- PrintArticle Summary
- Why Does Withdrawal Happen?
- Does It Happen to Everybody?
- What Are Typical Signs and Symptoms?
- Is Withdrawal Deadly?
- How Can I Get Treatment?
Withdrawal can be an uncomfortable and even painful consequence of chronic drug and alcohol use. Withdrawal can occur in anyone who develops physical dependence after using a drug for a period of time. Withdrawal syndromes may vary depending on the specific substances with which they are associated.
Withdrawal from some substances, including alcohol, may pose serious, even life-threatening, risks.
If you’re quitting drugs or alcohol, you can employ the help of a detox program to ensure that you withdraw in the safest manner possible.
Why Does Withdrawal Happen?
People who use drugs or alcohol consistently over a period of time may develop a substance use disorder (SUD), which is a diagnosis given when a person has a hard time quitting or cutting back despite experiencing considerable problems that arise directly from their substance use.1
Physiological dependence is a reality for many people who struggle with substance use disorders. In fact, dependence is one of the diagnostic criteria for this kind of disorder. Physical dependence is the condition in which the body has become so reliant on getting regular doses of a drug that when it no longer gets the drug (either at all or at the same dose), it goes through a period of adjustment during which physical and/or psychological symptoms come on.1,2,3 This period, which is relatively predictable in duration (in most cases), is known as withdrawal.
The type and duration of withdrawal symptoms that a person experiences can vary widely depending upon the specific drug, how long they were used, and other factors unique to the individual, such as their age and health.
Acute withdrawal symptoms are the first symptoms that a person experiences shortly after stopping or cutting back.3 Acute withdrawal can last from 4 days to a month depending upon the specific drug.3 In some instances, even after acute withdrawal symptoms resolve, some people go on to develop post-acute withdrawal. Also known as prolonged or protracted withdrawal, post-acute withdrawal symptoms are often milder but can persist for much longer than acute withdrawal symptoms. Like acute withdrawal, post-acute withdrawal symptoms can vary depending on the specific drug.
Does It Happen to Everybody?
While all drug and alcohol users may be at risk for developing acute and post-acute withdrawal, certain factors may put people at increased risk, such as heavy drug and alcohol use over a period of time, older age, history of physical or psychological health conditions, and nutritional deficiencies.2 Some drug and alcohol users continue to experience withdrawal after the acute stage, while others do not experience any protracted symptoms.3 Some people even experience a period of no symptoms and later develop post-acute withdrawal after several months of abstinence.3
The type of drug that a person uses plays a primary role in whether or not withdrawal will develop. Certain drugs are more likely than others to be associated with specific withdrawal symptoms:2,4
- Alcohol and central nervous system depressants, such as benzodiazepines, barbiturates, and certain sleeping medications, are associated with potentially severe withdrawal syndromes that, if not properly treated, can be deadly.
- Withdrawal from opioids, such as heroin and prescription Vicodin and OxyContin, and stimulants, such as cocaine and methamphetamine, rarely pose immediate health dangers but can be quite unpleasant and difficult for individuals in early recovery to endure.
- Other drugs associated with withdrawal include marijuana, anabolic steroids, inhalants, ecstasy/MDMA, synthetic cannabinoids and cathinones (bath salts), and phencyclidine (PCP).
What Are Typical Signs and Symptoms?
Withdrawal symptoms can vary widely based on the drug being abused.2,4 Common psychological symptoms you might experience while undergoing withdrawal from alcohol or other drugs include:
- Difficulty thinking clearly.
Withdrawal might also elicit certain physical symptoms, such as:
- Sleeping problems.
- Loss of appetite.
- Rapid heartbeat.
- Clammy skin.
This is not a full list, and the exact set of symptoms to arise will be dependent on various factors. When you decide to quit a drug, or drugs, you’ll need to visit a medical or addiction professional to discuss the risks and potential complications. For example, opioid withdrawal typically causes severe flu-like symptoms, while stimulant withdrawal may involve psychological symptoms like depression, anxiety, paranoia, and insomnia. In some cases, withdrawal from certain drugs can be extremely serious. In the case of alcohol, benzodiazepine, or barbiturate withdrawal, symptoms can include severe anxiety, confusion, agitation, hallucinations, and seizures.
When it comes to post-acute withdrawal symptoms, they may persist for weeks, months, or even years after a person stops using.3 Common symptoms of prolonged withdrawal can include chronic anxiety, irritability, depressed mood, anger, low energy, sleeping difficulties, problems with concentration and thinking, low libido, and physical pain.
Some drug users may develop polysubstance dependence. When they try to quit or cut back, they may experience withdrawal from several drugs at the same time, which can complicate the detox process and require specialized detox treatment.
Is Withdrawal Deadly?
Withdrawal from drugs and alcohol can be an uncomfortable and dangerous process. And yes, quitting certain drugs can lead to the development of withdrawal symptoms that may be deadly.2,4 Alcohol, in particular, has one of the most dangerous syndromes.
Alcohol withdrawal symptoms may manifest as delirium tremens, which is a potentially fatal condition that involves:2,5
- Severe confusion.
- Irregular heartbeat.
- Blood pressure changes.
