Dear Alice,

I have been shooting cocaine steadily for almost two months now and want to know what the difference between the physical and emotional addiction is. I am not sure if I have been experiencing withdrawals, but I feel sick a lot lately. I know shooting heroin has made me sick before. Can cocaine eventually make you dope sick as well?

Dear Reader,

It’s never fun to feel sick! It’s certainly possible that your body is reacting negatively to prolonged cocaine (commonly called coke) use, although it’s difficult to know for sure. You may want to try speaking to a health care provider about how you’re feeling and to determine if cocaine use is adversely affecting your day-to-day. In the meantime, read on for more information about withdrawal and addiction, as well as possible explanations as to why you’re feeling this way.

When talking about withdrawal symptoms and other problems associated with drug use, it may be helpful to first distinguish between tolerance, withdrawal, psychological dependence, physical dependence, and addiction:

  • Tolerance refers to a person’s decreased cellular response to the dosage of a drug or substance. This occurs when the body’s cells make adjustments to accommodate the substance being used. When used continually, a person’s body adjusts to the amount of the drug administered and doesn't have the same effects, which may lead a person to use higher amounts to achieve the desired effect. How the body habituates varies based on the drug, the amount used, and period of time in which the drug is consumed.
  • Withdrawal symptoms occur when a person’s body is adjusted to the presence of drugs, and the drug is suddenly no longer present. This is because it takes time for the body’s cells to adapt to a drug-free environment. Once the body shifts back, individuals can expect withdrawal symptoms to decrease. However, depending on the type of drug, amount consumed, and timeframe in which the drug was used, symptoms may last anywhere from days to weeks.
  • Physical dependence is when a person feels they must continue regular use of a drug in order to avoid withdrawal symptoms, and usually happens when a person has been using a drug for a significant period of time. This type of dependence is also associated with increased tolerance, which may prompt a person to up their dosage as well as chronically use.
  • Psychological dependence on a drug is when a person relies on said drug to manage their mental and emotional states. This is often experienced as the need to use a drug in order to feel and function typically in their day-to-day lives. Without the drug, an individual may feel incapable of self-care and emotional stability. Symptoms of psychological dependence include feeling irritable, anxious, paranoid, depressed, and restless, along with losing your appetite when not using the drug.
  • Addiction is specifically identified as a person’s continued, compulsive use of a drug that negatively impacts their daily functioning at home, with their family, at work, and in other personal and social environments. Once addicted, a person is usually fixated on getting and using the drug and will have trouble staying off the drug, even when attempting to quit. Trouble controlling how much of the drug is consumed, denial that the use is problematic, and observable behavior changes are also features of addiction.

People may experience physical and psychological dependence to substances spanning from over-the-counter medicines, prescribed medications (such as antidepressants) to recreational drugs (such as heroin and cocaine). Keep in mind that the presence of physical or psychological dependence doesn’t automatically imply a person is addicted to a substance. However, when a person is addicted to a drug, the characteristics of dependence are present.

Whereas withdrawal from heroin use, also known as “dope sickness,” are associated with more physical, flu-like symptoms (such as body aches, nausea, vomiting, fever, and dehydration), cocaine withdrawal symptoms are often more psychological. In fact, cocaine is one of the most addictive drugs because it interacts with the brain's reward centers. Although the initial effects of cocaine may be pleasant (confidence, motivation to work, increased sex drive, and a euphoric rush), coke raises a person’s blood pressure and heart rate, and it may lead to rapid breathing, tense muscles, and feeling jittery. All of the high-flying feelings that came on so quickly may suddenly disappear. This may leave you feeling exhausted, thoroughly depressed, and yearning for the pleasurable feelings cocaine induced. Other cocaine withdrawal symptoms include hypersomnia (sleeping too much), difficulty focusing, anxiety, agitation, having a bigger appetite, and paranoia. Thus, cocaine users may continue injecting, smoking, or snorting the drug in order to avoid emotional dependence symptoms. Note that although stomach pain, chills, headaches, sweating, nausea, and other physical symptoms have been linked with cocaine use, these symptoms are fairly uncommon.

Given that cocaine withdrawal symptoms are often emotional and not necessarily physical, your sick feelings may not be directly due to cocaine withdrawal. However, it’s also possible that your symptoms may be related to cocaine use to some degree. For example, one possible explanation is that cocaine withdrawal symptoms such as exhaustion, sleeping excessively, and discomfort may lead to physical symptoms such as the ones you’re experiencing currently. Another explanation is that your sick symptoms may be the result of getting little sleep and poor eating habits. Cocaine use is associated with lack of appetite and weight loss, and it may be that, while in the euphoric state induced by coke, you were highly active while getting little rest and few balanced meals. Your body may have been working overtime, and you may now be feeling the buildup of exhaustion that accrued while using cocaine. Cocaine use is also associated with a variety of gastrointestinal conditions, some of which may be quite serious. It's also common to have chronic nasal irritation from snorting or bronchial discomfort from smoking. Since you've been injecting the drug, muscle tension and other symptoms from the way the coke affects your central nervous system and vital organs may be making you feel sick.

Taking care of your body is key, so it's great that you're asking questions about how these substances may impact your health. Perhaps your drug use has reached a point where you’re no longer keeping up with your health needs. It's up to you to determine in what ways you'd like to examine your drug use and how it's affecting your body, emotional state, behavior, and relationships. Consider making an appointment with a health care provider or mental health professional to share more about your concerns. In addition, you may also find it helpful to take a look at the National Drug Information Treatment and Referral Hotline if you're looking for treatment resources in your area. You may also find it useful to look at the related Q&As and responses in the Go Ask Alice! Alcohol & Other Drugs archives to learn more about cocaine and other stimulants.

Alice!

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