Study of Cocaine Withdrawal Shows Symptoms Are Less Daunting Than Previously Thought

BUFFALO, N.Y. - Withdrawal from cocaine is no picnic, but a study by a researcher at the University at Buffalo has shown that it may not involve the wrenching ups and downs and intense cravings that specialists in the field have considered the norm.

Scott Coffey, Ph.D., a UB assistant professor of psychiatry and a specialist in drug craving in substance-dependent persons, reports in the current issue of Drug and Alcohol Dependence, that craving is relatively mild during cocaine withdrawal compared to other drugs of abuse, and that cocaine withdrawal symptoms decrease steadily over time.

Moreover, unlike earlier inpatient studies of cocaine withdrawal and research on alcohol withdrawal, these patients did not report significant disruptions in sleep.

The results are important for two reasons, Coffey noted: They convey a hopeful message to persons concerned about their ability to quit cocaine, and they define specific differences between cocaine withdrawal and withdrawal from other addictive drugs.

"We have been trained to think of withdrawal as a general condition," he said. "But we are finding that each substance has a different set of symptoms and requires a different approach to detoxification and treatment. For example, a person can die from alcohol withdrawal, and while cocaine withdrawal may be somewhat unpleasant, you'll live through it."

Previous studies of cocaine withdrawal involved inpatients, and they found relatively mild withdrawal symptoms, especially when compared to other drugs of abuse, such as alcohol or heroin. One criticism of these studies, Coffey said, was that the patients weren't exposed to their normal cues for cocaine use. Common cues would include a crack pipe, encountering the dealer or seeing acquaintances who use cocaine.

"To address this criticism, we examined cocaine-dependent patients in an outpatient setting," Coffey said, "and we found similar mild withdrawal symptoms, even when they were exposed to usual cues. Given the accumulating evidence, we believe the current characterization of cocaine withdrawal should be questioned."

Coffey conducted his research at the Medical University of South Carolina in Charleston, where he previously was a research associate. Study participants, who were all dependent on cocaine or both cocaine and alcohol, were required to abstain from cocaine use for 28 consecutive days. Twenty-four persons completed the study.

Drug status was monitored via urine analysis and Breathalyzer on day 2 (48 hours after the beginning of abstinence) and approximately every five days thereafter. During these clinic visits, a trained interviewer administered several standard questionnaires to determine patients' physical, emotional and psychological withdrawal symptoms

To determine if symptoms decreased gradually, or increased and decreased in phases as previously reported, Coffey grouped his results into three time blocks roughly coinciding with those phases: days 2 and 5; 10 and 14; and 21 and 28.

Analysis showed that patients experienced significant reductions in depression and anxiety, and that the improvements occurred in a linear fashion rather than in phases. Patients also reported relatively mild craving, significantly fewer psychiatric symptoms than early in abstinence, and an increase in energy and ability to think clearly.

In contrast to findings reported in inpatient studies, sleep patterns were stable and satisfactory following cocaine withdrawal. This difference was attributed to the assumption that, unlike inpatients, outpatients were sleeping in more familiar surroundings.

Defining the specific symptoms of cocaine withdrawl is essential for proper treatment, Coffey said. "The description of cocaine withdrawal we've given in the past warned of intense cravings that come and go, depending on the phase of withdrawal the patient is experiencing," he added. "Instead, we found that cravings decrease in a linear fashion.

"If we keep hammering away at intense cravings and patients aren't experiencing intense cravings, the treatment won't make sense. We've said the same thing about sleep during cocaine withdrawal. We've told people they would be sleeping fine at times, but they may not sleep well during a different withdrawal phase. Instead, we found that outpatients reported satisfactory sleep during cocaine withdrawal.

"When we tell patients that withdrawal symptoms will start and stop and start again, and this is not what the patient experiences, it paints a chaotic picture.

"Now we can provide patients with a more predictable scenario," Coffey said. "Now we can tell patients, 'You are going to get better over time. Things will definitely be better tomorrow as long as you continue to abstain.' It provides a very positive message."

This study is part of a larger investigation directed by Bonnie S. Dansky, Ph.D., of the Medical University of South Carolina, and was funded by the National Institute on Drug Abuse.