Cocaine: Absence Makes the Need Grow Stronger

Medically Reviewed by Jacqueline Brooks, MBBCH, MRCPsych
From the WebMD Archives

July 11, 2001 -- The longer a coke addict stays clean, the less likely he is to use again, right? Not according to animal research reported in the July 12 issue of Nature, which suggests that cocaine cravings get worse, not better, as time goes on after quitting.

"This is contrary to the common belief that the further away in time the addict is from his last drug use, the lower the risk of relapse," says senior researcher Yavin Shaham, PhD, an investigator with the Intramural Research Program of the National Institutes on Drug Abuse in Baltimore. "While this research was done in rats, it fits with reports of relapse in humans after many years of abstinence."

Shaham's group found that as time went on over a two-month withdrawal period, cocaine-addicted rats worked harder to try to get another fix, and became more sensitive to environmental cues -- a red light and a special sound -- that they had learned to associate with getting cocaine.

"The period immediately after drug withdrawal is not necessarily the period when the drug user is most vulnerable to those events that lead to relapse to drug taking," Jane Stewart, PhD, professor of behavioral neurobiology at Concordia University, in Montreal, Canada, tells WebMD after reviewing the study.

"These results point to the need for treating drug addicts well beyond the initial abstinence period," agrees Heather L. Kimmel, PhD, a neuroscientist at Emory University in Atlanta.

Although the biological explanation for these findings is still unknown, studying changes in the brain related to cocaine addiction may eventually leads to specific treatment, Michael A. Nader, PhD, tells WebMD when asked for independent comment.

"For individuals seeking treatment for cocaine addiction, or for those incarcerated for a brief period of time, abstinence by itself is not treatment," says Nader, associate professor of physiology, pharmacology, and radiology at Wake Forest University School of Medicine in Winston-Salem, N.C.

In addicts who have not used cocaine recently, environmental cues, like seeing a crack pipe, often trigger cravings that lead to relapse, explains Ronald E. See, PhD, professor of physiology and neuroscience at the Medical University of South Carolina in Charleston.

"Not only do these cues drive drug-seeking behavior in the absence of the drug, but they appear to grow more intense with prolonged periods of abstinence," says See, who was not involved in Shaham's study. "Long-term treatment approaches for addiction need to take [this] into consideration."

Since other drugs of abuse -- including heroin, nicotine, and alcohol -- affect the same brain systems as cocaine does, cravings for these drugs are also likely to increase during abstinence, Kimmel suggests.

Learn more about treatment for cocaine addiction.