Cocaine Addiction Treatment in Tennessee

What Is Cocaine?

Cocaine is a powerful central-nervous-system stimulant extracted and purified from the leaves of the coca plant (Erythroxylum coca), native to the Andes region of South America. In the United States it is used illicitly in two main forms: powder cocaine (cocaine hydrochloride), which is typically snorted or, less commonly, dissolved and injected; and crack cocaine, a smokable freebase form produced by processing powder cocaine with baking soda and water. Both forms produce intense, short-acting euphoria — typically 15 to 30 minutes when snorted, 5 to 10 minutes when smoked — followed by a sharp crash that drives repeat dosing.

Pharmacologically, cocaine blocks the reuptake of dopamine, serotonin, and norepinephrine at nerve terminals in the brain’s reward pathway. The resulting flood of neurotransmitters creates the “rush” users describe. With repeated use, the brain down-regulates its own dopamine production and receptor sensitivity, so that over time, the same amount of cocaine produces less pleasure while baseline mood becomes lower, flatter, and harder to regulate without the drug. This is the neuroscience behind cocaine cravings, and it is why stopping feels so hard even when someone clearly wants to.

Cocaine use disorder differs from opioid or alcohol use disorder in one important way: there is no FDA-approved medication-assisted treatment for cocaine use disorder. Decades of research have tested disulfiram, modafinil, topiramate, naltrexone, bupropion, and dozens of other compounds, and while some show modest benefit in specific patient subgroups, none has achieved FDA approval as a treatment for stimulant addiction. The foundation of effective cocaine treatment is therefore behavioral: evidence-based counseling, structured group programming, contingency management, and peer support.

Recovery from cocaine use disorder is realistic. Patients who engage with structured outpatient care have significantly better long-term outcomes than those who attempt to stop on their own — even without MAT as part of the plan. The data below tells you where Tennessee sits today, why the fentanyl-contamination crisis has changed the risk profile of cocaine use, and what treatment actually looks like when you walk in the door.

Signs of Cocaine Use Disorder

Cocaine use disorder is a medical condition diagnosed using the DSM-5 criteria for stimulant use disorder. It is not a moral failing, a lack of willpower, or a character defect — it is a brain-based disease of the reward system that responds to treatment. To meet diagnostic criteria, a person must show a pattern of use leading to clinically significant impairment or distress, as evidenced by at least two of eleven specific criteria within a 12-month period. Common signs and criteria include:

• Loss of control. Using more cocaine or for longer periods than intended. A weekend plan becomes a three-day binge; an “only on Fridays” rule erodes into daily use.
• Unsuccessful attempts to cut down. Wanting to stop or cut back but finding yourself using again, especially in particular situations or emotional states.
• Time spent on cocaine. Significant time obtaining, using, or recovering from the effects. Days lost to the crash after heavy use are part of this.
• Cravings. Strong urges to use, especially in environments, situations, or emotional states previously associated with cocaine use. Cravings for cocaine are famously cue-driven — a specific street, bar, person, or song can trigger intense wanting months after last use.
• Interference with responsibilities. Work performance declines, school attendance slips, or family obligations are missed because of cocaine use or its after-effects.
• Continued use despite consequences. Financial damage, relationship breakdowns, health problems, or legal issues not being enough to stop. Many patients reach this criterion well before they recognize they meet the others.
• Reducing activities. Giving up or reducing social, occupational, or recreational activities because of cocaine.
• Use in risky situations. Using in situations where it is physically hazardous — driving, operating machinery, or during pregnancy.
• Continued use despite psychological or physical problems. Continuing to use even when you know it’s causing or worsening anxiety, depression, sleep problems, heart issues, or nosebleeds.
• Tolerance. Needing more cocaine to feel the same effects, or finding that the previous amount no longer produces the same high. Tolerance to cocaine builds rapidly.
• Withdrawal. The characteristic cocaine crash — extreme fatigue, deep depression, increased appetite, vivid or disturbing dreams, and intense cravings — when stopping or cutting back.

Two criteria meets the threshold for mild cocaine use disorder; four to five indicates moderate; six or more indicates severe. Severity matters clinically because it guides the intensity of treatment recommended — mild disorder may respond to outpatient counseling alone, while moderate to severe disorder typically benefits from the structured commitment of IOP.

