0 to 7 Stages of Crack Cocaine Use and Withdrawal Pattern

0) Currently using: Auditory hallucinations, hypertensive, hyper vigilant. During usage a person may think they hear sirens, cars pulling up outside, music, people talking, etc. Some people will experience tactile hallucinations such as skin crawling or seeing bugs on their skin. They will be extremely alert to the point of paranoia — perhaps suspicious of any movement around the area where they are using. It is common to hide out in the area where use is occurring and refuse to answer the door.

1) Panic stage: 1-3 hours after last use. During this phase money for more is the prime concern. In this phase a person may look for something around their house to sell or pawn or may consider where they may beg, borrow or steal something to sell for cocaine. Looking for lint on the rug hoping something has fallen is common at this point. In this acute withdrawal period, people have been known to try to rob crowded public places (mall stores, convenience stores, fast food restaurants) to obtain goods to sell or money for more crack. The withdrawal is so intense and craving so high that the person has little ability to think or reason logically.

2) Crash Stage: 3-24 hours after last use. Depression; remorse (suicidal); brain is in desperate need of rest but the chemicals (serotonin) necessary for sleep have been depleted and it is difficult, at first, to sleep. In this phase one wonders why they spent all their paycheck, used funds that did not belong to them, pawned valuable household items for less than actual value, stole from persons they truly care about, etc. Often, under the influence of cocaine-induced depression, one makes promises to never do it again in this phase and believes it. Highest risk for suicide is during this period.

3) Honeymoon Stage: 1-5 days after last use. Characterized by feeling very good. The craving is not noticeable or is easily manageable during this phase. The drug effects seem to be wearing off and one is starting to regain confidence in their ability to handle the addiction. During this phase it is common to hear a person say, “I don’t even think about it, I’m not going to have any problem with it. I do not even want it anymore.” A delusive way of thinking that ignores their past cycles and paves the way for the next binge. The chemical messengers of the brain (serotonin/dopamine) necessary to enjoy crack are still depleted and behind this lack of interest in crack. This is a dangerous stage as it is easy to think there is not a problem and therefore, why worry about it? People let down their guard during this phase and commonly use defense mechanisms, e.g., rationalizing and minimizing, to convince themselves this time they are cured and so have no need of further support or treatment. There is a high risk for people in treatment to leave during this phase as they no longer feel, or are aware of, the physical and emotional affects of the original crisis.

4) Return of Craving: 5-14 days after last use. Tremendous upsurge of acute drug hunger, depression, anger. The body has produced enough serotonin/dopamine for the person to want to use more cocaine but not enough to affect stability of mood and emotions. During this phase one may experience vivid dreams, fantasies, and acute drug hunger. Thoughts may cycle around using until a person feels like giving in to the obsession to use. Defense mechanisms (rationalization, intellectualization, denial, minimizing) begin to make a strong comeback after being knocked down by the original crisis.

5) Emotional Augmentation: 14-28 days start - up to 1-2 years. Over-response to the normal stress and events of everyday life. At the top of the mood swing one is unusually happy and at the bottom one is unusually sad. The state of making mountains out of molehills. This is related to biochemical responses induced by strong emotions that stimulate areas where mood and mind altering drugs act on the brain. The body is now seriously undertaking the repairs of areas damaged by drug use and is replacing important chemicals needed to regulate mood and emotions. As a result, one is slightly off balance chemically without being consciously aware of it. There there is a strong need for accurate feedback on one’s behavior from an objective support group. (Recommend AA or NA or another type recovery support group.) This cannot be stressed too highly for long term success in recovery. Also, low impact exercise - walking, jogging, bicycling, low impact aerobics - and a well-balanced diet will shorten this phase and reduce the severity of the symptoms. Irritability, depression, anxiety, mood swings, memory loss, difficulty concentrating, short attention span, nightmares, insomnia, fatigue, and headaches are some of the normal recovery symptoms of the emotional augmentation stage.

6) Covert Cravings: 28-35 days. Secrets and bad judgments characterize this phase. Craving is not as strong on a regular basis but one may have periodic strong cravings and not want to admit it for various reasons. Thinking it is a sign of weakness, poor moral character, that they are not working a good program, that they simply should not be having cravings. Generally, the cravings are of a low level, e.g. euphoric recall (glorifying war stories), vivid dreams that trigger cravings upon awakening, or just general mild drug hunger. Without someone to talk with concerning these normal protracted withdrawal symptoms, they can evolve into high level cravings, e.g. acute drug hunger, drug seeking behavior, obsession and on to compulsion. Again the need for a support system is strongly recommended.

7) Cue Conditioning: 35 days upward. Cue conditioning - referred to as triggers - could be money, anger, disappointment, music, a film, or extreme joy. Anything strongly associated with using could cue/trigger a craving. The strength of these cue cravings will diminish in time but continue on for years although becoming few and far between. They can catch a person off guard and evolve into higher level cravings. Again, a long term support plan for sobriety AA/NA or recovery support group is recommended to alleviate these natural manifestations.

It is a normal part of recovery to have strong cravings due to acute withdrawal 3-7 days and then continued cravings at a lower level well into protracted withdrawal 6 months-2 years. Time and severity of protracted withdrawal depend upon type, amount, and frequency of drug used. Again, a program of good nutrition and low impact exercise can alleviate these normal recovery symptoms.

Please note that behavioral symptoms: compulsion, obsession, loss of control over time, place, amount used and continued use despite adverse consequences are secondary symptoms of the disease process. With continued treatment of the disease with abstinence and a good support system, these behavioral symptoms will diminish to normal discussions over time.