Are you struggling with addiction? Have you tried to quit, but had a difficult time dealing with withdrawal symptoms? You are not alone. While many people dealing with substance abuse had the intention of quitting, they kept falling back into old patterns.
Seeking help during those difficult days and weeks of getting clean could be the difference between lasting sobriety and relapsing. Finding the appropriate treatment can help you manage withdrawal symptoms and make necessary lifestyle changes to finally live drug free.
Getting the help you need is as simple as making a phone call. Our withdrawal hotline can provide you with the knowledge and resources for overcoming this difficult time in your life.
Table of Contents
- 1 What is Drug Addiction Withdrawal?
- 2 Why Does Withdrawal Happen?
- 3 Difference Between Detox and Withdrawal
- 4 Standard Care for Withdrawal Management
- 5 Drug Addiction Withdrawal Symptoms
- 6 Duration and Timeline of Withdrawal Symptoms
- 6.1 Alcohol Withdrawal Timeline and Duration
- 6.2 Heroin Withdrawal Timeline and Duration
- 6.3 Methadone Withdrawal Timeline and Duration
- 6.4 Benzodiazepine Withdrawal Timeline and Duration
- 6.5 Stimulant Withdrawal Timeline and Duration
- 6.6 Inhalant Withdrawal Timeline and Duration
- 6.7 Marijuana Withdrawal Timeline and Duration
- 7 Post-Acute Withdrawal Syndrome
- 8 Symptom Management During Withdrawal
- 9 Medication-Assisted Treatment for Drug Withdrawal
- 10 Risk Factors for Complicated Withdrawal
- 11 Delirium Tremens: Severe Alcohol Withdrawal
- 12 Dangers of Quitting Cold Turkey
- 13 Coping with Drug Addiction Withdrawal
- 14 What to Expect When Calling a Withdrawal Hotline
What is Drug Addiction Withdrawal?
When a person has used an addictive substance for a prolonged time and abruptly stops or drastically reduces the use of that substance, they can experience a variety of symptoms. Withdrawal refers to a combination of physical and psychological symptoms that a person experiences after they decrease or stop the use of substances like alcohol, prescription medications, or recreational drugs.
The intensity and duration of withdrawal symptoms can vary depending on a variety of factors, including the type of substance abused, the intensity and duration of drug use, how quickly the drug use was discontinued, and the person’s biological make-up and health status. The appearance of distressing withdrawal symptoms is one of the reasons addicts are driven to continue using drugs and alcohol.
Withdrawal can be unpleasant, but also potentially dangerous, even fatal. One can think of sudden withdrawal from drugs and alcohol like an accelerated vehicle in which the brakes have failed. The only way to avoid an “accident” is to gradually reduce the speed of the vehicle. Similarly, the only way to safely come off alcohol and drugs is to gradually reduce substance abuse under medical supervision.1 Withdrawal management refers to the medical care provided to people with alcohol or drug addiction. It allows them to safely withdraw from substance use in a supportive and supervised environment.
Why Does Withdrawal Happen?
When a person suddenly stops using drugs or drinking alcohol after prolonged and heavy abuse of these substances, the brain and body go through various changes. To understand why withdrawal occurs, we must first understand the principle of homeostasis. Homeostasis is the body’s ability to regulate conditions so that they remain relatively constant and stable. This is essential for the body to function efficiently. When conditions change, such as when a person abuses drugs or alcohol, the body is thrown off balance. In response to this, the body attempts to maintain homeostasis and restore balance by modifying the levels of various chemicals, neurotransmitters, hormones, and processes. 2
Because the body keeps adjusting the set point for homeostasis, the person needs larger quantities of the drug to obtain the same effects. This is called drug tolerance. When a person suddenly stops using the drug, the homeostasis that the body has developed is suddenly thrown off. The resulting imbalance leads to many physical and psychological symptoms which are known as withdrawal syndrome.
