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About Drug and Alcohol Withdrawal

Drugs and alcohol affect the body in myriad ways. They may impair the function of the brain and can damage other major organs, both acutely and in the long term. Over time, the body grows accustomed to the presence of drugs and alcohol and may become further imbalanced when they are no longer used. When regular users who have developed the physical need for substances attempt to cut back or stop, they often experience physical and psychological withdrawal symptoms.

Symptoms of withdrawal can range from uncomfortable aches and pains to life-threatening seizures. Certain people may be at higher risk of developing dangerous complications and will need the expert medical assistance available in a supervised detox environment. Your particular withdrawal syndrome will be affected by a number of factors like your health and your age and, most importantly, the type of drug from which you are withdrawing.

What Is Withdrawal?

Woman sitting on couch experiencing withdrawal symptomsWithdrawal refers to the body’s reaction to the drastic decrease in or lack of drug in the system. This reaction manifests as a set of physical and/or psychological symptoms that might be simply troublesome and uncomfortable or might be extremely serious, even deadly.1 While most people think only long-term heavy users will suffer withdrawal, this is not true. In fact, in some cases, substance dependence can develop in a matter of weeks.5 And you don’t need to be addicted to be dependent. Maybe you’ve been prescribed an opioid painkiller and have been taking it for a month. You might already be dependent and could experience some amount of withdrawal even if you never misused it.

Most symptoms will persist for days or weeks, but others can be protracted (last as long as months or even years).2 Certain substances are associated with a withdrawal syndrome that is sufficiently severe to require medical attention. For example, withdrawal from drugs like alcohol or benzos (e.g., Xanax) is especially risky because of the chance of developing life-threatening symptoms like seizures.1

People who develop physical dependence often simultaneously build a significant amount of tolerance to the substance in question. As a person becomes tolerant, their body becomes used to a certain dose and needs a higher one to feel the same magnitude of the substance’s effects. This pattern repeats as tolerance grows, leading the person to take escalating amounts that increase their health risks and may more easily lead them to overdose.3 Someone who is dependent and is used to taking very high and/or very frequent doses may suffer relatively severe withdrawal symptoms when they stop using.

Withdrawal symptoms can vary significantly based on the type of drug being used; however, this is not the only determining factor for withdrawal severity. Your symptoms may be influenced by:1

  • How long you used the drug.
  • How heavily you used the drug.
  • Your age.
  • Your physical and mental health condition.
  • Whether you have a history of going through severe withdrawal. 

What Drugs Cause Withdrawal?

Many drugs of abuse result in some form of withdrawal when slowed or altogether stopped, though different drugs can vary in the type, intensity, and duration of symptoms and the danger that they pose.1 For example:

  • Stimulants like cocaine and methamphetamine can cause noticeable physical and emotional reactions during withdrawal but carry a low risk for serious medical complications.
  • Heroin withdrawal can cause painful flu-like symptoms and strong cravings. Though uncomfortable, these symptoms are rarely dangerous but can significantly increase the risk for a relapse.
  • Withdrawal from central nervous system (CNS)-depressing substances like alcohol, prescription benzodiazepines, and barbiturates carry a high risk for complications during withdrawal which, if left untreated, may be deadly.
  • Classical hallucinogens (e.g., LSD, DMT) are not associated with any significant withdrawal syndrome; however, one drug with hallucinogenic properties—MDMA (Ecstasy, Molly)—may lead to certain psychological withdrawal issues (anxiety, depression) when not taken, potentially in connection with the temporary serotonin depletion that results after heavy use.1

Many prescription drugs are just as likely as illicit drugs to cause withdrawal:1

  • Withdrawal from prescription stimulants like Adderall and Ritalin can include symptoms similar to cocaine and methamphetamine withdrawal, such as changes in sleep and appetite, as well as paranoid thoughts.
  • Prescription opioids like OxyContin and Vicodin are associated with withdrawal symptoms similar to those encountered during heroin withdrawal, such as nausea, vomiting, and muscle pain.
  • Withdrawal from prescription benzos like Xanax and Valium and prescription barbiturates like phenobarbital can cause severe confusion and life-threatening seizures.

Common Symptoms

While the precise course of withdrawal may differ from person to person, people withdrawing from certain specific drugs may expect to experience some common symptoms. 

Alcohol

Alcohol withdrawal symptoms can include:1,4

*Delirium tremens is a dangerous condition that can develop in heavy drinkers who abruptly quit.1,4 Symptoms such as severe confusion, hallucinations, and seizures can occur. If not properly treated, delirium tremens may be deadly.

Opioids

Opioid withdrawal symptoms can include:1,5

  • Muscle aches and spasms.
  • Enlarged pupils.
  • Nausea/vomiting.
  • Diarrhea.
  • Anxiety.
  • Sleeping difficulties.
  • See more.

Most opioid withdrawal symptoms resolve within a few days or weeks, depending upon the specific type of opioid.1 However, anxiety, depression, and sleeping problems may persist for several weeks or months.2

Sedatives

Withdrawing from prescription sedatives like benzodiazepines and barbiturates can cause:1,6

  • Anxiety.
  • Insomnia.
  • Confusion.
  • Poor concentration and memory.
  • Dizziness.
  • Shaking.
  • Sweating.
  • Hallucinations.
  • Seizures.

