Cocaine detox at Castle Health

Unlike alcohol or opioid withdrawal, cocaine does not typically cause seizures or other physical symptoms. But the psychological symptoms that follow stopping cocaine can be severe, and for some people, dangerous.

The most common symptoms include:

• Intense cravings for cocaine
• Low mood and depression
• Anxiety and restlessness
• Difficulty sleeping, or sleeping too much
• Fatigue and low motivation
• Poor concentration
• Increased appetite

For some people, withdrawal also involves more acute psychiatric symptoms. Research published in the Journal of the American Medical Association found that cocaine withdrawal can involve severe anxiety and depression, hostility, and paranoia.

In some cases, withdrawal is associated with suicidal thoughts, particularly in the weeks following heavy or prolonged use.

The levels of the neurotransmitters norepinephrine and serotonin are thought to be significantly reduced by long-term cocaine use, according to research published in the National Center for Biotechnology Information. That depletion is part of why the crash that follows stopping can feel so severe. It’s a physiological response to a powerful drug.

Cocaine withdrawal doesn’t follow a clean timeline the way alcohol withdrawal does.

Clinical guidance on stimulant withdrawal indicates that symptoms typically begin within 24 hours of last use. The most acute phase lasts around three to five days (National Center for Biotechnology Information). But the psychological symptoms like depression and cravings can persist for several weeks or months after that.

MedlinePlus notes that the craving and depression can last for months after stopping long-term heavy use. For heavy or long-term users, the post-acute phase is riskier than the first few days.

At Castle Craig, you remain under medical supervision throughout, and are transferred to the main treatment programme only once the clinical team is satisfied it is safe to do so.

Cocaine withdrawal doesn’t carry the same physical risks as alcohol or heroin withdrawal. There are no seizures, and no dangerous autonomic effects. That has led to a dangerous and widespread assumption that cocaine detox doesn’t need medical support.

The most serious risks in cocaine withdrawal are depression, paranoia and suicidal ideation. Research from ISSUP (the International Society of Substance Use Professionals) notes that some individuals face greater challenges in managing withdrawal than others, and that the depression following a cocaine binge can be significant and last for several days.

The need for close support is critical in these cases, but that level of oversight isn’t standard across treatment providers.

Crack cocaine and powder cocaine are pharmacologically similar, but the way crack is used creates a different clinical picture. Because it’s smoked, crack reaches the brain faster and produces a sharper, shorter high, then a more intense crash.

According to research published in PubMed, there is greater abuse liability and a more severe dependence profile when cocaine is smoked, compared with intranasal use. The detox approach is the same in principle, but the post-acute psychological symptoms, like depression and anxiety, tend to be more pronounced.

If you have been using crack cocaine, your clinical assessment at Castle Craig will take this into account so we can tailor your detox plan.

There’s no licensed medication specifically for cocaine withdrawal. What we can do clinically is manage the symptoms that withdrawal produces. Where depression or severe agitation is present, short-term antidepressants or anxiolytics may be prescribed. If sleep is badly affected, we can help with that too. 

NICE guidance on stimulant withdrawal supports a cautious approach to medication: used only in cases where it could help. Every patient at Castle Health is assessed on arrival. Any medication used during detox is prescribed based on your needs and reviewed by our resident doctor and consultant psychiatrist.

Some people do stop using cocaine without clinical support. But cocaine use disorder carries a high relapse rate, and the psychological crash, combined with no clinical monitoring, are usually what lead to relapse.

The research from ISSUP notes that less than 25% of primary cocaine-dependent patients were abstinent at discharge in unsupported settings. Inpatient detox changes that. You’re out of your normal environment, under medical supervision, and move directly into the next stage of treatment rather than going home.

The gap between detox and therapy is when people are most vulnerable. At Castle Health, there is no gap. You can read more about how our inpatient treatment programme is structured, or speak to the admissions team directly.

All patients arriving at Castle Craig begin their stay at Kirkurd House, a 12-bed admissions and detoxification unit with full-time nursing presence and on-site medical assessment on arrival.

A resident doctor and consultant psychiatrist review every patient’s file shortly after admission. For cocaine detox, where the risks are predominantly psychiatric, that level of oversight is what makes our approach different from a standard monitored withdrawal.

You remain at Kirkurd House until the clinical team is satisfied it’s safe to transfer you to the main treatment programme. That assessment is made individually, based on your progress. There’s no fixed timeline, and no pressure to move before you’re ready.

The first conversation with our admissions team is confidential and comes with no obligation. Our job at that stage is to understand your situation and work out whether Castle Health is the right fit. 

If admission is appropriate, the pre-admission process typically takes two to three days, though in some cases it can move faster. Your case manager will stay in contact with you throughout, right up to the day you arrive.

You can find more detail about what to expect on our admissions process page.

If someone in your life is using cocaine and you’re wondering whether to say something, you’ve likely been dwelling on that question for a while. It’s common to feel like you’re getting it wrong whatever you do. You may feel like saying something will push them away, but saying nothing will make you complicit.

There’s no single right way to approach it. But what tends to help is being direct without being confrontational. Say what you’ve noticed and that you’d like to help them find support. You’re not trying to force a decision. Just open the door.

Our admissions team can also speak with family members and friends who are researching options on someone else’s behalf. You don’t need to have a firm plan in place before you call.

Supporting someone through a decision about treatment, especially when they’re not yet ready to make it, takes a real toll. The sense that you’re not doing enough is something most people in that position feel.

Your own wellbeing matters here. Looking after yourself is part of how you support someone else.

Addiction affects the people around it. Our family programme at Castle Craig is designed to address that directly, giving family members their own space to understand what has happened, process its impact, and build a stable foundation for the person in their life returning home.

Family therapy sessions can take place while your family member is in treatment. There are also workshops available to close family members that run separately. You can find out more on our family support programme page.

The cost of cocaine detox varies depending on the length of stay and individual clinical needs. We’ll give you a clear cost breakdown during the admissions process. To get a personalised figure, speak to our admissions team directly.

Our cocaine detox programme is residential, which means you live at Castle Craig for the duration. Most people take a planned period of leave from work. Our admissions team can discuss the practicalities with you, including what documentation we can provide.

Using cocaine alongside alcohol or other substances is common, and it changes the clinical picture. It doesn’t prevent you from accessing treatment, but it needs to be factored into your detox plan from the start. Tell our team everything at the assessment stage. The more we know, the safer we can make your detox.

Some private health insurance policies cover residential addiction treatment, including detox. We can help you understand what your policy covers. Speak to the admissions team, or visit our [Check your insurance] page for more information.

Yes. Your confidentiality is carefully managed throughout. What we share, and who we share it with, is governed by your consent, which you can update at any time during treatment. If you have concerns about specific people being contacted, you can detail these to the nursing or therapy team on arrival and they will be noted on your file.