Let’s take the example of heavy drinkers. After prolonged or heavy alcohol use, the brain becomes accustomed to the continuous depressive effects of alcohol. Over time, the chemistry in the brain is adjusted to compensate for the effects of alcohol. Certain neurotransmitters in the brain are produced in larger quantities than normal. When alcohol is suddenly withdrawn, the chemistry in the brain needs to be readjusted again. During this period of change, the brain struggles to regulate vital functions like circulation and breathing. This can lead to dramatic and unpredictable changes in heart rate and blood pressure, creating a risk for serious medical complications like heart attack, stroke, and death. 3
Difference Between Detox and Withdrawal
It’s not unusual for the terms detox and withdrawal to be used interchangeably. However, professional organizations like the World Health Organization and the American Society of Addiction Medicine say there’s a difference between detox and withdrawal. Detoxification is performed by the liver and withdrawal symptoms are managed by clinicians. The term withdrawal management is used to refer to the process as a whole.
The term detoxification refers to the removal of toxins from the body. The liver performs this function every day to eliminate waste. Therefore, detoxification is a natural process in healthy individuals. In the context of people who are physically dependent on drugs or alcohol, detoxification is the period during which the body adjusts to the absence of drugs. It is also the period during which recovering addicts begin to make the psychological adjustment necessary for recovery. Detox is usually the first phase of addiction treatment. The goal is to provide safe withdrawal from drugs, prepare the person for ongoing treatment, and enable the person to become drug-free. 4
Withdrawal symptoms appear when the body does not get the drugs to which it is accustomed. Withdrawal can manifest with both physical and psychological symptoms. During withdrawal, the person needs to be monitored by a team of addiction specialists and healthcare providers. The goal is to make the person as comfortable as possible and ensure a safe and effective withdrawal from the harmful substance. Withdrawal management refers to the care provided to patients who are experiencing withdrawal symptoms as a result of stopping or reducing drug use.
Standard Care for Withdrawal Management
Patients who are in withdrawal from drugs or alcohol require comprehensive medical care. This includes physicians who assess the patient at the time of admission and are available to manage any medical complications that arise during withdrawal. It also includes nurses and other healthcare providers who monitor the patient during withdrawal, dispense medications, and provide emotional support.
Withdrawal management facilities are usually calm and quiet to allow patients to rest and sleep. Meditation and other calming activities as well as light exercise, such as walking, are encouraged during withdrawal. However, intense physical exercise is not recommended as this can prolong withdrawal or make the symptoms worse.
It is not unusual for patients to feel scared or anxious during withdrawal. Healthcare providers can allay these fears by providing accurate and realistic information. Experts do not recommend engaging in counseling or psychotherapy at this stage of addiction treatment. Some patients become difficult to manage with aggressive or disruptive behavior caused by confusion or disorientation. Various behavior management strategies can be used to manage these withdrawal symptoms. Last but not least, many of the physical symptoms of withdrawal can be alleviated with medications. 5
Drug Addiction Withdrawal Symptoms
Withdrawal symptoms vary according to the type of drug abused and the severity of the addiction. Someone who has abused a drug for a prolonged period or used large amounts of the drug or used the drug frequently is likely to suffer more severe withdrawal symptoms compared to a person with mild drug abuse. The method of drug use and the presence of underlying physical and mental health issues can also affect the severity of the withdrawal syndrome. The following paragraphs describe some of the common withdrawal symptoms associated with alcohol, prescription drugs, and illegal substances.
Alcohol withdrawal can be very uncomfortable for patients. In rare cases, withdrawal from alcohol can lead to life-threatening complications that require emergency medical interventions. Symptoms of alcohol withdrawal include anxiety, sweating, tremors, increased heart rate, increased blood pressure, dehydration, insomnia, nausea, vomiting, and diarrhea. In severe cases, the person may experience delirium, hallucinations, extreme agitation, seizures, and severe fluctuations in blood pressure and body temperature.
Opioid drugs include the illegal drug heroin as well as prescription pain medications, such as codeine, OxyContin, and methadone. Opioid withdrawal can feel like a bad case of the flu and it is usually not life-threatening. Symptoms of opioid withdrawal include anxiety, insomnia, nausea, vomiting, diarrhea, sweating, hot and cold flushes, muscle cramps, and watery eyes and nose.
