- PrintArticle Summary
- Who Gets Withdrawal?
- When Does Withdrawal Begin and End?
- Is the Timeline the Same for Everyone?
- What Is Protracted Withdrawal?
- Do Medications Lessen the Duration?
Withdrawal can bring about a host of effects that, while not always dangerous, can be physically and/or mentally agonizing. For example, the withdrawal effects that arise when someone who is heroin-dependent tries to quit can be sufficiently painful to send them running back to heroin to relieve the discomfort.
However, the good news is that withdrawal won't last forever, and with the help of professionals, the process can be completed with as little pain and as much emotional support as possible. There are various options for people seeking professional detox treatment, and attending an inpatient detox is not always required. Continue reading to discover more about withdrawal and which detox method is safest for you or a loved one.
Who Gets Withdrawal?
People who are physically dependent on alcohol or other substances are at risk of experiencing withdrawal symptoms.1 Many people believe that all addicts will go through withdrawal when they quit, but this isn't always the case. Addiction is a disorder that involves compulsive drug-seeking despite the harm that it causes, and while many addicts are physically dependent on a drug or drugs, not all of them are. Physical dependence must be present for withdrawal to occur.1
Physical dependence refers to the changes that take place in the brain from regular substance use that make it so that the substance is needed for the person to feel "normal". Both normal prescription drug use and recreational substance abuse can result in dependence.1
Someone who uses or abuses a substance sporadically is not usually in great danger of becoming dependent. In most cases, substance use needs to be consistent/chronic for a period of time to create the brain changes linked to dependence and withdrawal.1
When Does Withdrawal Begin and End?
Withdrawal refers to a set of unwanted physical and psychological symptoms that are unique to the specific substance used.1 Not only do the substances dictate the types of symptoms experienced but also the general timeline of those withdrawal symptoms.2
As a class, opioids cover a wide range of substances, legal and illegal, that differ in terms of strength and purpose. Common opioids include heroin, morphine, hydrocodone, and methadone.3
Opioid withdrawal will be heavily influenced by the type of drug being used:
- Someone dependent on a short-acting opioid like heroin may experience withdrawal symptoms that begin just a few hours after the last time they used, peak between at 36 and 72 hours, and continue for between 5 and 10 days.3
- Longer-acting opioids aren't cleared from the body as quickly so the symptoms of withdrawal may be delayed as compared to those of shorter-acting ones. For drugs like methadone, the onset of symptoms may begin as late as 48 hours after the last dose, peak around day 3, and take up to 21 days to diminish.4
As opioid withdrawal symptoms begin, a person may experience:4
- Runny nose.
- Watery eyes.
- Excessive sweating.
- Dilated pupils.
As withdrawal progresses, more intense symptoms may begin and include:4
- Loss of appetite.
- Increases in blood pressure and heart rate.
- Agitation and restlessness.
- Bone and muscle pain.
As with opioids, the specific sedative abused will determine sedative withdrawal timelines— someone dependent on short-acting drugs like Ativan, for example, may experience the onset of effects within hours of quitting; with longer-acting sedatives, such as Valium, a person who quits may not experience significant withdrawal symptoms until a week after the last use.2
- Short-acting sedative withdrawal symptoms will usually peak around day 2 and resolve on day 4 or 5.2
- Long-acting sedative withdrawal symptoms may not peak until the second week and may take up to 4 weeks to decrease significantly.2
Quitting sedatives, specifically benzodiazepines, will tend to produce 3 stages of withdrawal.4
- Early withdrawal:
- GI distress.
- Increases in pulse rate and blood pressure.
- Mid withdrawal may bring about more symptoms such as:
- Poor appetite.
- Late withdrawal is associated with the more dangerous symptoms such as:
- Changing/unstable heart rate and blood pressure.
Due to the dangers of late withdrawal, inpatient medical detox is the preferred option for sedative detox.
Alcohol is associated with a rapid onset of withdrawal—symptoms often begin just hours after the last drink, in some cases when the person still has a measurable blood alcohol level.5 Symptoms usually resolve within 10 days, but those days can be very precarious, especially as the symptoms peak (typically between 36 and 72 hours of quitting).3
Within 12 hours, a person may experience withdrawal symptoms that include:5
- Heart palpitations.
- GI distress.
- Poor appetite.
Alcoholic hallucinosis (visual, auditory, or tactile hallucinations) may arise within 12-24 hours of the last drink.5Alcohol withdrawal seizures represent one of the biggest dangers of alcohol withdrawal. They most commonly begin between 24 and 48 hours after the last drink.5
Some people will experience a very severe form of alcohol withdrawal, called delirium tremens, which typically arises within 2-3 days of the last drink. It is marked by:5
- Hallucinations (primarily visual).
- Severe disorientation.
- Rapid heart rate.
- High blood pressure.
Stimulants—drugs like cocaine, methamphetamine, and amphetamines such as Adderall—all have similar withdrawal syndromes. Symptoms that often begin within 24 hours and last up to 5 days include:3
- Increased need for sleep and food.
- No interest in substance use.
- Low mood.
