Evidence-based outpatient care for cocaine use disorder — CBT, the Matrix Model, contingency management, IOP, and certified peer support at four clinics across Southeast Tennessee and North Georgia. No FDA-approved MAT exists for stimulants; structured behavioral treatment does work.
CARF AccreditedLicensed in Tennessee & GeorgiaSame-day appointments availableConfidential from your first call
At a glance
How we treat cocaine addiction
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Restoration Recovery treats cocaine use disorder through structured outpatient counseling, Intensive Outpatient Programming in Chattanooga, and behavioral health integration. No FDA-approved medication exists for cocaine use disorder, so treatment focuses on contingency management, cognitive-behavioral therapy, and addressing co-occurring conditions like depression, anxiety, or polysubstance use. Patients with co-occurring opioid use disorder receive MAT (Suboxone, Sublocade, Brixadi) for the opioid component while engaging in counseling for the stimulant component.
First visits include DSM-5 evaluation, counseling intake, doctor evaluation, and treatment planning. Same-week appointments available; TennCare, BlueCare, BCBS, UHC, and most commercial insurance accepted.
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 shows 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.
TN OD deaths with cocaine detected
Tennessee SUDORS, 2019 – 2023
4142019
8652021
1,0842023↑ 162% vs 2019
Cocaine-involved overdose deaths in Tennessee rose 162% from 2019 to 2023 — driven almost entirely by fentanyl contamination.
% cocaine deaths also involving fentanyl
TN stimulant-involved deaths, 2023
49%2018
72%2020
79%2023↑ 30 pts vs 2018
79% of Tennessee stimulant-involved deaths in 2023 also involved an opioid — and 97% of those opioids were fentanyl.
The Tennessee & Stimulant Picture
Cocaine looks very different today than it did ten years ago — and most of the change is about what is mixed with it, not the drug itself.
Cocaine was detected in 28% of Tennessee’s 2023 overdose deaths (methamphetamine was detected in 44%), making stimulants the second-most-common drug class after illicit opioids.
Cocaine-involved overdose deaths in Tennessee rose 162% from 2019 to 2023 — a rate of increase faster than any other drug category tracked by the state.
Polysubstance overdoses involving both opioids and stimulants rose roughly 200% in Tennessee between 2019 and 2023. Many “stimulant” overdose deaths today are not pure stimulant overdoses — they are fentanyl overdoses in people who didn’t know their supply was contaminated.
79% of Tennessee stimulant-involved overdose deaths in 2023 also involved an opioid, with fentanyl the most frequently involved opioid (97%). This is up from 49% polysubstance involvement in 2018.
Nationally, nearly 30,000 overdose deaths involved cocaine in 2023 (about 28% of all overdose deaths), an 85% increase from 2019.
The practical implication for anyone currently using cocaine in Tennessee: fentanyl test strips and naloxone access matter for stimulant users too, even those who have never intentionally used opioids. If you are buying cocaine on the illicit market today, the single highest-leverage harm-reduction step is assuming your supply could be contaminated, never using alone, and carrying naloxone. Treatment lowers that risk further — both by helping you stop and by giving you a clinical team that hands you naloxone on day one.
Sources: Tennessee SUDORS Report 2025 (Tennessee Department of Health, June 2025); Tennessee Overdose Response Coordination Office (ORCO) Annual Report 2023/24 (TDH, May 2025); CDC MMWR 2025 “Drug Overdose Deaths Involving Stimulants — United States, January 2018–June 2024”; CDC WONDER provisional 2023 overdose mortality data.
Recognizing it
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 or a lack of willpower — 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 or emotional states previously associated with cocaine. 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 where it is physically hazardous — driving, operating machinery, or during pregnancy.
Use despite psychological or physical problems. Continuing 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 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 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 & 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 — which is why structured outpatient care, especially IOP, makes such a large difference in outcomes.