Beyond the diagnostic criteria, long-term cocaine use leaves physical traces that are worth mentioning at your evaluation. For powder cocaine users: chronic sinusitis, nosebleeds, loss of smell, and in severe cases perforation of the nasal septum. For crack users: chronic cough, respiratory issues, and burns on the hands or lips. For injection users: vein damage, skin infections, and exposure risk for HIV and hepatitis C. Cocaine use at any route puts serious strain on the cardiovascular system — hypertension, arrhythmias, cardiomyopathy, and cocaine-induced heart attacks can occur even in young, otherwise healthy users. If several of the signs above apply to you or someone you care about, a professional evaluation can help clarify where you are and what options exist. You do not have to hit a “rock bottom” before reaching out.

Cocaine Withdrawal: Timeline and Symptoms

Cocaine withdrawal is different from opioid, alcohol, or benzodiazepine withdrawal: it is primarily psychological rather than physically dangerous. Most patients can stop cocaine use safely on an outpatient basis without formal medical detox. That said, the psychological symptoms are real, often severe, and the single biggest driver of early-recovery relapse. This is why relapse rates are high for patients who try to quit cocaine on their own and why structured outpatient care (especially IOP) makes such a large difference in outcomes.

A general timeline for cocaine withdrawal looks like this:

• First 24 to 72 hours (the “crash”). Extreme fatigue, excessive sleep or difficulty sleeping, dramatically increased appetite, vivid or disturbing dreams, profound low mood, irritability, agitation, and intense cravings. Many patients describe this phase as feeling emotionally and physically “flattened” — the opposite of the cocaine high.
• Day 3 to week 2 (acute withdrawal). Persistent low mood, anhedonia (inability to feel pleasure), irritability, difficulty concentrating, motor slowing, appetite changes, and continued cravings that are often cue-triggered rather than constant. Sleep remains disrupted. Suicidal thinking can occur in this window, especially in patients with pre-existing depression — this is a clinical situation that needs attention right away.
• Week 2 to week 10 (post-acute withdrawal). Intermittent cravings, mood instability, and heightened sensitivity to triggers tied to people, places, substances, and situations previously associated with cocaine use. Low mood lifts gradually but can spike back down around stressors. This is the window where most relapses happen — and the window where IOP, contingency management, and peer support make the largest difference.
• Month 3 and beyond. Most physical and emotional symptoms resolve. Dopamine function gradually recovers. Cravings become less frequent but can still appear in response to specific cues (particular locations, people, holidays, or emotional states). Ongoing counseling and peer support help patients build the cognitive and behavioral skills to navigate triggers without returning to use.

Because the withdrawal is psychological, treatment focuses on managing the emotional and behavioral symptoms through counseling, structured programming, and coordinated psychiatric care rather than through a detox medication. For patients with severe depression, active suicidal thoughts, or stimulant-induced psychotic symptoms during early recovery, psychiatric medication management is part of the clinical plan, and in rare cases we coordinate with regional partners for a higher level of care before outpatient treatment resumes.

How We Treat Cocaine Addiction

At Restoration Recovery, cocaine use disorder is treated primarily through counseling, structured programming, and coordinated medical care. There is no FDA-approved medication-assisted treatment for stimulant use disorder, so the foundation of effective care is behavioral: evidence-based counseling, group-based programming within an IOP structure, contingency management, and peer support. Treatment components include:

• Individual counseling with licensed therapists who use evidence-based approaches including cognitive-behavioral therapy (CBT) and contingency management, both of which have decades of research support specifically for stimulant use disorders. CBT helps you identify the thought patterns, emotional triggers, and behavioral habits that drive use, and replace them with healthier coping strategies. Contingency management provides structured incentives for documented abstinence and engagement — the single most effective behavioral intervention for stimulant addiction in the research literature.
• The Matrix Model and other structured outpatient curricula integrate individual counseling, group sessions within IOP, family education, and relapse-prevention skills. The Matrix Model was developed specifically for stimulant use disorder and is one of SAMHSA’s evidence-based practice recommendations.
• Intensive outpatient programming (IOP) for patients who benefit from a more structured treatment schedule — delivered in IOP’s group format by design, with clinician-led sessions multiple times per week. For cocaine use disorder specifically, IOP’s group format matters: shared experience, peer accountability, and learning from others navigating the same cue-driven cravings is part of what makes it work.
• Certified peer support from specialists who have lived experience with recovery themselves. Peer support specialists can talk with you about what it actually feels like to get through the first 30, 60, and 90 days — in a way that a clinical provider who has not been through it cannot.
• Psychiatric medication management for co-occurring mental health conditions. Many patients with stimulant use disorders also experience depression, anxiety, trauma-related conditions, ADHD, or bipolar disorder — treating these conditions is part of a comprehensive plan. While no medication is FDA-approved for cocaine use disorder itself, psychiatric medications for co-occurring diagnoses are often an essential part of the plan.
• Integrated care for co-occurring medical conditions, including hepatitis C treatment for patients with a history of injection drug use.

