Stimulant withdrawal: cocaine and methamphetamine

Withdrawal from cocaine or methamphetamine is not usually medically dangerous, according to SAMHSA’s TIP 45. The risk that matters is your mood. The crash can bring heavy depression, and with methamphetamine and other amphetamines that depression can last longer and hit harder. There’s no FDA-approved medication for it, so the help is people: monitoring, support and treatment for the depression if it’s needed.

If you’re having thoughts of suicide, or you’re worried about someone who is, call or text 988 any time.

What it feels like

TIP 45 lists the usual symptoms:

• Depression
• Sleeping far too much, or not being able to sleep
• Fatigue
• Anxiety and irritability
• Trouble concentrating
• Feeling slowed down
• Paranoia
• Craving

None of these are the shaking, seizing kind of withdrawal you see with alcohol. That’s partly why people underestimate it. You may sleep for a very long time and feel flat, then feel a pull to use again to get out of it. That craving is part of withdrawal, not a personal failing.

When it’s an emergency

Call 911 if:

• Someone has a seizure.
• They have chest pain or a racing or irregular heartbeat, especially after mixing cocaine with alcohol.
• They’re in immediate danger of hurting themselves or someone else.

Why the depression is the part to watch

TIP 45 says depression after amphetamine use “is more prolonged and may be more intense,” so people coming off amphetamines should be watched closely during detox for signs of suicidality and treated for depression when appropriate.

What that looks like in practice for a family member:

• Check in often during the first days, in person if you can.
• Take talk of not wanting to be alive seriously, even if it sounds offhand.
• Don’t leave them alone if they say they’re thinking of ending their life. Call 988 together, or 911 if there’s immediate danger.

988 is the Suicide & Crisis Lifeline. You can call, text or chat, 24/7. SAMHSA describes it as judgment-free support for mental health, substance use and more. Congress designated the 988 number in 2020, and it launched in July 2022.

Other medical risks

“Not usually” isn’t “never.” TIP 45 flags a few things:

Cocaine and alcohol together form a compound called cocaethylene. It brings a risk of heart rhythm problems (including a prolonged QTc interval) and heart attack.

Seizures can be a complication of stimulant use, and they can happen during detox.

Then there’s everything else being used. If you’ve also been drinking heavily or taking benzodiazepines daily, that withdrawal is the medically risky one, and it needs its own plan. See alcohol withdrawal and benzodiazepine withdrawal. ASAM’s alcohol guideline does note that coming off a stimulant alongside alcohol is less complex than coming off alcohol plus another sedative.

There’s no approved medication

NIDA says there is no FDA-approved medication for methamphetamine use disorder or any other stimulant use disorder, and none approved for cocaine use disorder. TIP 45 adds that no medication has been proven to treat stimulant withdrawal itself.

That doesn’t mean there’s nothing to do. A clinician can still watch your mood and treat depression when it’s needed. And the treatments with the best evidence for stimulant use are behavioral, per NIDA:

• Contingency management, the best-studied of them
• Cognitive behavioral therapy (CBT)
• Motivational interviewing

Do you need a detox program?

The physical risk is usually low, but some things change the picture. Tell a clinician if:

• you’ve had thoughts of suicide, or a history of severe depression;
• you’ve also been using alcohol, benzodiazepines or opioids;
• you’ve had a seizure or heart symptoms;
• you can’t stay safe at home, or there’s no one around to check on you.

A clinician can help decide the setting. Our guide to levels of withdrawal care explains the options, and detox at home covers what guidelines say about outpatient withdrawal for each drug.

What matters most is what comes next. TIP 45 describes detox as one part of a continuum of care, not treatment by itself. Ask any program what therapy it offers afterward, and whether it uses contingency management. More in what comes after detox.

Where to turn

If mood is the worry, call or text 988 now. For a program near you, search by ZIP in the finder. SAMHSA’s National Helpline, 1-800-662-4357 (free, 24/7), refers callers to local treatment.

Sources

• SAMHSA, Quick Guide for Clinicians Based on TIP 45: Detoxification and Substance Abuse Treatment, based on TIP 45 (2006)
• NIDA Research Report: Methamphetamine, What treatments are effective for people who misuse methamphetamine?, Nov 2024
• NIDA, Cocaine research topic page, Sep 27, 2024
• ASAM, The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management, J Addict Med, 2020
• SAMHSA, 988 Suicide & Crisis Lifeline, last updated Sep 26, 2025
• 988 Lifeline, About, accessed Oct 24, 2026
• SAMHSA National Helpline, last updated Jun 9, 2023