- PrintArticle Summary
- Is Withdrawal Deadly?
- Which Drugs Have the Worst Withdrawals?
- Does Detoxing at Home Raise the Risk?
- What Can I Do to Stay Safe?
Withdrawal is a frightening proposition for many substance-dependent people. Some people who are sick of using alcohol or other drugs avoid quitting due to fears about the pain of withdrawal.
In fact, in some cases, withdrawal can produce life-threatening symptoms that require emergency management, so for those looking to take this essential first step toward recovery, it's important to discuss the risks with a doctor or addiction specialist and seek appropriate treatment.
Is Withdrawal Deadly?
In the best situations, withdrawal symptoms are a slight annoyance, but in the worst cases, withdrawal can be life-threatening.
Understanding why detox can be deadly requires a basic understanding of a substance's effects on the brain. Consistent use of alcohol and certain drugs has the potential to make significant changes in the activity of the brain. In some cases, this can happen very quickly (a matter of weeks).1 Each time alcohol or another drug is consumed, the substance triggers a series of changes, which often involve abnormal surges of certain chemicals in the brain that are associated with desirable effects such as pain relief, relaxation, or a euphoric high.2,3
A person taking a substance regularly may notice a growing tolerance to it. They'll find they no longer get the same effects with the amount they're used to taking and they have to keep taking more.4 Eventually, they may also notice they don't feel well without the drug. When the body and brain need the drug at regular intervals at a certain dose and no longer function as expected without it, the person is said to be physically dependent. Physical dependence is the reason for withdrawal. When the drug is no longer available at the expected levels, withdrawal symptoms emerge.4
The withdrawal process from alcohol and drugs is a highly variable experience; while drugs have relatively predictable symptoms, individual differences—such as the average amount and duration of substance use, overall mental and physical health, and any previous withdrawal experiences—can mean that one person's experience might be very different from another's. Certainly, some people will undergo withdrawal without complications, but others may suffer very severe symptoms that will require medical intervention and, in some cases, may be deadly if not managed properly.5
Not everyone will experience life-threatening symptoms during withdrawal. Substance type is a major factor in whether withdrawal will be dangerous (see below). However, another predictor of severe withdrawal is the presence of one or more preexisting mental or physical health conditions. Someone with a history of cardiac issues, seizures, depression, and violence may be at higher risk of an adverse withdrawal experience when they detox.5
Which Drugs Have the Worst Withdrawals?
Withdrawal syndromes differ among substances. The most serious symptoms are associated with withdrawal from:5
- Sedatives (benzodiazepines, barbiturates, non-benzodiazepine sedative hypnotics)—Medications commonly prescribed to alleviate anxiety and induce sleep, such as Xanax.
- Opioids—Heroin and prescription pain medications, such as oxycodone.
- Stimulants—Drugs like cocaine, methamphetamine, or prescription stimulants (e.g., Ritalin) for attention-deficit/hyperactivity disorder (ADHD).
Alcohol and Sedatives
Though very different substances, alcohol and sedatives affect the brain in similar ways, and quitting them may produce comparable withdrawal symptoms that include:2
- Nausea and vomiting.
- Agitated movements.
Seizures present the greatest physical risk to the person’s well-being during withdrawal from these substances.5 Without immediate medical care, these seizures may cause death.
Opioid withdrawal symptoms include:2
- Nausea, vomiting, and diarrhea.
- Excessive sweating.
This list of symptoms may appear more distressing than deadly, but the hazards increase in more severe cases of withdrawal. During opioid withdrawal, life-threatening concerns include:5
- Dehydration/electrolyte imbalance resulting from vomiting, sweating, and diarrhea.
- Aggravation of underlying cardiac issues due to changes in blood pressure, pulse rate, and sweating. Though rare, the most severe incidents could be fatal.
- Choking and aspiration related to vomiting. Vomit can block the airway or be inhaled into the lungs.
Stimulant withdrawal often produces excessive fatigue, insomnia, and increased appetite, none of which present immediate physical dangers.2 However, stimulants have a profound impact on the cardiovascular system. Someone who has recently used cocaine, for example, may experience heart arrhythmia or a heart attack during the acute withdrawal period.5
Seizures, as well as bleeding in and around the brain, have also been noted during some cases of stimulant withdrawal.5
While the physical risks of withdrawal are the most obvious risks, the mental health symptoms represent another major cause for concern. Increased depression triggered by drug withdrawal may lead to thoughts of suicide in some cases, especially when people have preexisting depressive disorders and/or are addicted to multiple substances.5
When significantly severe mental/psychological changes arise in association with withdrawal, the risks sometimes extend beyond the individual in question to those around them. For example, some people experiencing withdrawal will experience anger, aggression, hallucinations, or delirium, and may lash out in violence toward others.5
Does Detoxing at Home Raise the Risk?
