What Is Drug Withdrawal?
Withdrawal is the various symptoms that a person may experience if they suddenly stop using or abruptly reduce the heavy or prolonged use of drugs or alcohol.1 The severity of symptoms, the time of onset, as well as length of withdrawal, may vary depending on several factors: the substances that have been abused, the length of time each substance was abused, and the amount of each dose when the substance used.1,2 Depending on the symptoms, medication may be used to help ease discomfort and ensure safety.1 Withdrawal may be severe—possibly even life threatening—or it may be less dangerous, but it is an important first step on the path toward recovery.
In the simplest terms, withdrawal from a substance is usually the opposite of its pharmacologic effects.2 For example, a person who has been under the influence of depressant drugs or medications (e.g. alcohol, opioids, sedatives) tends to rebound with overly stimulated symptoms during the period of withdrawal; on the opposite end of the spectrum, a person who has been abusing excitatory stimulant drugs (e.g. cocaine, methamphetamine) will experience a rebounding depression of physiologic function once the drug is stopped and withdrawal begins.
Withdrawal from drugs and alcohol may be an unpleasant experience. More importantly, however, certain withdrawal syndromes can be quite dangerous. The course of withdrawal can be unpredictable and wide variations can be seen from individual to individual. It’s important that each person be assessed by a medical professional to determine the proper treatment environment and level of care.
Drug Withdrawal Symptoms
Depending on the drug that has been used, withdrawal can have differing levels of effect and risk.
Acute alcohol withdrawal can be very dangerous. As such, it should not be carelessly handled, or done without the guidance of a medical professional. Depending on the severity of alcohol use, symptoms can appear just a few hours after the last drink but can last for as long as a week.3
Possible symptoms of alcohol withdrawal may include:4,5,10
- Increased heart rate.
- Increase in body temperature/sweating.
- High blood pressure.
- Nausea or vomiting.
- Hallucinations or illusions.
Alcohol withdrawal symptoms can progress over the course of time to seizures or another serious condition known as delirium tremens (DTs), a potentially fatal syndrome that begins 48 to 72 hours after the last drink. DTs are characterized by confusion, agitation, hallucinations, and violent tremors of the arms and legs. DTs may significantly elevate the body’s vital signs, including blood pressure, heart rate and respiratory rate, and episodes of DTs have a mortality rate of 1 to 5%.2,3,10
However, unlike alcohol, the period of withdrawal from benzos may last much longer, taking anywhere from a week to a month before symptoms subside.6 Benzodiazepines are sedative medications normally indicated for anxiety, so a withdrawal from them includes heightened anxiety. Other symptoms of benzodiazepine withdrawal include slurred speech, lack of coordination, elevated blood pressure and heart rate, hallucination and, potentially, delirium, and seizures.6
Further complicating matters, users of benzos may also be using alcohol, other sedative-hypnotics, or other drugs. The combination of benzos with another drug may be dangerous, and potentially fatal, and withdrawal from the combination must be handled appropriately in order to protect the health and safety of the patient.10
Opioid withdrawal can be severely uncomfortable but doesn’t carry the life-threatening risks characteristic of alcohol and benzodiazepine withdrawal unless there are underlying medical conditions such as advanced HIV or coronary artery disease.11 Those withdrawing from opioids, including heroin, OxyContin or hydrocodone, may experience symptoms including:7
- Abdominal cramping
While potentially very uncomfortable, opioid withdrawal symptoms don't tend to be life threatening.
Stimulant withdrawal involves withdrawing from drugs such as cocaine, amphetamines, methamphetamine, or medications such as methylphenidate or Ritalin. While stimulant withdrawal may be unpleasant, it is not typically life-threatening.