Psychosis, agitation, and thoughts of self-harm may also arise in some individuals going through withdrawal from stimulants, especially methamphetamine.3
Acute stimulant withdrawal is followed by a longer-lasting phase of protracted withdrawal. (See symptoms below.)
Is the Timeline the Same for Everyone?
The specific drug used and the method of use will be the major factors driving the timeline, so people using the same drug in the same way will generally be expected to withdraw on similar timelines.6
However, the detoxification process—including the specific onset of and resolution of withdrawal symptoms—is unique for each person due to individual differences in their substance use (duration and method), the severity of dependence, their physical and mental health, and whether there have been previous negative withdrawal experiences.
While the timelines may be similar, the experiences can vary widely. Also highly variable are the symptoms that last beyond the acute phase, known as protracted withdrawal.
What Is Protracted Withdrawal?
Acute withdrawal symptoms have a limited duration and are directly related to the reaction of the body and brain to the abrupt end to or decrease in substance use.7 These acute withdrawal symptoms do not always represent the absolute end of substance withdrawal, however.
Protracted withdrawal may endure after the acute symptoms conclude. Sometimes called post-acute withdrawal syndrome (PAWS), these symptoms are common among people recovering from dependence on: 7
Just like acute withdrawal, protracted withdrawal involves ongoing cravings and other symptoms specific to the substance used.3,7
PAWS symptoms associated with alcohol may last for months to several years and include:
- Mood instability.
- Problems thinking and concentrating.
- Lower quantity and quality of sleep.
- Lower desire for sex.
- Increased pain.
Symptoms related to opioids include:
- Emotional numbness.
- Poor sleep.
- Low energy.
- Decreased focus.
- Impaired problem-solving skills.
Symptoms related to benzos may fluctuate for months and include:
- Increased anxiety.
- Panic attacks.
- Obsessive thoughts or compulsive behaviors.
Stimulants like methamphetamine and cocaine can trigger PAWS symptoms that last for a month or more, such as:
- Low energy.
- Lower impulse control.
- Rapidly changing moods.
- Poorer ability to manage feelings and emotions.
- Decreased attention, focus, and concentration.
- Worsening of problem-solving skills.
These symptoms may be very troublesome and, because they can be so long-lasting, they may lead a person otherwise committed to recovery to relapse back to their substance of choice to find some relief. Additional addiction treatment beyond detox can help in learning to cope with these symptoms, and the use of medications (see below) may provide relief both for the acute and the protracted symptoms of withdrawal.
Do Medications Lessen the Duration?
Professional detoxification services help people through the withdrawal process in the safest and most comfortable way possible.8 Many detoxes utilize medications to minimize the symptoms and side effects of the process.
At times, medications used to keep the patient safe and comfortable may actually increase the overall duration of withdrawal.8 Someone with a benzodiazepine dependence, for example, may be first switched to another, longer-lasting benzodiazepine. Once stabilized on the new benzo, the patient will be slowly tapered off the substituted benzodiazepine.8 This process results in a longer withdrawal period but one that is safer and much less intense.
Medications may also be used treat withdrawal from alcohol, opioids, and other sedatives. For opioids, methadone and buprenorphine are often used to decrease withdrawal severity. Alcohol withdrawal, like sedative withdrawal, can be managed with a benzodiazepine or phenobarbital.8 Medications don't usually lessen the duration of withdrawal, but they can make it a much easier experience.
Rapid and ultrarapid detoxes for opioid dependence are sometimes advertised as an easier way to finish withdrawal in a very short period of time.8 In these treatments, the individual is given a medication called an opioid antagonist, like naloxone, during the early stages of withdrawal. These drugs increase the speed of onset and intensity of withdrawal symptoms.8 Detox professionals then provide a number of other medications like clonidine and benzodiazepines to treat the emergent symptoms until the resolution of withdrawal.8 In the case of ultrarapid detox, the patient is placed under general anesthesia throughout the majority of detox.8 Rapid and ultrarapid detoxes have numerous risks, especially when general anesthesia is utilized, and they may not actually ease the process of withdrawal.8,9
Withdrawing from a substance can be scary and painful. To help relieve the burden, be sure to contact a professional detox treatment program so that experts can guide you through the process.
Even after acute withdrawal ends, the symptoms of PAWS can make recovery difficult. This is when medication-assisted treatment (MAT)—the use of medications (such as methadone or naltrexone) to reduce cravings, reduce PAWS, and encourage recovery—can come in to help you maintain your sobriety.1 For assistance in starting your journey to a life no longer shackled to a substance, call today.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- World Health Organization. (2009). Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Setting.
- Federal Bureau of Prisons. (2018). Detoxification of Chemically Dependent Inmates.
- American Family Physician. (2004). Alcohol Withdrawal Syndrome.
- National Institute on Drug Abuse. (1997). Rate and Duration of Drug Activity Play Major Roles in Drug Abuse, Addiction, and Treatment.
- Substance Abuse and Mental Health Services Administration. (2010). Protracted Withdrawal.
- Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
- National Institute on Drug Abuse. (2006). Study Finds Withdrawal No Easier With Ultrarapid Opiate Detox.