People who abuse stimulants like cocaine, methamphetamine, or even prescribed ADHD medication are familiar with the “crash” they experience after using the drug. The crash can come hours or days after the drug was used and is the largely the result of the brain working to chemically re-balance itself. During a crash, the user experiences unpleasant symptoms like extreme fatigue and depression that make it hard to function.
Many people addicted to stimulants will cycle through highs and crashes several times before finally breaking the cycle. When they do break the cycle and stop using, the crash period can extend for a period of days or weeks while the brain tries to heal itself from the addiction. Below is information about the phases and timeline of stimulant withdrawal, what to expect, and how to cope.
Stimulant Crash Timeline
Stimulant crashes are the mirror opposite of stimulant highs. Stimulant highs are characterized by dramatic boosts in mood and energy and can cause users to feel euphoric, confident, energized and almost superhuman. The crash from these drugs can be just as dramatic and includes symptoms like (1, 2, 3):
- Mental and physical exhaustion
- Debilitating depression
- High levels of irritability
- Aches and pains
- Feeling anxious or edgy
- Mood swings and emotional reactivity
- Psychosis or paranoia
- Increased appetite
- Feeling jittery or having tics
- Inability to focus or concentrate
- Impaired thinking, learning and memory
- Disturbing dreams and nightmares
- Sleeping too little or too much
- Drug cravings
Typically, stimulant users will go through the following phases of withdrawal after they stop using (1, 2, 3):
Phase 1: The Early Crash
This phase usually begins within 24 hours of the last dose and last between 1-3 days. Symptoms are more severe during this phase and can include severe depression, irritability, and fatigue. Interestingly, this is not normally the period where users experience strong drug cravings. People who have used stimulants only for a short period of time may only experience this crash phase and not progress to withdrawals.
Phase 2: Withdrawal Phase
This phase begins after the early crash phase passes, which is about 2 days after the last use of cocaine and 4 days after the last use of methamphetamines and can last 2-4 weeks. During this phase, the user will experience strong drug cravings, continued mood swings which include increased depression, anxiety, and irritability. Extreme fatigue is often common during this phase, although some users describe being unable to sleep. People who have used for long periods of time or who have used long-acting stimulants like meth are more likely to experience more severe and lasting symptoms during this phase.
Phase 3: Protracted Withdrawal
Some stimulant users (especially long-term users) will experience ongoing withdrawal symptoms that wax and wane over the course of several weeks or months. Not all users will experience protracted withdrawal syndrome (abbreviated as PAWS) but those who do will begin this phase around the 4-6 week mark when acute withdrawals are ending. Protracted withdrawals from stimulants can include any of the symptoms experienced in earlier phases, but to a less severe extent. The most common symptoms reported by stimulant users who experience PAWS are lingering depression, fatigue, cognitive difficulty, and periodic drug cravings.
Challenges for Stimulant Addiction Recovery
Because the crash and withdrawal phases from stimulants are the opposite of the high, people in recovery from stimulant addiction are often tempted to relapse. They know that if they were to use, these symptoms would temporarily resolve – they would feel happier, more energetic, and closer to their “normal” self. This knowledge can make it very hard for a person in early recovery from stimulant addiction to avoid relapse.
In reality, stimulant addiction is characterized by constant swings of dramatic highs and crashes. Over time, the lows get lower and the highs do as well.
A person who has developed a high tolerance to stimulants will find that stimulants no longer give them the same dramatic boost in mood and energy, but that the crashes continue to be debilitating. Dosing during a crash can sometimes provide immediate relief but this relief might even be lessened as a person develops a tolerance and would inevitably restart the cycle leading to another crash.
Once an addiction forms, the only way to fully break free from the cycle is to stop using stimulants altogether.
Letting the Body and Brain Heal from Stimulant Addiction
The reality is that stimulant crashes are really just the result of chemical depletion and are the brain’s way of rebounding and trying to reach homeostasis. (3). It takes time for the brain to heal from the damaging effects of stimulant abuse, and the difficult symptoms of withdrawal indicate this process is happening.