Restoration Recovery is an outpatient clinic. We do not provide medical detox or residential care. Because cocaine withdrawal is primarily psychological rather than physically dangerous, most patients can start outpatient treatment without a formal detox. For patients with severe psychiatric symptoms, active suicidal thinking, or stimulant-induced psychosis during early recovery, we coordinate with regional partners for a higher level of care and welcome you back to outpatient treatment when you’re stable enough to step down.

What to Expect at Your First Appointment

Your first visit typically lasts 60 to 120 minutes and follows a four-step clinical flow designed for stimulant use disorder:

1. Intake. You’ll complete paperwork and a clinical intake that includes a DSM-5 assessment for stimulant use disorder — a structured review of the eleven diagnostic criteria above, with severity scoring (mild / moderate / severe). The intake also covers your medical history, current health status, current medications, co-occurring mental health conditions (depression, anxiety, trauma, ADHD, bipolar disorder, psychosis), and any prior treatment experience. Note: cocaine use disorder assessment does not use the COWS scale — that’s an opioid-specific withdrawal measure. For cocaine, the DSM-5 criteria plus a clinical review of recent use, cravings, and crash symptoms is what guides the plan.
2. Counseling. You’ll meet with a counselor to discuss your substance use history, prior treatment, current stressors and triggers, and your personal recovery goals. Because there is no FDA-approved MAT for stimulant use disorder, counseling and behavioral interventions form the core of your treatment plan — and this first conversation is how we match you to the right counseling approach (CBT-focused, Matrix Model, contingency management elements) and the right intensity (weekly individual sessions vs. IOP).
3. Doctor evaluation. A medical provider reviews your intake and counselor notes, performs a targeted physical assessment (with special attention to cardiovascular health given cocaine’s cardiac risks), evaluates any co-occurring psychiatric conditions that may warrant medication, screens for polysubstance use, and answers your questions. If you have been using cocaine that may be fentanyl-contaminated, you will also receive naloxone and overdose-response education during this visit regardless of your history with opioids.
4. Treatment plan. You’ll leave with a personalized treatment plan, which may include individual counseling, enrollment in our intensive outpatient program (IOP), psychiatric medication for any co-occurring conditions, connection with a certified peer support specialist, and follow-up care. Your first follow-up is scheduled before you leave. Note: unlike opioid use disorder, there is no same-day medication prescription for cocaine — the treatment plan is behavioral, and the “prescription” is the structured commitment to counseling and IOP.

Bring a valid photo ID, your insurance card if applicable, and a list of any medications you currently take. If you’ve been using other substances alongside cocaine (alcohol, benzodiazepines, opioids, methamphetamine, kratom), bring that history too — polysubstance use is the rule, not the exception, in stimulant use disorder, and it changes the clinical plan.

Why Behavioral Treatment Works for Cocaine

While there is no FDA-approved medication for stimulant use disorder, decades of research support several evidence-based behavioral interventions. Effective treatment for cocaine use disorder typically combines several of these approaches, layered according to severity and patient preference:

• Cognitive-behavioral therapy (CBT). Helps patients identify the thought patterns, emotional triggers, and behavioral habits that drive substance use, and replace them with healthier coping strategies. Meta-analyses consistently show CBT reduces stimulant use and improves treatment retention compared to no treatment or treatment as usual.
• Contingency management. Uses structured incentives (typically vouchers or small prizes) for documented abstinence and treatment engagement. Contingency management has the strongest research support of any behavioral approach for stimulant use disorder — more than 40 years of randomized trials, and a large evidence base showing higher abstinence rates, longer retention, and better outcomes than counseling alone. Elements of contingency management are woven into our counseling and IOP structure.
• The Matrix Model. A structured, manual-based outpatient program specifically developed for stimulant use disorder, combining individual counseling, group sessions within IOP, family education, urine drug testing, and relapse-prevention skills in an integrated curriculum. It is a SAMHSA-recommended evidence-based practice for stimulant addiction.
• Motivational interviewing. A counseling style that helps patients resolve ambivalence about change and strengthen their own motivation for recovery. Especially useful in early treatment when patients are still weighing whether they really want to stop.
• Peer support. Certified peer support specialists provide ongoing accountability, practical help navigating recovery, and the kind of lived-experience guidance that clinicians cannot offer. Research on peer support specifically for stimulant use disorder is still emerging, but the clinical evidence is strong enough that peer support is now standard of care in most evidence-based outpatient programs.
• Treatment of co-occurring conditions. Many patients with cocaine use disorder have untreated depression, anxiety, ADHD, PTSD, or bipolar disorder. Treating these conditions — with therapy, psychiatric medication, or both — is often a critical part of why behavioral treatment works when it works.

Stimulant use disorder is a medical condition that responds to treatment — sometimes gradually, sometimes with setbacks along the way. Recovery is realistic, and patients who stay engaged with structured outpatient care have significantly better long-term outcomes than those who attempt to stop on their own. The absence of a medication like buprenorphine does not mean treatment doesn’t work; it means the structured commitment to counseling, IOP, and peer support is the treatment.

Why Restoration Recovery

Choosing where to start treatment matters. Restoration Recovery brings together the clinical depth, the practical access, and the kind of care that keeps patients in treatment long enough to get well.

• Chattanooga’s longest-running outpatient addiction treatment clinic. Our providers have decades of clinical experience treating substance use disorders in Southeast Tennessee — including stimulant and polysubstance cases that are now the norm rather than the exception.
• CARF accredited. The Commission on Accreditation of Rehabilitation Facilities is the gold standard for outpatient addiction care — our accreditation is reviewed on an ongoing basis, not a one-time stamp.
• Four clinic locations across Southeast Tennessee and North Georgia, with telehealth follow-up available for established patients.
• Most major insurance accepted — TennCare, Georgia Medicaid, commercial plans, Medicare, and supplemental Medicare. Our patient services team verifies your benefits before your first visit so there are no surprises.
• Same-day appointments in most cases. You don’t have to wait weeks to start.
• One integrated team. Medical providers, counselors, certified peer support specialists, and psychiatric care under one roof — not parallel referral tracks that leave you coordinating your own care.
• Licensed in both states. Licensed in Tennessee and Georgia, HIPAA compliant, 42 CFR Part 2 compliant — your treatment is confidential from the first phone call.
• Polysubstance-ready clinical team. Most of our stimulant-use patients report some opioid, alcohol, or benzodiazepine use alongside cocaine. We are built to treat the whole picture, not just the drug at the top of the intake form.

Insurance and Access

Restoration Recovery accepts most major insurance plans, including TennCare, Georgia Medicaid, a broad range of commercial plans, and Medicare (plus supplemental Medicare plans). Our patient services team can verify your benefits before your first appointment so you know exactly what to expect in terms of cost.

If you do not have insurance, contact us anyway. We can help you explore options and will walk you through self-pay pricing. For a full list of accepted carriers and details on the verification process, visit our insurance page.

Four Clinic Locations

We operate four outpatient clinics across Southeast Tennessee and North Georgia. All locations offer cocaine addiction treatment with same-day appointments in most cases:

• Chattanooga, TN — 6141 Shallowford Rd, Suite 100, Chattanooga, TN 37421
• Cleveland, TN — Serving Bradley County and surrounding areas
• Soddy-Daisy, TN — Serving Hamilton County north and the Sequatchie Valley
• Ringgold, GA — Serving Catoosa County and Northwest Georgia

Telehealth follow-up visits are available for established patients who have completed their initial in-person evaluation. For directions, hours, and contact information, visit our locations page.