Benzodiazepines are a class of drugs used to treat anxiety and sleep disorders. Long-term use of benzos can lead to dependence. During withdrawal from benzodiazepines like Valium and Xanax, patients may experience symptoms such as anxiety, insomnia, agitation, restlessness, irritability, inability to focus, poor memory, and muscle aches.
Stimulants are drugs like methamphetamine (meth) and cocaine. Although their effects are different, the withdrawal syndrome for meth and cocaine is similar. Symptoms include depression, agitation, irritability, muscle aches, increased sleeping, and increased appetite. Heavy methamphetamine use can give rise to hallucinations and paranoia during withdrawal, which may need to be managed with anti-psychotic medications.
Inhalants are volatile substances that produce chemical fumes that are inhaled for their psychoactive (mind-altering) effects. They include things like hair sprays, fabric protectors, and whipped cream dispensers. Inhalant addiction is not well understood and only some people develop a dependence on these substances or experience withdrawal symptoms. Symptoms of inhalant withdrawal may include nausea, headache, tremors, insomnia, lethargy, anxiety, poor concentration, irritability, and hallucinations.
The withdrawal syndrome associated with cannabis (marijuana) is typically mild and can include symptoms such as irritability, restlessness, anxiety, fear, dissociation, poor appetite, sleep disruption, night sweats, vivid dreams, and tremors.
Duration and Timeline of Withdrawal Symptoms
The onset, duration, and severity of withdrawal symptoms vary with different drugs and alcohol. There is no way to predict how bad withdrawal symptoms will be in any particular person. However, the typical durations and timelines associated with withdrawal from the most common drugs of abuse are listed below.
Alcohol Withdrawal Timeline and Duration
- Symptoms appear 6-24 hours after the last drink.
- Symptoms are severe for the first 36-72 hours.
- Symptoms last for 2-10 days.
Heroin Withdrawal Timeline and Duration
- Symptoms appear 8-24 hours after last use.
- Symptoms last for 4-10 days.
Methadone Withdrawal Timeline and Duration
- Symptoms appear 12-24 hours after the last use.
- Symptoms last for 10-20 days.
Benzodiazepine Withdrawal Timeline and Duration
- Symptoms appear 1-2 days after the last dose for benzos like alprazolam and temazepam (Xanax, Restoril) that are shorter lasting, and continue for 2 weeks to one month.
- Symptoms appear 2-7 days after the last dose for benzos like diazepam (Valium) that are long lasting, and continue for between two weeks and two months.
Stimulant Withdrawal Timeline and Duration
- Symptoms begin within 24 hours of last use.
- Symptoms last for 3-5 days.
Inhalant Withdrawal Timeline and Duration
- Symptoms begin a few hours to a few days after stopping use.
- Symptoms last from 2 days to 2 weeks.
Marijuana Withdrawal Timeline and Duration
- Symptoms are usually mild and can last for 1-2 weeks.
Post-Acute Withdrawal Syndrome
In some instances, withdrawal symptoms can last beyond the usual timelines or reappear after first getting better. This is known as protracted or extended withdrawal or post-acute withdrawal syndrome (PAWS). PAWS symptoms can last for weeks to months after cessation of substance use. They typically consist of mood swings, anxiety, irritability, and insomnia. There can be difficulties with learning, problem-solving, and memory. Some people experience cravings, obsessive-compulsive behaviors, and difficulties with social relationships.
PAWS symptoms are most common after withdrawal from alcohol, opioids, and benzos. It is believed that roughly 90% of opioid abusers and 75% of recovering alcoholics experience protracted withdrawal symptoms. 6
Symptom Management During Withdrawal
During medically-supervised drug addiction withdrawal, clinicians use a variety of medications to treat the physical symptoms of withdrawal. For example, benzodiazepines may be used during alcohol withdrawal to manage discomfort, delirium, and seizures. 7Medicines for other symptoms, such as muscle aches, anxiety, nausea, and insomnia are offered under careful supervision. Patients may also be given vitamin supplementation and encouraged to hydrate aggressively as part of withdrawal management.