When a person can see these withdrawals as symptoms of the body and brain healing itself, these symptoms can be seen less negatively.
In many ways, the recovery process from an addiction is similar to recovering and healing from another type of illness or injury. For example, after an injury some people need to go through physical or occupational therapy, regaining their normal range of movement and functioning. This process can be difficult, painful and frustrating for people who are just ready to feel “normal” again, but it isn’t possible to skip these steps.
People who are in physical or occupational therapy to retrain their body and brain do better when they are patient with themselves and with the recovery process.
The same is true with the process of recovering from a stimulant addiction. In the beginning, the depression, fatigue, and brain fog that come with the withdrawal process are hard and increase the temptation to relapse.
Remembering that this is an addiction that developed over time and will take time to overcome is important, as is looking for the small gifts that each day in recovery brings.
Coping with Stimulant Withdrawals
Over time, symptoms of stimulant withdrawal start to lift and subside. People gradually start to feel like themselves again and notice that the things that were hard a week ago are coming more naturally. These are the small gifts of recovery that are important to look for and appreciate. Otherwise, it can be all too easy to focus in on the parts of recovery that are hard, frustrating and uncomfortable.
Some additional gifts that people in recovery from stimulant addiction may experience include:
- Feeling their mood begin to level off instead of constantly shifting
- Noticing sleep patterns regulating and feeling more rested after sleep
- Developing a new appreciation for foods they loved
- Being able to sit still and feel relaxed for longer periods of time
- Enjoying sights and sounds in a different way than when they were high (i.e. music)
- Being able to be more present in interactions with friends and family
- Feeling more confident in things and tasks they accomplish (vs attributing these to drugs)
- Reconnecting with hobbies and activities they used to enjoy
- Not having drastic ups and downs in energy throughout the day
- Skin, hair or nails improving or becoming healthier
- Not feeling like they have to keep secrets or hide their drug use anymore
- Not needing to plan their day or routine around doses
- Feeling more like their old “normal” self again
- Feeling proud of overcoming the addiction
- Feeling better able to handle stress and difficulties
Help to Overcome Stimulant Addiction
Stimulant addiction is possible to overcome. People who seek professional treatment and utilize recovery resources often have an easier time establishing and maintaining their recovery. Some options for treatment for stimulant addiction include:
- Inpatient rehab or inpatient detox: These hospital-like settings offer comprehensive medical and psychological treatment to people during the crash and withdrawal phase. The support provided in inpatient treatment is typically centered around the immediate needs of a person who has just stopped using drugs, and can include a combination of medication, brief individual therapy, group therapeutic activities, and coordination of outpatient care after discharge.
- Residential and sober living options: Residential and sober living programs are sometimes a helpful bridge for those discharging from inpatient rehab. People in residential or sober living homes stay for months or even a year in a home shared by others in recovery. Requirements like working, clean drug screens, treatment attendance, chores and rent are often conditions of staying in these homes.
- Intensive outpatient treatment: These programs offer several hours a week of group and/or individual addiction treatment and are good options for those transitioning from inpatient care. These programs often last between 3-9 months and help people in recovery develop the skills needed to resist cravings and maintain their sobriety during early recovery.
- Outpatient counseling: Outpatient counseling for addiction involves weekly individual, family or group therapy sessions with a trained addiction specialist and can provide long-term support in maintaining recovery, as well as addressing underlying root causes of addiction.
- Support groups: Support groups for people in recovery from an addiction are not considered a treatment, but are very helpful resources for many people in recovery. Attending 12 step meetings or Smart recovery meetings is usually an option in most communities, and provides a forum for people in recovery to support each other.
With time and treatment, overcoming a stimulant addiction and breaking the debilitating cycle of highs and crashes is possible.
Sources:
- Australian Government Department of Health.
- Center for Substance Abuse Treatment. Treatment for Stimulant Use Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US)
- Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development, Brain Communications, 1