What to Expect From Drug Withdrawal

Withdrawing from alcohol or drugs comes with many unpleasant symptoms. These symptoms range in severity and depend on several factors. Which drug you were addicted to plays the largest role, but personal factors like genetics and metabolism make a difference too.

Signs of withdrawal can begin within a few hours of your last use of the drug, or they may take days to appear. They can last anywhere from days to weeks. In cases of severe addiction to certain drugs, long-term symptoms may linger for months.

Withdrawal symptoms usually have several stages. They include:

  • An acute withdrawal period, when the symptoms begin and are most intense – This lasts anywhere from a couple days to a week.
  • A protracted withdrawal period, when symptoms are at their worst, then start to fade.
  • A prolonged withdrawal period after physical symptoms subside – This includes long-term symptoms like cravings and depression.

It’s easy to relapse while getting sober. This is because of the many uncomfortable and even painful symptoms of withdrawal. Physician-assisted detox programs (medical detox) ease discomfort and treat potentially dangerous withdrawal symptoms. After you detox, a treatment program, like partial hospitalization or intensive outpatient, treats long-term withdrawal symptoms while teaching you to live a sober lifestyle.

What Is Physical Dependence, and Why Does It Matter?

You are considered physically dependent on a drug when you can’t stop taking it without experiencing withdrawal effects. It’s also known as chemical dependency, and it becomes worse when your tolerance builds. Tolerance means you need to take more of the drug over time to get the same high. Most people who regularly use drugs and/or alcohol develop tolerance.

Tolerance is thought to be the result of your body’s attempt to maintain homeostasis. Homeostasis is your body’s natural drive to maintain a stable level of functioning. It’s part of what allows you to function efficiently. For example, if you enter a cold room, your body will help warm you up by generating heat through shivering.

When you repeatedly use a drug or alcohol, the connections in your brain change. This helps it adapt to the effects of the drugs and maintain homeostasis. When your brain adapts, you no longer get the same high from the same amount of drugs. You need to take more because throwing off your body’s homeostasis is what allows you to feel high.

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Common Withdrawal Symptoms

The concept of tolerance helps us understand why withdrawal symptoms happen. It doesn’t tell us why you may experience certain symptoms and someone else withdrawing from the same drug may not. A couple things help determine which effects you will experience, like:

  • The type of drug used
  • How high your tolerance is

Some similarities exist among withdrawal from all substances:

Rebound effects. These are symptoms that the drug was originally designed to control. They arise in full force once you stop taking the drug. For example, you might feel significant pain during opioid withdrawal, anxiety during benzodiazepine withdrawal, or lethargy during stimulant withdrawal.

Decreased tolerance. This occurs rapidly during drug withdrawal. It can be dangerous if you relapse because you may overdose due to your reduced tolerance.

Depression. A lack of motivation or inability to experience pleasure are common effects of withdrawal. “Anhedonia” is the inability to feel happiness. It occurs among people in recovery whose brains have been hijacked to produce too much dopamine—the feel-good chemical. In the absence of so much dopamine, people find they can’t feel happy.

Changes to the automatic nervous system. These symptoms include:

  • Irregular heartbeat
  • Irregular breathing
  • Changes in blood pressure

How Long Does Withdrawal Last?

The timeline for withdrawal syndromes varies depending on the drug used. Other factors influence the timeline of withdrawal too:

  • How much of the drug you typically took
  • The manner in which you took it (snorting, injection, etc.)
  • Whether you combined it with other drugs
  • How long you abused the drug
  • Individual factors like your genetic profile, your metabolism, and your weight

Withdrawal timelines are generally broken down into three stages: acute, protracted, and post-acute. It’s important to understand what these phases look like because knowing what to expect will help you—and your loved ones—put the right treatment and resources in place.

Check out the following guide to learn more about what specific withdrawal timelines can look like:

Alcohol

The severity of alcohol withdrawal depends a lot on how severe your addiction is. Light to moderate drinkers will most likely experience mild to moderate symptoms. They may not require medical attention. Because there’s always the potential for seizures, a doctor trained in alcohol withdrawal should monitor you.

Heavier drinkers are at an increased risk of developing seizures, delirium (confusion and psychosis), and other life-threatening symptoms. There is still a risk that these could occur in light drinkers who have abused alcohol for a long time.