First 24–72 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 – Week 2 · Acute
Acute withdrawal
Persistent low mood, anhedonia, 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 — a clinical situation that needs attention right away.
Week 2 – Week 10 · Post-acute
The long window
Intermittent cravings, mood instability, and heightened sensitivity to triggers tied to the 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.
This is where IOP, contingency management, and peer support make the largest difference — the structure is built for this window.
Most physical and emotional symptoms resolve and 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 build the 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 a detox medication. For patients with severe depression, active suicidal thoughts, or stimulant-induced psychotic symptoms during early recovery, we screen at intake and psychiatric medication management is part of the outpatient plan.
How We Treat Cocaine Addiction
There is no FDA-approved medication-assisted treatment for stimulant use disorder, so the foundation of care is behavioral — but the research base is strong, and outcomes for patients who stay engaged are significantly better than for those who attempt to stop alone.
Strongest evidence
Contingency management
Structured incentives for documented abstinence and treatment engagement — the single most effective behavioral intervention for stimulant use disorder, with more than 40 years of research support. Its elements are woven into our counseling and IOP structure.
Strongest evidence
The Matrix Model
A manual-based outpatient program developed specifically for stimulant use disorder and a SAMHSA-recommended evidence-based practice. Its concepts — individual counseling, group sessions, family education, relapse-prevention skills — are embedded in our IOP curriculum.
Individual counseling & CBT
Licensed therapists using cognitive-behavioral therapy and motivational interviewing — identifying the thought patterns, emotional triggers, and habits that drive use and replacing them with healthier coping.
Intensive outpatient (IOP)
Clinician-led group sessions several times a week. For stimulant use disorder, IOP’s group format matters: shared experience and peer accountability are part of what gets people through the cue-driven post-acute window.
Certified peer support
Specialists with lived recovery experience who can talk through what the first 30, 60, and 90 days actually feel like — in a way a clinician who has not been through it cannot.
Psychiatric medication management
For the depression, anxiety, trauma, ADHD, and bipolar disorder common in stimulant use — no medication is FDA-approved for cocaine use disorder itself, but treating co-occurring conditions is often what keeps patients engaged.
Integrated medical care
Care for co-occurring medical conditions under one roof, including hepatitis C treatment for patients with a history of injection drug use.
Not sure which of these fits your situation?
That’s exactly what the first visit is for. Our team builds the plan with you — you don’t have to figure it out first.
Your first visit typically lasts 2 to 3 hours and follows a four-step clinical flow designed for stimulant use disorder. Unlike an opioid intake, there is no COWS score and no same-day maintenance-medication prescription, because no such medication exists for stimulants — the structure is built around diagnosis, psychiatric evaluation, and a realistic behavioral plan.
01
Intake
Paperwork and a clinical intake — a DSM-5 assessment for stimulant use disorder, medical history, pattern of use, co-occurring conditions, and a screen for fentanyl exposure.
02
Counseling
You meet with a counselor to discuss your history, triggers, and goals. Because there’s no MAT for stimulants, this is where the core of the plan takes shape.
03
Doctor evaluation
A medical provider performs a physical assessment with attention to cocaine’s cardiac risks, evaluates co-occurring psychiatric conditions, and screens for polysubstance use.
04
Treatment plan
You leave with a personalized, written plan — counseling, IOP, contingency management, peer support, psychiatric care as needed — and your first follow-up already scheduled.
About 2–3 hours.You leave with a written plan and your next follow-up booked.Bring a photo ID, your insurance card, and a list of any medications.
What each step covers in detail+
Intake. A DSM-5 assessment for stimulant use disorder covering the eleven diagnostic criteria and severity level (mild, moderate, or severe), plus your medical history, current medications, pattern of cocaine use, co-occurring mental health conditions (depression, anxiety, trauma, ADHD, bipolar disorder, psychosis), and any prior treatment. Note: cocaine assessment does not use the COWS scale — that is 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.