Long-term drinkers are also likely to suffer from serious medical complications, such as liver damage, pancreatitis, and gastrointestinal bleeding—all of which may require intensive management during the acute withdrawal period, which is already rife with other medical risks.2 Alcohol withdrawal typically begins within about 6-24 hours after the last drink is consumed (sometimes when alcohol concentration in the blood is relatively high); however, for some people, it may take several days for symptoms to appear.2 After the symptoms begin to arise, they usually peak between 24 and 72 hours after the last drink and can continue for weeks.5
Choosing to attempt detox from alcohol, benzodiazepines, or barbiturates without help is a decision that can kill you.
Withdrawal from certain prescription drugs like benzodiazepines and barbiturates can trigger dangers similar to those of alcohol withdrawal that may also be life-threatening. Choosing to attempt detox from alcohol, benzodiazepines, or barbiturates without help is a decision that can kill you.
In addition to the physical symptoms of withdrawal, many drugs are associated with significant psychological issues, such as anxiety, aggression, panic, and depression.2,4 Often, these symptoms go away within several days or weeks, but in some cases, they may progress in severity. If left untreated, people experiencing depression may be at risk of experiencing suicidal thoughts, suicidal attempts, and other attempts at self-harm.
Another danger of drug withdrawal is the risk for relapse and subsequent overdose. Strong cravings combined with the discomfort of withdrawal can lead to a relapse.2 People who have detoxed from drugs like heroin may not realize that their tolerance to the drug has lowered significantly. They may relapse by using the amount of the drug they’re used to and easily overdose because they are no longer equipped to handle a dose of that strength. The majority of opioid overdoses happen shortly following detox and withdrawal.6
How Can I Get Treatment?
Drug and alcohol withdrawal can pose risks for relapse, overdose, medical and psychological complications, and even death. Attempting to withdraw on your own can increase the risk for dangerous outcomes, especially when withdrawing from alcohol and other central nervous system depressants. Detoxification programs offer the opportunity to go through withdrawal in a safe environment with careful monitoring by professionals.
Finding the right type of detox program is important, since factors like the type of drug being abused and a person’s health can impact the severity of withdrawal. Medical detox programs carefully monitor withdrawal symptoms and provide medical treatment to reduce discomfort and prevent complications like delirium and seizures. This type of detox from drugs and alcohol can be accomplished in an inpatient setting where a medical professional can watch for potentially dangerous signs. Inpatient medical detox programs offer the opportunity to detox in a highly structured environment with 24-hour monitoring. These programs may be offered in a hospital or other inpatient treatment facility.
Some lower-risk detoxes can progress with regular check-ins with a clinician in a doctor’s office or as part of an outpatient program, but you should always speak with your physician as to whether this is an appropriate and safe option for you.
Medical detox programs may utilize certain medications to alleviate the discomfort of withdrawal, reduce cravings, and minimize the risk of medical complications. Medications utilized may include benzodiazepines for alcohol withdrawal and opioid substitutes like methadone or buprenorphine for opioid withdrawal.7
Unlike medical detox programs, social detox programs do not typically offer medications or medical treatment. Instead, these programs focus on providing support through therapy sessions and recovery meetings. If medical complications do arise, they may refer you to a local hospital or doctor’s office. Some facilities may allow you to take medications prescribed by outside doctors under staff supervision. These programs are not appropriate for those going through withdrawal from alcohol, benzodiazepines, or barbiturates. Additionally, while you may be able to white-knuckle it through opioid withdrawal, the Substance Abuse and Mental Health Services Administration recommends medical detox in a hospital or other 24-hour care environment to reduce the extreme discomfort and prevent relapse.7
It is important to continue treatment even after detoxification is complete. Detox only addresses the physical reliance on a drug and none of the psychological issues that keep a person using.
Treatment after withdrawal involves learning how to cope with triggers and urges to use alcohol and other drugs and to investigate what contributed to the addiction. Continuing treatment options can include inpatient rehab, where a person stays at a facility for an extended period of time, or outpatient treatment, where a person comes and goes from the facility once or more per week to attend therapy sessions. Inpatient treatment provides intensive 24-hour care that can be helpful for people who don’t have the support or the tools to remain sober in their home environment. During an inpatient stay, you will have the opportunity to focus exclusively on your recovery without the stressors of everyday life. Outpatient treatment allows you more freedom and time to work, go to school, and take care of responsibilities at home. This type of treatment is ideal for people with high levels of support who feel ready to manage triggers and cope with cravings outside of a structured environment.
Continuing treatment after detox can help drug and alcohol users maintain long-term sobriety and prevent the likelihood of a future relapse.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- 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.
- Center for Substance Abuse Treatment. (2010). Protracted withdrawal. Substance Abuse Treatment Advisory, 9(1), 1-8.
- National Institute on Drug Abuse. (2018). Commonly abused drugs chart.
- U.S. National Library of Medicine. (2017). MedlinePlus, Alcohol withdrawal.
- U.S. National Library of Medicine. (2016). MedlinePlus, Opiate and opioid withdrawal.
- Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2006. (Treatment Improvement Protocol (TIP) Series, No. 45.) 4 Physical Detoxification Services for Withdrawal From Specific Substances.