk of heart attack or stroke.