Although cocaine and methamphetamine are structurally dissimilar, they have very similar pharmacologic actions.
Stimulant drugs produce increased energy, motivation, mental alertness and a profound sense of wellbeing.
Click here to read more about the medical consequences of cocaine and menthaphetamine use.
Perhaps the most significant difference in the effects of cocaine and methamphetamine is their duration of action. Unlike cocaine, which is rapidly metabolized, methamphetamine has a long duration of action. The cocaine-induced high typically lasts for less than 1 hour, whereas the methamphetamine-induced high can last for up to 12 hours.
Because of this, meth and cocaine addiction can produce markedly different patterns of use and likelihood of adverse consequences. For example, methamphetamine may be more likely to produce a pattern of marathon high-dose binges resulting in more profound post-drug dysphoria and other adverse effects on mood and mental state, including panic, anxiety and paranoid psychosis. If your mood is affected by drug use, or if an underlying psychiatric disorder is behind your drug use, please reach out for help.
When the stimulant high wears off, especially after a prolonged binge, the user’s mood typically does not return to pre-drug levels, but instead plummets into a state of agitated dysphoria known as the “crash.” This reaction is characterized by depressed mood, anxiety, fatigue, and irritability accompanied by strong cravings, urges and a compulsion to reuse the drug. In general, the severity of the crash is directly related to the dose, longevity of use and method of use. Smoking or injecting as compared to snorting stimulants produces a more intense high and a more severe crash.
The post-stimulant crash is time-limited, often resolving after sleep without medical intervention. For some users, however, crash-induced depressive reactions can be extremely severe and may include potentially dangerous but temporary suicidal thoughts that require psychiatric intervention. This reaction can occur even in relatively naive, non-dependent users who have no history of depressive disorders or contemplation of suicide.
Cushioning the Crash
Importantly, the post-stimulant crash is a major contributor to the simultaneous use and abuse of other substances. Alcohol, benzodiazepines, marijuana, and opioids are often used, sometimes in unusually large doses, to counteract unpleasant after-effects such as agitation and insomnia. Alcohol is often consumed before, during, and/or after stimulant use not only to cushion the crash, but also to enhance or prolong the stimulant-induced euphoria.
Cocaethylene, a byproduct of combining alcohol and cocaine that produces psychoactive effects similar to cocaine but longer lasting, is thought to be an important contributor to simultaneous use of these two substances. Similarly, intravenous cocaine users sometimes mix heroin and cocaine in the same syringe (a drug combination known as a “speedball”) to enhance the drug-induced euphoria and reduce unpleasant side-effects.
In recent years, snorting heroin or ingesting prescription opioids (e.g. codeine, hydrocodone, oxycodone) has become increasingly popular, especially among middle-class users as a way to “take the edge off” or “come down” from stimulant drugs.
Alcohol is a relapse trigger
Substances used in combination with stimulant drugs often become relapse triggers for stimulant drug use. For example, after repeatedly using cocaine and alcohol together, alcohol becomes a conditioned trigger for cocaine cravings and cocaine-seeking behavior, often leading to another episode of stimulant use.
Accordingly, when stimulants and alcohol have been used together extensively, abstaining from alcohol is often an important part of preventing relapse to stimulants during addiction treatment.
Even those with no history of drinking are in danger of relapsing
This is true even for stimulant users who have no prior history of serious alcohol problems, who understandably are often quite resistant to the idea of not drinking at all, citing their lack of previous problems with alcohol as justification to continue social drinking in addiction treatment for stimulants.
Regrettably, this rarely works out and it often takes one or more alcohol-precipitated relapses to cocaine or methamphetamine use for these individuals to become convinced that abstaining from alcohol is going to be necessary if they want to abstain from using stimulants.
A similar scenario unfolds with other substances used repeatedly to “come down” from a run on stimulants and/or alleviate the crash.
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