Drug and Alcohol Withdrawal
What is Withdrawal?
Withdrawal is a physiological response to a decline in use of a substance to which you’ve developed dependence. An acute withdrawal syndrome consists of a cluster of symptoms that arise after your use of a substance slows or stops after a period of prolonged or heavy use.1,2 Not all substances are associated with significant withdrawal, but for those that are, the accompanying symptoms can be vastly different depending on the substance.1 Some of the more pronounced or easily observable signs of withdrawal are associated with alcohol, opioids, and benzodiazepines.1
When do Withdrawal Symptoms Start?
The onset of withdrawal symptoms will be influenced by several factors, including the specific substance that was used. For example:
- Alcohol withdrawal commonly starts within 6-24 hours after your last drink.3,4
- Opioid withdrawal can begin as soon as 6-12 hours if you’ve used relatively short-acting opioids such as heroin; or may take as long as 2-4 days to arrive with longer-acting opioids such as methadone.1,5
- Benzodiazepine withdrawal can begin within 6-8 hours if you’ve used shorter-acting benzodiazepines such as lorazepam (Ativan) or temazepam (Restoril), or might not develop for 7 days or more with longer-acting benzodiazepines such as diazepam (Valium).1
Though the details differ somewhat from one substance to another, withdrawal occurs due to imbalances and resultant counter-regulatory mechanisms that kick in after you stop taking a substance you’ve been using chronically.2 For instance, alcohol and other drugs can alter the activity of certain brain chemicals known as neurotransmitters; in some cases, when these changes are prolonged, the production of the chemicals themselves as well as the body’s response to them can become imbalanced. Should the use of the drug in question suddenly slow or stop, our bodies may struggle to achieve a rebalanced state; as this rebalancing takes place, withdrawal symptoms can occur.2,6,7,8
What is Dependence?
Dependence develops as a physiological response to chronic exposure to alcohol or other drugs. Though dependence is a common part of many types of addiction, it is not the same thing as addiction. 9 As a person develops drug and/or alcohol dependence, they adapt to the persistent chemical effects of the substance being used.2,6,7,9 These adaptations take place in the brain, on a neurochemical level. Once these adaptations are made—or, as dependence develops—you may need to continue using the substance that led to the adaptations to continue to function or feel normal.2,6,7
After you become physiologically dependent on a substance, you may experience symptoms of withdrawal if you stop taking the substance.2,7,9 As mentioned, withdrawal symptoms vary in terms of the types of substance dependence they are associated with. Symptoms of withdrawal can be both physical and psychological in nature, depending on the substance in question.
Symptoms of Withdrawal
The precise character and severity of withdrawal will differ across substance types, however, substances with similar effects during active use often have somewhat similar withdrawal syndromes associated with them.1 Alcohol and benzodiazepine withdrawal may have a similar set of withdrawal symptoms, which can include:4,7,12,13,14
- Feeling irritable or restless.
- Sleep problems, such as trouble falling asleep or nightmares.
- Increased heart rate.
- Raised blood pressure.
- Increased body temperature.
- Nausea or vomiting.
- Lack of appetite.
A severe complication of withdrawal from alcohol is known as delirium tremens (DT) and is marked by profoundly altered levels of consciousness and awareness. 1,3,4 This can lead to problems with memory, perception, and communication.1,3,4 Delirium tremens also involves difficulty controlling body temperature and heart rate, and may lead to hallucinations.3,4 Typically, DTs are present in only 5% of patients experiencing withdrawal symptoms but can be extremely dangerous when left unmanaged.15
DTs can be fatal. If you suspect you or someone you know is experiencing this form of severe withdrawal, seek medical attention immediately.
Which Substances Can Be Dangerous to Detox From?
Withdrawal is an uncomfortable process, but in some cases, it can be severely unpleasant and, in some cases, dangerous. In such instances, attempts to detox without medical supervision are discouraged. If you’re trying to detox from opioids, benzodiazepines, or alcohol, a supervised, medical detox may be necessary due to the potential for severe symptoms and/or complications that can become life-threatening.1,5,8,13
Attempting to detox alone can be risky, since you aren’t being treated by a doctor, and may not be able to access proper medical care if needed, should complications arise.8
Vomiting and diarrhea associated with opioid withdrawal can also lead to dehydration and electrolyte imbalance, which can be fatal in severe cases.5,14 Risks associated with alcohol and sedative withdrawal include seizures and delirium, which can be progressive and life-threatening in severe cases.1,3,8
A person who is dependent on opioids will experience symptoms of withdrawal should they reduce or suddenly stop taking opioids. Regardless of the type of opioid used, signs of withdrawal are similar for all opioids and can include:17
- Nausea and vomiting.