The use of medications and close clinical monitoring during drug withdrawal has several benefits, including: 8
- Improved patient survival
- Increased compliance with treatment
- Decreased drug use
- Reduction in criminal activity among people with substance use disorders
- Increased ability to obtain and maintain employment
- Better outcomes in pregnant women with substance use disorders
Medication-Assisted Treatment for Drug Withdrawal
In addition to symptomatic management during drug withdrawal, the Food and Drug Administration (FDA) in the United States has approved several medications for the treatment of addiction, specifically opioid addiction and alcohol dependence.
There is a misconception among some people that medication-assisted treatment (MAT) is simply substituting one drug for another. However, this is not true. Certain medications mimic the effects of harmful drugs and are used during withdrawal to relieve physical symptoms and reduce psychological cravings. Examples of medications used during drug withdrawal include:
Naltrexone (Vivitrol) reduces the urge to drink or use opioid drugs by blocking opioid receptors in the brain, which are responsible for the pleasurable effects of these substances. When the receptors are blocked, the person stops associating opioid drugs or alcohol with pleasurable feelings. 9
Disulfiram (Antabuse) was the first medication approved for use during alcoholism withdrawal. It works by producing unpleasant side effects such as nausea, vomiting, flushing, and fast heart rate if a person consumes alcohol. The fear of feeling sick encourages recovering alcoholics to remain abstinent. 10
Acamprosate (Campral) decreases cravings for alcohol and reduces withdrawal-associated distress by providing relief of physical and emotional symptoms. This medication appears to work by balancing neurotransmitters in the brain. 11
Methadone is an opioid medication that is used to treat severe opiate addiction. It works by attaching to the same opioid receptors in the brain as heroin and opioid painkillers and blocking or blunting the effects of these drugs. Since methadone is a longer-acting opioid, it does not make a person “high.” Methadone maintenance in recovering opioid addicts helps suppress cravings and allows for a smoother withdrawal. 12Methadone is dispensed through federally-regulated opioid treatment programs (OTPs) under the supervision of a physician because of its potential for addiction. 13
Buprenorphine (Subutex) has a similar mechanism of action to methadone but has a lower potential for addiction. It is available in combination with naloxone (Suboxone) for use in the treatment of opioid dependence. Buprenorphine helps reduce the extremely uncomfortable symptoms of opiate withdrawal and is an effective means to decrease opioid drug use. 14
Risk Factors for Complicated Withdrawal
Some people are at higher risk of experiencing severe withdrawal with numerous medical complications. The risk factors for complicated withdrawal include: 15
- Older age (more than 65 years old).
- Numerous previous drug withdrawal episodes during the person’s lifetime.
- Comorbid medical or surgical conditions (for example, traumatic brain injury).
- History of delirium or seizures during prior withdrawals.
- Long duration or heavy use of drugs or alcohol.
- Autonomic hyperactivity on presentation (manifested by high blood pressure, heart rhythm irregularities, high or low body temperature, and numerous other symptoms). 16
- Concomitant use of multiple addictive substances.
- Co-occurring psychiatric disorders.
Patients with severe withdrawal require more intensive care and more frequent monitoring to ensure effective outcomes.
Delirium Tremens: Severe Alcohol Withdrawal
Delirium tremens (DT) is a type of severe alcohol withdrawal syndrome that can potentially result in death. Also called withdrawal delirium, it is characterized by symptoms of agitation, hallucinations, confusion, hyperactivity, and delirium (fluctuating cognition and sleep/wake cycles). Patients with DT also have alcohol withdrawal symptoms like tremors, nausea, agitation, and seizures.
Delirium tremens usually appears after long periods of heavy drinking. It affects roughly 2% of people with alcohol addiction, although some studies have reported a prevalence of up to 12%.
