Cocaine and prescription stimulants cross more living rooms in this region than most people realize. Cocaine remains one of the most commonly used illicit stimulants in the United States, and its current drug market profile has become significantly more dangerous with the widespread introduction of fentanyl adulteration.
Many people using cocaine today are unknowingly exposed to fentanyl, dramatically increasing their overdose risk even without an opioid use history. At the same time, the misuse of prescription stimulants such as Adderall, Vyvanse, and Ritalin has increased substantially, particularly among young adults and working professionals navigating the demands of school, work, or both at once.
Cocaine and stimulant use disorders are treatable. The clinical evidence supports specific behavioral interventions, and our treatment approach applies those interventions inside the PHP and IOP structure with attention to the substance-specific clinical realities of stimulant recovery.
Cocaine Withdrawal
People sometimes assume cocaine withdrawal will be mild because it is not physically dangerous in the medical sense. The body cooperates. The brain does not. Cocaine withdrawal is primarily psychological rather than physically dangerous, which means medically supervised detox is generally not required before beginning outpatient treatment. The clinical picture is still significant, and the symptoms are a major driver of return to use.
Intense, persistent cravings
Among the most powerful cravings of any substance and a defining feature of early stimulant recovery.
Profound dysphoria and depression
The neurochemical aftermath of stimulant-induced dopamine depletion, which can mimic primary depression. Learn more
Fatigue and hypersomnia
A rebound from the sleep suppression that accompanied active use.
Increased appetite
A rebound from cocaine’s appetite-suppressing effects.
Irritability, anxiety, and restlessness
Emotional symptoms that often peak during the first weeks of sobriety. Learn more
Cognitive slowing and concentration difficulties
Functional symptoms that gradually clear with sustained abstinence.
Treatment Approach for Cocaine and Stimulant Use Disorder
Here is what the work looks like in practice. Roanoke Refuge applies the evidence-based modalities that the research most strongly supports for stimulant use disorders. The pieces of a typical plan look like this.
- Contingency Management — The strongest evidence-based behavioral intervention for stimulant use disorders, using tangible reinforcement of treatment attendance and drug-free urine results. We incorporate Contingency Management principles into our program structure.
- Cognitive Behavioral Therapy — Focused on cue identification, craving management, and recurrence-prevention skills specific to the social and environmental triggers that surround cocaine and stimulant use.
- Motivational Enhancement Therapy — Particularly useful for clients carrying ambivalent motivation about stopping, which is common in the early phase of stimulant recovery.
- Cocaine Anonymous and broader peer communities — Cocaine Anonymous specifically, plus broader 12-step and SMART Recovery options across the Roanoke region, for ongoing peer support after the formal program.
- Family therapy: The Family Program structures the relational work alongside parents, spouses, and adult children.
Prescription Stimulant Misuse
This category sneaks up on a lot of high-functioning people, and we hear about it on intake calls every week. Prescription stimulants are a growing category of misuse, particularly among college students, young professionals, and individuals using the medications without a prescription for performance, weight loss, or euphoria at high doses.
Treatment for prescription stimulant misuse follows the same behavioral framework as cocaine use disorder, with additional attention to the underlying functional drivers of misuse (academic pressure, work performance, weight management) and to the treatment of co-occurring conditions such as ADHD where present. For clients with a primary ADHD diagnosis, non-stimulant pharmacological options may be appropriate, coordinated with an outside prescriber.
Fentanyl-Contaminated Cocaine and Stimulants
This is the conversation we want every family to hear, even families that do not associate themselves with opioid risk. Cocaine and other stimulants in the current drug supply are frequently contaminated with fentanyl. Clients with no opioid tolerance who encounter fentanyl-contaminated cocaine face an extremely high risk of fatal overdose.
Naloxone education and access are a priority for every client with cocaine or stimulant use disorder at Roanoke Refuge, regardless of whether opioids are part of the use history. Naloxone is available without a prescription at most Virginia pharmacies, and a family with a member in active cocaine use should keep it in the home as a baseline safety measure. We treat that as a serious clinical conversation, not an optional one.
Our Clinical Approach to Stimulant Use Disorder
Clients with cocaine or stimulant use disorder typically transition directly into PHP or IOP without requiring inpatient detox. Our clinical approach incorporates Contingency Management principles, CBT, psychoeducation on stimulant neuroscience, and close attention to the depression and craving patterns of early stimulant recovery.
The cognitive impairment that accompanies the first weeks of stimulant sobriety is held with patience rather than treated as a sign of poor engagement. The clinical reality is that cognition clears gradually across the first weeks and months of sobriety, and the treatment plan accounts for that trajectory rather than expecting a sharper or faster recovery than the neurobiology supports.
For clients whose stimulant use began with prescription medications used for academic, professional, or weight-management purposes, the clinical work also includes addressing the underlying functional drivers. The treatment plan often involves coordination with primary care or specialty providers for any clinically appropriate non-stimulant alternatives, particularly for clients with a primary ADHD diagnosis. The clinical question is not whether the drivers existed but how to address them in a way that does not require continued stimulant use.
Dual Diagnosis and Stimulant Use Disorder
If the cocaine started as a way to feel something, or feel nothing, or get through the week, we want that named. Co-occurring anxiety disorders, bipolar disorder, and ADHD are common in clients with cocaine or stimulant use disorder. The stimulant use often began as an attempt to self-medicate one of those conditions. Treating the stimulant use without treating the underlying mental health condition is like treating the smoke while leaving the fire burning. Our integrated dual diagnosis program addresses both at the same time, in the same setting, and by the same clinical team.
Local, regional, and accessible.
Treatment for this substance is delivered from our Salem facility at 1630 Braeburn Drive — just off I-81 exit 137. The Roanoke Valley service area covers Roanoke City, Salem, Vinton, and the surrounding counties of Roanoke, Botetourt, and Bedford. The Salem VA Medical Center sits roughly two miles away and serves as a referral partner for veterans transitioning to civilian outpatient care.
The path in is a single phone call. The admissions team walks through fit, level of care, insurance, and what the first week of treatment will actually look like — at no cost and with no clinical commitment until you are ready. Insurance benefits get verified during the same call. Call (540) 900-0353 to start the conversation.