- Increased body temperature.
- Racing heart.
- Muscle and bone pain.
- High blood pressure.
Stimulant medication may be prescribed to treat symptoms of attention deficit hyperactivity disorder or ADHD. It does have the potential for abuse. Withdrawal symptoms may be both physical and psychological in nature, and they can range in intensity, depending on how strong the dependence on the stimulant is. Symptoms may include:2,9
- Change in appetite
- Mood swings
- Suicidal thoughts
- Drug cravings
- Trouble concentrating
- Lack of motivation
- Muscle aches.
Addiction to Marijuana is possible. According to the National Institute of Drugs and Alcohol, the THC level in marijuana has increased over the past few decades, making it easier to become addicted to the drug and experience adverse side effects from use.
The symptoms of withdrawal may appear within one week after the individual stops smoking marijuana. Marijuana withdrawal symptoms may include:
- Feelings of anger, irritability, and/or aggressiveness
- Sensations of extreme nervousness or anxiety
- Disturbances with sleep that may include insomnia or very disturbing dreams and even nightmares
- A decrease in appetite that may or may not be associated with a significant loss of weight
- Feelings of restlessness
- The onset of feelings of depression
- Physical symptoms that cause significant distress, such as abdominal pain, fever, chills, sweating, headache, and/or tremors or shakiness.
How to Detox Safely
There are a number of options available to help you detox safely. You can receive the support and treatment you need to withdraw from substances safely and with as little discomfort as possible while lowering the risk of developing complications.4,6
The type of detox program or level of intensity needed for appropriate withdrawal management will depend on the severity of the addiction, the magnitude of dependence, and the risk of experiencing a complicated withdrawal.8 A doctor or other treatment professional may evaluate for the above factors prior to making a recommendation for the level of detox care needed to keep a person safe and comfortable.
Various levels of detoxification services include:3,4,7,8
- Outpatient detox: You’ll receive treatment during scheduled daily appointments at a facility or clinic while you live at home and can participate in your usual daily routine. Medical staff provides medication and monitoring while counseling staff provides therapy and support.
- Medically monitored inpatient detox: You’ll stay at a detox facility while you’re in treatment and receive medication and monitoring by medical staff around the clock. The counseling staff provides therapy and support during treatment.
- Medically managed intensive inpatient detox: You’ll stay in a hospital setting while you are in withdrawal, receive medication and intensive monitoring by medical staff around-the-clock, and support and therapy from counseling staff. This intensive level of care may be best suited toward people who are likely to experience complications or have co-occurring medical or psychiatric issues or have experienced severe withdrawal symptoms in the past.
Different medications may be used to ease symptoms of withdrawal, depending on the type of substance dependence.10 For opioids, methadone or buprenorphine are prescribed to stabilize and manage a person in withdrawal, after which the dose will be tapered down slowly.5,8,10 If all symptoms aren’t effectively managed, other medications may be added to address individual complaints.5,8
For alcohol, withdrawal is managed through the use of a relatively long-acting benzodiazepine, such as chlordiazepoxide (Librium) or diazepam (Valium), which will be slowly tapered once you are stabilized.3,6,7,8,12 For benzodiazepines being taken as part of a prescribed regimen, you may be gradually tapered off the drug you’ve been using or switched to a longer-acting medication, such as Librium or Klonopin (clonazepam) prior to initiating a tapered schedule.8
Treating Substance Abuse and Addiction
Detox is an important step toward lasting sobriety, but it is not a substitute for more comprehensive rehabilitation efforts; after withdrawal has been successfully managed, many people move forward with additional treatment to work toward long-term recovery.3,5,8,10 This may take the form of inpatient or outpatient rehab, depending on your individual needs.7,8,10
In either type of treatment setting, you will receive a combination of individual and group counseling sessions; behavioral therapy techniques to help you learn how to cope with triggers and prevent relapse.3,10
Medications may also be incorporated to support your progress in recovery from alcohol or opioid use by reducing cravings, blocking the effects of substances if you take them, or causing unpleasant effects if you take them.3,5,10
Though there is no cure for addiction, with treatment and ongoing support, it can be successfully managed.16 Though any treatment may be beneficial, studies indicate that lengthier treatment times (often 3 months or more) can improve your treatment outcomes.10 Since substance use disorders are chronic conditions, recovery is a life-long process for many. However, with ongoing treatment, support, and diligent recovery efforts, lasting sobriety is possible.
Additional information on what a general admissions process entails can be found on our how to get admitted to rehab page.