DT symptoms typically develop 48-72 hours after cessation of heavy drinking. The condition is relatively short-lived with a duration of 3-4 days. However, DT is a medical emergency and requires timely intervention to reduce complications and prevent death. Treatment consists mainly of supportive care with IV fluids and medications such as benzodiazepines to calm agitation and prevent hallucinations. 17
The risk factors for delirium tremens include a prior history of DT, presence of infectious comorbidities, development of early withdrawal symptoms, and a genetic predisposition (family history of DT). 18
Dangers of Quitting Cold Turkey
Why is medically-supervised withdrawal management necessary? What are the dangers if someone simply stops using drugs or alcohol at home?
Getting into drugs and alcohol is insidiously easy. It can start with one drink, one puff of a joint, or one line of coke at a party. Before you know it, you’re battling a full-blow addiction with withdrawal symptoms when you try to quit.
It can be appealing to many alcoholics and drug addicts to try and leave their addiction behind once and for all without professional help. Simply stopping the consumption of harmful substances means the person doesn’t have to disclose their addiction to anyone. It also means saving on the considerable costs of addiction treatment. However, quitting cold turkey (abruptly stopping drug use) at home is not recommended.
The reason is that the body needs time to purge the harmful substance and adjust to a new normal. With medically-supervised withdrawal management, recovering addicts can come off the drugs in a safe, controlled environment. The painful and difficult withdrawal process can be made somewhat easier through expert medical management.
The potential complications of addiction withdrawal should not be underestimated. Any number of complications can occur from seemingly innocuous symptoms. For example, persistent vomiting and diarrhea can lead to severe dehydration, high blood sodium levels, and heart failure. 19
With professional medical care, even the most severe withdrawal symptoms can be safely managed in the majority of cases. Another advantage of supervised withdrawal management is that the person does not have access to drugs or alcohol. In contrast, withdrawal at home carries the risk of giving in to cravings and abandoning the drug withdrawal.
Withdrawal management does not necessarily require an inpatient stay in a hospital or drug rehab facility. Outpatient detoxification and withdrawal management can be offered to many patients with mild withdrawal syndrome who have the support of family or friends to monitor withdrawal symptoms. 20
Coping with Drug Addiction Withdrawal
Alcohol or drug withdrawal can be overwhelming and frightening to many people with a long history of substance abuse. There are various things a person can do to make the withdrawal process easier, such as:
Support. Even when you’re undergoing withdrawal under the supervision of a healthcare team, it’s important to have social support. Family and friends can support recovering addicts by being there during the withdrawal process.
Nutrition. Recovering addicts should focus on eating well-balanced, nutritious, healthy meals during withdrawal. This allows the body to replace lost nutrients and aids the healing process by supplying energy.
Hydration. Some of the most common withdrawal symptoms include vomiting, diarrhea, increased sweating, and other flu-like symptoms. It’s important to stay well hydrated during the withdrawal process to help the body’s natural detoxification abilities.
Exercise: People going through drug withdrawal should try to get some physical activity every day, such as walking, swimming, yoga, or sports. Exercise boosts mood, reduces anxiety symptoms, and decreases the urge to use drugs or alcohol.
Sleep. Withdrawal from drugs and alcohol is often associated with sleeping difficulties. However, it is vital to try and get adequate rest. People going through drug withdrawal should practice good sleep hygiene and maintain a regular sleep schedule as much as their symptoms will allow.
Medications. There are various over-the-counter and prescription medications available to relieve withdrawal symptoms such as nausea, diarrhea, headache, etc. It is advisable to discuss all medications with a healthcare provider before using them during drug addiction withdrawal.
What to Expect When Calling a Withdrawal Hotline
If you’re struggling right now, a simple call may set you at ease. A withdrawal helpline can help you:
- Gain insights into addiction and drug withdrawal
- Have someone talk you through a difficult moment in your life
- Learn specific facts about the drug you are detoxing from
- Find out more about physical and psychological withdrawal
- Learn how to get a loved one through withdrawal
- Discover treatment options for making withdrawal more tolerable
- Learn how changing certain aspects of your life can help maintain your sobriety
- Get specific resources based on your personal needs
Of course, some people hesitate to call a drug and alcohol withdrawal hotline. After all, wouldn’t it be easier to just get a little more of the drug? Tomorrow will be a different day. This mentality is not you–it’s the addiction talking to you. While you may feel uncomfortable, even sick, the help for lasting change is just a phone call away.