Symptoms may begin as soon as drug usage has stopped, and some symptoms may last up to 2 weeks.8 Symptoms may include anxiety, difficulty concentrating, increased drug craving, agitation, sadness, exhaustion, insomnia, and depression.8
Withdrawal from stimulants isn’t life-threatening, in most cases, and typically does not require management with medication. Emotionally, though, there is increased risk for those going through withdrawal. Intense depression is a possible symptom of stimulant withdrawal and can lead to thoughts or planning suicide or even suicide attempts.8
Marijuana use is increasing in the United States and with that increase comes an increase in cannabis withdrawal syndrome.12 Marijuana withdrawal, though not as potentially dangerous as withdrawal from alcohol or benzodiazepines, can still be uncomfortable. Withdrawal typically begins within 24 hours of when drug use stops.3
Those going through withdrawal from marijuana may experience symptoms including the following:3,12
- Depressed mood.
- Weight loss/lack of interest in food.
Less commonly experienced symptoms may include tremor, sweating, nausea, and vomiting. Medication is not typically needed to manage withdrawal.12
Medical Detox and Withdrawal
What is detox? Detox is the process through which drugs are cleared from the body.9 Detox at a professional facility is intended to minimize the physical harm caused by the use of substance and help patients cope with uncomfortable, painful, or potentially dangerous withdrawal symptoms.
In some cases, medications might be needed to help patients with withdrawal side effects and reduce drug cravings. Depending on the substance that the body is ridding itself of, medically managed withdrawal may be necessary so that patients can receive medications prescribed or administered by a doctor.9Medical detox helps ensure careful management of the withdrawal symptoms, providing a safe and comfortable environment in which a person can begin his or her addiction treatment and recovery.
As noted previously, some of the acute withdrawal syndromes (alcohol withdrawal, benzodiazepine withdrawal) can pose great risks to the patient. It is sometimes necessary for trained medical staff to supervise the course of withdrawal to control some of the more dangerous physiological responses to no longer having drugs in the system.9
If you or someone you love suffers from drug abuse, a period of drug withdrawal will need to take place before you can work toward sobriety. Qualified drug treatment centers can help guide you through the process as safely and comfortably as possible.
Successfully Withdrawing from Drugs
Successfully dealing with drug withdrawal sometimes begins with the help of professionals. For some people struggling with addiction, it would be quite difficult and inadvisable for them to attempt to successfully navigate a withdrawal period at home by themselves. For many, the uncomfortable symptoms of withdrawal and even the fear of them occurring leads to continued drug use and hinders the decision to begin recovery.
But detox is a necessary and important first step in the recovery process. Medically managed detoxification can ease withdrawal symptoms and ensure your safety. It is an opportunity to uncover alternatives to a lifestyle of drug or alcohol abuse. Detox is the first step in ending a life of addiction and compulsive drug/alcohol use.13
Detox alone is rarely sufficient enough to support long-term abstinence, but it is a critical first step for comprehensive drug treatment that can provide the tools needed to leave alcohol and drugs behind and minimize relapse.13
- National Institute on Drug Abuse. (2019). Frequently Asked Questions.
- Gupta, M., Gokarakonda, S.B., Attia, F.N. (Updated 2020 Jul 2). Withdrawal Syndromes. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
- Center for Substance Abuse Treatment. (2006). 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.
- MedlinePlus. (2019). Alcohol withdrawal.
- Harvard Health Publishing. (2019). Alcohol Withdrawal.
- Petursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction, 89(11): 1455-1459.
- U.S. National Library of Medicine. (2020). MedlinePlus: Opiate and opioid withdrawal.
- Center for Substance Abuse Treatment. (1999). Treatment for Stimulant Use Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 33: Chapter 5—Medical Aspects of Stimulant Use Disorders.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
- Bayard, M., Mcintyre, J., Hill, K.R., Woodside, J. (2004). Alcohol Withdrawal Syndrome. Am Fam Physician, 69(6): 1443-1450.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- Livne, O., Shmulewitz, D., Lev-Ran, S., Hasin, D.S. (2019). DSM-5 Cannabis Withdrawal Syndrome: Demographic and clinical correlates in U.S. adults. Drug Alcohol Depend, 195: 170-177.
- National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of Effective Treatment.