Many people find the idea of detoxing at home appealing not only because the idea of staying home and being surrounded by loved ones can be comforting but also because of:
- Cost. They assume professional detox will be unaffordable.
- Shame and guilt. They do not want other people to know they have a problem with drug or alcohol abuse.
- They worry about taking the time to attend detox due to work, school, or childcare needs.
Despite the allure, detoxing at home can be a mistake, especially for drugs with known life-threatening withdrawal syndromes. Only professional detox staff can:5
- Institute preventive measures to preclude the onset of withdrawal complications.
- Recognize and address immediately the potentially severe medical and psychiatric complications that emerge.
Trying to detox at home is possible under ideal circumstances and it may, in fact, go well, but if problems arise, you may not be able to access the necessary resources in time, and the outcomes could be dire.
Relapse and accidental overdose is another risk of trying to detox at home. Many people will experience extremely strong cravings for their drug(s) of choice during the detox process and are driven to re-initiate substance use to quell their withdrawal symptoms.5 Without the sober environment and support of professionals, the person may be more likely to acquire, use, and possibly overdose on drugs.
What Can I Do to Stay Safe?
There are many options available from which to learn about and connect to safe detox treatment, including:
- Your primary care physician.
- A local mental health or addiction treatment center.
- The nearest hospital’s emergency department.
- Your insurance company.
- National treatment hotlines.
If you have developed a physical dependence to a medication prescribed by your doctor, it's a good idea to start a discussion about the problem with the prescriber to plan the safest ways to withdraw.
Factors that will influence the recommended course of treatment may include your:5
- Drug or drugs of choice.
- The level, duration, and method of use.
- Preexisting medical and mental health issues.
- Previous withdrawal attempts (negative past experiences can predict more severe withdrawal).
- Current levels of stress and support from your life.
- Issues standing in the way of treatment, such as transportation and childcare.
Inpatient treatments are better options for people at greater risk of poor outcomes based on their use, health status, or previous withdrawals because these treatments offer the highest level of safety and provide round-the-clock access to professional staff.5
Not only will inpatient detox professionals care for your needs related to withdrawal, they will care for your preexisting issues like mental health and cardiac concerns to reduce emergent and long-term risks.5 Inpatient detox also helps to ensure safety by providing linkage to additional care in the case of medical emergencies that require care beyond that which is possible in the program.5 Inpatient detox options are found in hospitals, freestanding detox centers, and other acute care settings.5
The need for comprehensive care during withdrawal is especially important for pregnant women.5 Professional detox treatments during pregnancy can save the life of the mother and her unborn child by minimizing risks like spontaneous abortion, premature labor, and birth defects.5 With appropriate treatment, neonatal abstinence syndrome (NAS), a condition where the child is dependent on substances and must experience withdrawal after birth, can be prevented if treatment starts early enough during pregnancy.4
The Substance Abuse and Mental Health Administration (SAMHSA) recommends inpatient detox for alcohol, sedative, and opioid dependence.5
Outpatient detox services may work well for people who, by the estimations of an evaluating treatment professional, will encounter fewer dangers during withdrawal.5 Outpatient treatment options allow for the recovering individual to continue living at home, working, and tending to their other responsibilities while presenting to the treatment center at scheduled intervals. Outpatient treatments can involve several hours of treatment per day or only a few hours per month.
Regardless of the treatment setting, medications are frequently used during detox treatment to:5
- Ease cravings.
- Treat symptoms such as insomnia and GI distress.
- Establish medical and psychological stability.
Not all detoxes will utilize medications, though. Programs called social, or nonmedical, detox will instead provide a safe environment and support from a trained staff to ease the withdrawal process but will forego the use of medical detox medications.5 For substances with known life-threatening withdrawal syndromes, such as alcohol, this will not be an appropriate option.
Withdrawal can be very serious and in some cases, can put your life in danger, but when you enter a professional detox program with qualified medical staff, you can have the peace of mind that you'll be well taken care of.
- DailyMed: U.S. National Library of Medicine. (2017). Halcion.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- Medscape. (2017). Withdrawal Syndromes.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.