Tomorrow will be a better day if you bravely take the steps to do your best today.
Last updated: July 24, 2020
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- Gupta M, Gokarakonda SB, Attia FN. Withdrawal Syndromes. [Updated 2020 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459239/
- Harvard Health Publishing. Alcohol Withdrawal. Published April, 2019. Available online: https://www.health.harvard.edu/a_to_z/alcohol-withdrawal-a-to-z Accessed July 24, 2020.
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- Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings. Geneva: World Health Organization; 2009. 4, Withdrawal Management.Available from: https://www.ncbi.nlm.nih.gov/books/NBK310652/
- UCLA Semel Institute for Neuroscience and Human Behavior. Post-Acute Withdrawal Syndrome (PAWS). No date. Available online. https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS Accessed July 24, 2020
- World Health Organization. Management of Alcohol Withdrawal. 2012. Available online. https://www.who.int/mental_health/mhgap/evidence/alcohol/q2/en/ Accessed July 24, 2020.
- Substance Abuse and Mental Health Services Administration (SAMHSA). Medication and Counseling Treatment. No date. Available online. https://www.samhsa.gov/medication-assisted-treatment/treatment#medications-used-in-mat Accessed July 24, 2020.
- Anton RF. Naltrexone for the management of alcohol dependence. N Engl J Med. 2008;359(7):715-721. doi:10.1056/NEJMct0801733
- Skinner MD, Lahmek P, Pham H, Aubin HJ. Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis. PLoS One. 2014;9(2):e87366. Published 2014 Feb 10. doi:10.1371/journal.pone.0087366
- Witkiewitz K, Saville K, Hamreus K. Acamprosate for treatment of alcohol dependence: mechanisms, efficacy, and clinical utility. Ther Clin Risk Manag. 2012;8:45-53. doi:10.2147/TCRM.S23184
- Kleber HD. Pharmacologic treatments for opioid dependence: detoxification and maintenance options. Dialogues Clin Neurosci. 2007;9(4):455-470.
- Substance Abuse and Mental Health Services Administration (SAMHSA). No date. Available online. https://www.samhsa.gov/medication-assisted-treatment/treatment/methadone Accessed July 24, 2020.
- Welsh C, Valadez-Meltzer A. Buprenorphine: a (relatively) new treatment for opioid dependence. Psychiatry (Edgmont). 2005;2(12):29-39.
- The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management. No date. Available online. https://www.asam.org/docs/default-source/quality-science/the_asam_clinical_practice_guideline_on_alcohol-1.pdf?sfvrsn=ba255c2_2 Accessed July 24, 2020
- Oxford Medicine Online. Autonomic Hyperactivity. Edited by Eduardo Benarroch. DOI: 10.1093/med/9780199920198.001.0001 Published online May 2014. https://oxfordmedicine.com/view/10.1093/med/9780199920198.001.0001/med-9780199920198-chapter-13
- Grover S, Ghosh A. Delirium Tremens: Assessment and Management. J Clin Exp Hepatol. 2018;8(4):460-470. doi:10.1016/j.jceh.2018.04.012
- Thiercelin N, Rabiah Lechevallier Z, Rusch E, Plat A. Facteurs de risque du delirium tremens : revue de la littérature [Risk factors for delirium tremens: a literature review]. Rev Med Interne. 2012;33(1):18-22. doi:10.1016/j.revmed.2011.08.002
- UNSW Sydney. National Drug and Alcohol Research Center. Yes, people can die from opiate withdrawal. No date. Available online. https://ndarc.med.unsw.edu.au/blog/yes-people-can-die-opiate-withdrawal Accessed July 24, 2020.
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