Like alcohol withdrawal, sedative withdrawal can be deadly, especially if complications like seizures occur.1,6

Stimulants

Withdrawing from stimulants like cocaine and methamphetamine can cause:1

  • Anxiety.
  • Increased or decreased sleep.
  • Increased appetite.
  • Low energy.
  • Paranoia.
  • See more. 

Is It Dangerous?

Withdrawal can be dangerous because of the risk for complications and death.1 The greatest risks of withdrawal occur when detoxing from alcohol, benzodiazepines, and barbiturates because of the possibility of developing seizures or DTs. These conditions can result in death if not treated properly or quickly.

Mature business man holding head feeling painIn particular, the acute alcohol withdrawal period may be fraught with serious health issues beyond seizures and/or delirium tremens, including those complications related to:1

  • Low blood sugar.
  • Chronic malnutrition.
  • Gastrointestinal bleeding.
  • Cardiomyopathy.
  • Pancreatitis.
  • Liver failure.
  • Hepatic encephalopathy.
  • Generalized impaired brain functioning.
  • Lung infections (resulting from impaired levels of consciousness and subsequent aspiration).

Ignoring the risks of withdrawal from these drugs can be deadly. You must get professional help when you’re dependent on these types of substances and trying to quit.

While opioid and stimulant withdrawal is generally not considered life-threatening, withdrawing from these drugs can cause intense discomfort and strong cravings.1 Detoxing from these drugs alone can significantly increase the risk for a relapse.

Relapsing on opioids after withdrawal may more easily lead to an overdose, even when taking a smaller dose of the drug, because of the incremental drop in tolerance that occurs during the withdrawal period.5 In fact, the majority of opioid overdose deaths occur following withdrawal.5

Safest Ways to Get Clean

It’s tempting to stay home and try to detox alone, but it might not be the best thing for you. Even if you’re not facing significant risks, the extreme discomfort and cravings you face may derail your efforts before they’ve even begun.

Detox programs provide a safe and comfortable environment for withdrawing from drugs and alcohol. These programs are staffed with professionals who specialize in treating addiction. Detox centers offer short-term care for the duration of acute withdrawal, which is typically 5-10 days but in some cases may be longer. Once detox is complete, a person may be referred to another program for further addiction treatment.

The extreme discomfort and cravings you face may derail your efforts before they’ve even begun.

Social detox programs offer non-medical services for people withdrawing from drugs and alcohol.1 Participants usually stay at the facility and partake in therapy and support groups, where they are taught about addiction and how to maintain sobriety. There are also ample opportunities to develop relationships with other sober people, which will be helpful when detox is complete. If medical or psychiatric complications arise, a person may be referred to another facility, hospital, or doctor’s office for treatment. The goal of social detox programs is to help people withdraw from drugs and alcohol in a supportive environment. Social detox provides no medical support, so it should only be sought by those with little risk of complications and who have spoken with their doctor and gotten their sign-off.

Medical detox programs can take place in a treatment facility or hospital where the focus is on medically treating withdrawal symptoms.1 These programs are often staffed with doctors, nurses, and other addiction professionals who provide around-the-clock supervision and care. They may regularly check a person’s vital signs, assess for complications, and prescribe medications to alleviate certain symptoms and reduce the risk for delirium and seizures.

Several medications have been shown to be effective for treating cases of opioid, alcohol, and sedative withdrawal. Medications may be used in the treatment of withdrawal symptoms. For example, methadone and buprenorphine may be utilized to relieve symptoms and reduce cravings during opioid detox, while benzodiazepines may be used to prevent seizures and DTs during alcohol detox. 1,3,5

Withdrawal from sedatives like benzos and barbiturates may involve slowly tapering users off of these drugs.1 Doctors may lower the drug’s dose over a period of weeks or months or may transition a person to a drug with a longer half-life. For example, Xanax, a short-acting benzo, may be replaced with a longer-acting benzo like Valium. This can minimize the intensity of withdrawal symptoms, facilitate a tapering schedule, and prevent medical emergencies.

Medically supervised detox is important, especially in cases where severe physical or psychological complications may arise.1

People who are withdrawing from alcohol, benzos, and barbiturates, those with a history of physical or mental health problems, and anyone with a history of previous complications during withdrawal are best served in a medical detox program. Those withdrawing from opioids can also benefit from medical detox due to the intense discomfort and relapse risk.

Medically supervised detox programs carefully monitor and treat withdrawal symptoms before they can become life-threatening. Withdrawal can be an uncomfortable and possibly dangerous process. Rather than risking your health and possibly your life, consider withdrawing with the help of professionals.

References:

  1. Center for Substance Abuse Treatment. (2015). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
  2. Center for Substance Abuse Treatment. (2010). Protracted withdrawal. Substance Abuse Treatment Advisory, 9(1).
  3. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition).
  4. U.S. National Library of Medicine. (2017). Alcohol withdrawal.
  5. U.S. National Library of Medicine. (2016). Opiate and opioid withdrawal.
  6. Ashton, H. (2005). The diagnosis and management of benzodiazepine dependence. Current Opinion in Psychiatry, 18(3), 249-255.
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