Table of Contents
What is Withdrawal?
Withdrawal refers to the mental and physical symptoms that occur as someone detoxes from substances like alcohol or narcotics. Drug withdrawal typically occurs following the development of dependence or addiction.
The American Association of Medical Colleges (AAMC) in 2019 reported that twenty-one million Americans experience addiction each year. Yet few – an estimated 11% – ever seek support for treatment.1 In addition, according to the CDC, drug overdose deaths rose 29.4% in 2020 to a total of 93,331.2
While the prospect of substance withdrawal can feel daunting, it is a critical first step to safeguarding your health, preventing overdose, and getting started on the road to recovery.
Physical dependence occurs when someone’s body begins to rely on a substance to function “normally.” It can occur with or without addiction and refers to the body’s need for a substance to function optimally. Dependence can result from taking prescriptions as prescribed and from substance abuse.
Just as we can become dependent on substances to trigger physical changes, we can also become psychologically dependent. Psychological dependence involves a mental attachment to the habit of taking the drug, which connects to our brain’s reward system.
Withdrawal: What to Expect
Although withdrawal symptoms look different depending on the drug, numerous factors like symptoms, timeline, and cravings are shared across various substance addictions.
Withdrawal comes in many forms and can affect people differently depending on the length of use, type of drug abuse, and personal factors. However, regardless of the drug, several symptoms remain common to the withdrawal experience, including:
- Shakes or tremors
- Congestion and a runny nose
- Nausea or vomiting
- Stomach issues
- Trouble sleeping
- Shifts in appetite
- Mood changes
- Muscle pain
In more severe situations, symptoms may also include delirium, hallucinations, and seizures. These symptoms are rarer, however, and do not affect everyone experiencing drug withdrawal.
Perhaps one of the most easily recognizable signs of dependence and addiction is cravings.
Cravings, best defined as severely intense sensations of wanting or needing, often set in as our body finishes metabolizing the last of the drug that someone is dependent on. As the body clears the drug from the system, it signals the brain to let it know it needs more of the substance. Cravings and withdrawal symptoms are telltale signs of dependence.
The time it takes to detox from a drug varies based on the type of drug and personal use factors. For example, alcohol withdrawal looks different from Xanax withdrawal, which looks different from meth withdrawal.
Drug withdrawal often starts within a day, with acute symptoms lasting up to a week, and longer-lasting symptoms for up to a month and beyond.
Common Types of Addiction Withdrawals
Symptoms will often appear within eight hours from the last drink and peak over the next twenty-four to forty-eight hours. Alcohol withdrawal can cause seizures, which are more likely within the twelve-to-forty-eight-hour window. Additionally, it is critical that people experiencing alcohol withdrawal watch for Delirium Tremens, a life-threatening symptom that can occur within three days of your last drink.
Withdrawal from commonly abused drugs like Xanax, Valium, and Klonopin sets in within one to four days from last drug use. Benzo withdrawal takes longer than alcohol withdrawal, peaking in severity within the first two weeks. In some cases, people may experience a protracted withdrawal (acute withdrawal syndrome), where symptoms continue for months beyond last drug use.
The symptoms that accompany meth withdrawal typically set in within the first twenty-four hours. Meth withdrawal symptoms can last for about two weeks, although some may experience acute withdrawal syndrome.
Short-acting opioid (heroin) withdrawal symptoms usually peak within the first eight to twenty-four hours, with symptoms potentially lasting up to four days. Longer-acting opioid withdrawal from opioids like methadone can take two to four days for symptoms to start and around ten days before symptoms fade.
Withdrawal Without Medical Help
Drug withdrawal is possible without medical help for certain substances, although this method of detoxing is not recommended. Moreover, some substances require medical supervision during detox, as they can precipitate life-threatening symptoms if someone attempts to quit without professional help.
Medical supervision not only helps someone ward off potentially life-threatening symptoms, but it can also bring someone more comfort and support to what often seems like a daunting journey to recovery.
Medical professionals do not recommend unassisted withdrawal from dangerous substances like alcohol or benzodiazepines.
Alcohol and benzo withdrawal can prompt potentially life-threatening symptoms such as seizures, extreme agitation that can lead to injury, and delirium tremens. People undergoing these types of withdrawal symptoms should seek out medical supervision to help them stay safe and diminish the discomfort associated with this experience. Although the journey to recovery can be challenging, it is not something that you have to do alone.
What is the Brain Reward System?
When drugs or alcohol are consistently misused over long periods, they can disrupt the brain’s reward system. The reward system is a circuit that triggers pleasure when we witness something that’s brought us enjoyment before. This pleasure can be considered a craving, which comes in the form of excitatory signals that motivate us to take action towards eliciting that reward. The reward system involves the nucleus accumbens, which elevates dopamine levels and brings feelings of pleasure and happiness.
Drug Addictions and the Brain
Addiction and dependence impact us in two ways: the drug’s direct effect and the brain’s reward system. When we consume a substance to the point we become dependent, our brains learn to rely on the chemicals triggered by that drug. Simultaneous to the drug’s effects, our reward system releases dopamine each time we use it, creating a secondary addictive effect.
The “anti-reward system” is related to our stress response. People struggling with addiction often experience the effects of the anti-reward system, which can become overactive and add psychological stress as the drug wears off.
Impact on Drug Withdrawal
As the drug wears off, people with addiction often experience a dysphoric phase characterized by sensations of sadness, heaviness, irritability, numbness, and mood swings. For this reason, the anti-reward system can make it more difficult to feel motivated while recovering from substance withdrawal.