Doctor evaluation. A medical provider reviews your intake and counselor notes and performs a targeted physical assessment, with special attention to cardiovascular health given cocaine’s cardiac risks. If you have been using cocaine that may be fentanyl-contaminated, you will receive naloxone and overdose-response education during this visit regardless of your history with opioids.
Treatment plan. You will not leave with a maintenance-medication prescription — none exists for stimulants — but psychiatric medication for co-occurring conditions may be part of the plan. Bring a valid photo ID, your insurance card if applicable, and a list of any medications you take. If you have been using other substances alongside cocaine (alcohol, benzodiazepines, opioids, methamphetamine, kratom), bring that history too — polysubstance use is the rule, not the exception, and it changes the plan.
Why Behavioral Treatment Works for Cocaine
The absence of an FDA-approved medication does not mean there is no effective treatment — it means the evidence base is built on behavioral science. Meta-analyses consistently show cognitive-behavioral therapy reduces stimulant use and improves retention; contingency management has the strongest research support of any behavioral approach for stimulant use disorder, with more than 40 years of randomized trials showing higher abstinence and longer retention than counseling alone; the Matrix Model is a SAMHSA-recommended evidence-based practice; motivational interviewing helps patients resolve ambivalence and strengthen their own motivation early in treatment; and peer support is now standard of care in most evidence-based outpatient programs. Underneath all of it, treating co-occurring depression, anxiety, ADHD, PTSD, or bipolar disorder is often a critical part of why behavioral treatment works when it works. The barrier to outcomes is almost never the treatments not working — it is staying engaged long enough for them to. Our contingency management, IOP, and peer support are built around keeping patients engaged through that window.
Evidence base: SAMHSA evidence-based practice resources on the Matrix Model and contingency management; NIDA Clinical Trials Network stimulant-treatment research; and decades of randomized controlled CBT trials for stimulant use disorder.
Why Restoration Recovery
Chattanooga’s longest-running outpatient addiction treatment clinic. Decades of clinical experience treating substance use disorders in Southeast Tennessee — including the stimulant and polysubstance cases that are now the norm.
CARF accredited. The gold standard for outpatient addiction care — reviewed on an ongoing basis, not a one-time stamp.
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.
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.
Four clinic locations across Southeast Tennessee and North Georgia, with telehealth follow-up for established patients.
Most major insurance accepted — TennCare, Georgia Medicaid, commercial plans, Medicare, and supplemental Medicare. We verify your benefits before your first visit.
Same-day appointments available. You don’t have to wait weeks to start.
Licensed in both states. Tennessee and Georgia, HIPAA compliant, 42 CFR Part 2 compliant — confidential from the first phone call.
CARF-accredited outpatient addiction care
TennCare, BlueCare, BCBS, UHC, Medicare & most commercial insurance accepted. We verify your benefits before your first visit — no surprises. Licensed in TN & GA · HIPAA · 42 CFR Part 2.
Don’t have insurance? Contact us anyway. We can help you explore options, including TennCare eligibility screening for those who may qualify, and we’ll walk you through self-pay pricing. For a full list of accepted carriers and 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 available.
Telehealth follow-up visits are available for established patients who have completed their initial in-person evaluation. Phones are answered Monday through Friday, 9am to 4:30pm Eastern. After hours? The 988 Suicide & Crisis Lifeline and the free, confidential SAMHSA National Helpline (1-800-662-4357) are available 24/7.
Questions
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 does not 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. We screen every new patient for suicidal ideation and psychiatric symptoms at intake, and psychiatric medication management is part of your outpatient plan when it is needed.
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.
4 clinics across Tennessee & North Georgia
Ready to start cocaine addiction treatment?
Same-day appointments available, and most major insurance is accepted. You don’t need to have all the answers before you call, and you don’t need to be clean before your first appointment. Our team will walk you through every step — from your first call to your first visit and every follow-up after.