Frequently Asked Questions

Can you treat cocaine addiction without medication?

Yes. There is no FDA-approved medication-assisted treatment for cocaine or any other stimulant use disorder — and the absence of a medication doesn’t mean treatment doesn’t work. The foundation of effective cocaine care is behavioral: cognitive-behavioral therapy (CBT), contingency management, the Matrix Model, intensive outpatient programming (IOP), and certified peer support. Decades of research support these interventions, and patients who engage with structured outpatient care have significantly better long-term outcomes than those who try to stop on their own. If you also have depression, anxiety, trauma, or ADHD alongside cocaine use, psychiatric medication can treat those co-occurring conditions as part of a comprehensive plan.

What is contingency management for cocaine addiction?

Contingency management is a behavioral intervention where patients receive structured incentives (typically vouchers, small prizes, or recognition) for documented abstinence and engagement with treatment. It is the single most effective behavioral treatment for stimulant use disorder based on over 40 years of research. Patients in contingency-management programs have higher rates of abstinence, longer treatment retention, and better long-term outcomes than those receiving counseling alone. At Restoration Recovery, the elements of contingency management are woven into our counseling and IOP structure so that every patient gets the benefit of the approach even outside a formal research trial.

Is cocaine withdrawal dangerous?

Cocaine withdrawal is rarely physically dangerous. Unlike opioid or alcohol withdrawal, stopping cocaine does not typically require medical detox. The symptoms are primarily psychological: extreme fatigue, deep depression, anhedonia (inability to feel pleasure), vivid or disturbing dreams, increased appetite, and intense cravings. These symptoms are real and often severe, which is why relapse rates are high for patients who try to stop alone — and why IOP, counseling, and peer support during the first weeks make such a large difference. If you develop severe depression, active suicidal thoughts, or stimulant-induced psychosis during early recovery, that is a clinical situation that needs attention right away, and psychiatric medication management or a short-term higher level of care can be part of your plan.

How does IOP work for cocaine use disorder?

Intensive outpatient programming (IOP) is a structured treatment schedule where you attend clinician-led sessions multiple times per week while continuing to live at home. A typical IOP commitment at Restoration Recovery is nine hours per week delivered across three sessions, which meets the definition of IOP under ASAM level-of-care criteria. The format is group-based by design, which research shows is particularly effective for stimulant use disorder because peer accountability and shared coping strategies matter in a way they don’t for every diagnosis. IOP is not residential or inpatient care — you go home each night, keep working if your schedule allows, and step down to less intensive outpatient care as you stabilize.

What if my cocaine is contaminated with fentanyl?

Fentanyl contamination in cocaine is common and deadly. In 2023, 79% of stimulant-involved overdose deaths in Tennessee also involved an opioid, and fentanyl was the opioid present in 97% of those cases. If you are using cocaine today, assume your supply could be contaminated. Never use alone, carry naloxone (Narcan), and use fentanyl test strips when possible. Tell your provider at your first appointment that you have been using cocaine that may be contaminated — this affects our clinical plan, the education you will receive, and the naloxone prescription you should leave with even if you have never intentionally used opioids. If an overdose reversal is on your record, that is a clinical indication to start treatment, not a disqualifier.

How long does cocaine stay in your system for a drug test?

Cocaine itself has a short half-life of about one hour, but its primary metabolite, benzoylecgonine, is what drug tests actually detect. In a typical urine drug screen, benzoylecgonine is detectable for 2 to 4 days after a single use for occasional users, and up to 10 to 14 days for heavy or chronic users. Hair tests can detect cocaine metabolites for up to 90 days. Saliva tests detect for 1 to 2 days, and blood tests for up to 48 hours. These windows vary with body composition, hydration, metabolism, frequency of use, and how much cocaine was used. Your provider can explain what drug testing you will encounter during treatment and how that ties into our clinical plan — testing at Restoration Recovery is used clinically, not punitively.

Take the Next Step

Cocaine addiction is survivable, and treatment works. You don’t have to figure this out alone — and you don’t need to have all the answers before you call. You don’t need to be clean before your first appointment. Our team will walk you through the process from your first phone call to your first visit and every follow-up after that.

Same-day appointments are available in most cases. Contact us today to schedule your evaluation, or call 423-498-2000 to speak with our team directly.