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Withdrawal from Stimulants

Stimulants (Cocaine, Crack Cocaine, Amphetamines, and Methamphetamine) detox

The two most commonly abused stimulants are cocaine and methamphetamine. Intermittent binge use of both agents is common. The withdrawal symptoms that occur after a 2- to 3-day binge are different than those that occur after chronic, high-dose use. The withdrawal syndromes are similar.

Following a 2- to 3-day binge, stimulant abusers are dysphoric, exhausted, and somnolent for 24 to 48 hours. Because cocaine abusers commonly take alcohol, marijuana, or even heroin with cocaine to reduce the irritability caused by high-dose stimulant abuse, the withdrawal may be in response to the combination of drugs. The patient also may have become dependent on more than one drug.

Following regular use, the withdrawal syndrome consists of dysphoria, irritability, difficulty sleeping, and intense dreaming. Often stimulant abusers experience signs and symptoms of the abuse of multiple drugs. The symptoms subside over 2 to 4 days of drug abstinence.

There is no specific treatment for stimulant withdrawal. Mild sedation with phenobarbital or chloral hydrate for sleep may ameliorate patients’ distress.

In the medical literature, descriptions of cocaine withdrawal can be confusing because some authors define cocaine craving as a prominent withdrawal symptom. Scientists are not yet certain that craving is a withdrawal symptom. Cocaine craving usually rapidly diminishes in inpatient cocaine abusers when they are unable to get the drug and no longer come in contact with the environmental stimuli associated with cocaine use.

Although the mechanism of drug craving is not well understood, recent studies have demonstrated that environmental and other stimuli can trigger the physiological process of craving (O’Brien et al., 1991). Therefore, exposure to stimuli (which include other drugs) must be controlled.