Medications Used to Treat Withdrawal from Common Substances
Numerous medications are approved to help curb cravings, find relief from withdrawal symptoms, and support you on your journey to recovery from substance withdrawal.
Beyond general drug withdrawal symptoms, alcohol withdrawal symptoms can include:
- Delirium tremens (DTs)
- Heart palpitations
While these symptoms can be life-threatening, several medications can bring relief.
Acamprosate provides people suffering from alcohol use disorder with relief from cravings and alleviates withdrawal symptoms.
Disulfiram reduces cravings by causing unpleasant side effects when combined with alcohol. Even a few sips can cause side effects of headache, nausea, vomiting, breathing problems, impaired vision, and more.
Naltrexone helps lessen cravings for alcohol by diminishing the “reward” associated with using the substance. Naltrexone suppresses the substance’s euphoric effects, making it less attractive for consumption. Naltrexone also helps with opioid and meth withdrawal.
While not life-threatening in the same way as alcohol or benzodiazepines, opioid withdrawal symptoms can lead to intense cravings where medical support can be beneficial.
Opioid withdrawal symptoms include:
- Increased sweating
- Nausea and vomiting
- Stomach pain and diarrhea
- Runny nose
- Muscle pain
- Dilated pupils
- Rapid heartbeat
- Raised blood pressure
Methadone is a long-acting, full opioid agonist medication. It helps mitigate the low points of opioid withdrawal and stabilize those recovering from opioid use disorder.
A partial opiate antagonist medication, buprenorphine helps reduce withdrawal symptoms and manage cravings for mild, moderate, and severe opioid withdrawal.
The World Health Organization called naloxone one of the medications most essential to the healthcare system.3 It works by reversing the toxic symptoms of an opioid overdose.
Clonidine is a blood pressure medication that lessens more moderate opioid withdrawal symptoms like vomiting, chills, sweating, and insomnia.
As one of the most commonly abused drugs, Xanax withdrawal is more dangerous than alcohol withdrawal. Withdrawal from benzodiazepines like Xanax leads to higher rates of seizures, including Grand Mal seizures, and can be life-threatening. Benzo and Xanax withdrawal can also prompt severe psychological effects that can increase the risk of suicide.
Benzo withdrawal symptoms include:
- Panic attacks
- Confusion, agitation
- Changes in mood
- Depersonalization (feeling like one has no identity or isn’t real)
Also known by its brand name Valium, diazepam helps the body slowly adjust to the decreasing levels of benzodiazepines in the blood.
Better known as Ambien, zolpidem helps target sleep issues associated with withdrawal and is said to bring a calming effect.
Also known by its brand name Klonopin, clonazepam is often prescribed when anxiety and insomnia symptoms are particularly severe.
Going through drug withdrawal from meth can be particularly challenging due to the psychological symptoms that can occur. Most notable are the intense cravings that peak in the first few days and the often severe depression that follows in the weeks after.
Meth withdrawal symptoms include:
- Severe cravings
- Delusions and hallucinations
- Anhedonia (loss of pleasure)
- Suicidal ideation
- Feelings of despair
- Excessive fatigue and sleepiness
- Shifts in appetite
- Dry mouth
- Restlessness or jitteriness
Commonly prescribed for those with narcolepsy to help regulate sleep, modafinil’s stimulant effects manage irregular sleep cycles and cravings.
Paroxetine is an SSRI commonly prescribed for depression, as well as certain forms of anxiety. Ongoing research suggests paroxetine may help reduce similar symptoms during meth withdrawal.4
Naltrexone and Bupropion
While used separately to assist with drug withdrawal treatment, a recent twelve-week study featuring 400 patients found that combining the two drugs could prove significant in meth withdrawal.6
Therapy Used to Treat Withdrawal
While medications may ease the physical and mental symptoms of drug withdrawal, therapies are critical for addressing the root cause and triggers for the addiction, so relapse does not occur after detox.
Cognitive Behavioral Therapy (CBT)
CBT is a popular therapy created with the premise that stress and problems result from the meaning we give our thoughts. So by changing the way we think, we can change how we feel. CBT helps us become more aware of our thoughts so we can disrupt and replace them with more helpful behaviors and enjoyable experiences.
Dialectical Behavioral Therapy (DBT)
Like CBT, DBT is a talk therapy that focuses on the impact of thought and behavior on feeling. DBT is a subtype of CBT used to support those with extreme emotional responses to specific environments. More specifically, DBT helps individuals feel comfortable acknowledging discomfort or pain while still feeling “ok” and balancing healthy behaviors and coping mechanisms, rather than becoming reactive.
When it comes to recovery, it is critical that people feel self-motivated. Motivational interviewing aims to dissolve insecurities and beliefs, causing ambivalence to boost internal motivation. Research suggests this type of therapy works well for individuals who are unmotivated and may not want to change.
Treatment for Withdrawal
Detox serves as an essential first step to drug withdrawal treatment, but to prevent relapse, it’s beneficial to explore additional treatment options.
Residential treatment is helpful for those who feel they’d benefit from more support and guidance than their home and support structure can give. People who have recently overdosed may also find residential treatment preferable to outpatient, as it means round-the-clock access to support and a safe, comfortable environment to recover in.
Outpatient drug withdrawal treatment is a great option for people who cannot get extended time off from work or home responsibilities. People in outpatient programs still receive all the benefits of residential programs and are required to attend multiple counseling and group therapy sessions each week – just based on their schedule.
Several medications provide significant relief during drug withdrawal treatment. As discussed above, medications like naloxone, naltrexone, buprenorphine, methadone, acamprosate, and disulfiram are all commonly prescribed to support different types of substance withdrawal.