You could experience withdrawal symptoms within a day or two after you stop drinking. If you chronically, heavily abused alcohol, withdrawal symptoms may begin only a few hours after your last drink.

Mild to moderate alcohol withdrawal symptoms typically last a week or two. More severe symptoms can last for several weeks or longer, depending on the situation.

If you have an alcohol use disorder, you should begin with medical detox. Supervision from a physician will be needed; do not simply stop drinking on your own. Learn more about withdrawing from alcohol here.

Benzodiazepines

Withdrawal from benzodiazepines like Xanax and Valium can appear similar to alcohol withdrawal. Both can occur rapidly, produce severe confusion, and trigger seizures that can be fatal. Both are typically treated by administering long-acting benzodiazepines in a physician-assisted medical detox program.

In detox, benzodiazepines are administered on a tapering schedule. That means you receive a smaller and smaller dosage over time until you are weaned off of them once your withdrawal symptoms stop.

Opioids

Opioids include drugs like oxycodone, hydrocodone, heroin, and fentanyl. Although withdrawal from opioid drugs can be very distressing, the symptoms are typically not fatal. There is a smaller risk that you will have seizures than there is when withdrawing from other drugs, unless you have a pre-existing condition that increases your risk for seizures.

A person’s tolerance level to opioids increases rapidly. If you’ve been chronically abusing opioids, you may have a very high tolerance. This allows you to take amounts of opioids that may be fatal to someone without tolerance. The major risk associated with opioid withdrawal is that you will relapse. Since your tolerance will have significantly decreased, relapse could easily lead to a fatal overdose. Other risks include dehydration and self-harm due to emotional distress.

For chronic, heavy users, opioid withdrawal symptoms can begin within several hours. For mild to moderate opioid use disorders, it may take a day or two for symptoms to appear.

Medical detox for opioids may involve medication-assisted treatment (MAT) and the use of an opioid replacement medication. Commonly used medications are methadone and buprenorphine (Suboxone) and/or naloxone. When used as part of MAT, these medications can be very helpful in long-term opioid recovery.

Learn more about withdrawing from opioids here.

Stimulants

Common stimulants include methylphenidate (Ritalin), meth, cocaine, and amphetamines. Withdrawal from these drugs typically produces more emotional symptoms than physical symptoms, but you may also experience:

  • Sweating
  • Nervousness
  • Lethargy

With meth in particular, there is a “crash” phase that can include several days of sleepiness.

For most people, withdrawing from stimulants produces extreme mood swings and cravings. These symptoms greatly increase your risk of relapse. As part of medical detox, medications help control cravings and reduce lethargy. Long-term treatment addresses apathy and depression. Learn more about withdrawing from stimulants here.

What Is Medical Detox?

To rid your body of drugs, you must go through the detoxification process. When you stop using drugs or alcohol, your body naturally gets rid of those substances, but this doesn’t mean it’s safe to detox on your own. Detoxing in a medical facility is the safest option. A physician-supervised medical detox program doesn’t speed up the process, but it helps you through safely and as comfortably as possible. It also addresses the symptoms of withdrawal that may cause you to relapse.

Medical detox is highly recommended for anyone with a substance use disorder. If you are addicted to alcohol and benzodiazepines, it’s necessary. We highly recommend it for the other types of addiction because it gives you the best chance possible at a healthy, sober life.

Medical Detox Isn’t the End

A medical detox program can reduce your risk of relapse in the early stages of recovery, but it’s not enough on its own to avoid relapses in the future.

Relapse rates for all types of substance use disorders are high. The potential to relapse is significantly decreased if you participate in treatment following detox. Generally, this means getting involved in some type of addiction treatment program where therapy is the backbone. When you complete a structured program, an aftercare program should be your next step.

In therapy, you’ll address the types of issues that caused your substance abuse in the first place. You’ll learn strategies to deal with these issues. With your therapist, you’ll develop a plan for avoiding alcohol or drugs long term. The longer you remain in treatment for your substance abuse disorder, the greater your chances are of remaining sober.

Are you looking to detox from drugs or alcohol in a safe, compassionate environment? Contact our team at Footprints to Recovery. We can help!

References

  1. https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/there-difference-between-physical-dependence-addiction
  2. https://www.verywellmind.com/definition-of-homeostasis-22207
  3. https://www.medicinenet.com/script/main/art.asp?articlekey=40362

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