Guide to Drug Withdrawal

If you are addicted to any substance, the concept of drug withdrawal can be daunting. But with the right support in place, including Medication for Addiction Treatment (MAT), you can successfully and safely make it through drug withdrawal and into ongoing recovery.

What Is Drug Withdrawal?

Withdrawal symptoms can be extremely varied, and they are based on a variety of factors. Different drugs lead to different withdrawal symptoms, and the length of time a person has been dependent on the drug also influences withdrawal symptoms.

Common drugs that may cause withdrawal when misused and abruptly stopped include alcohol, opioids (including both prescription painkillers and heroin), stimulants, and sedatives. Withdrawal symptoms can range from mild to very uncomfortable. In some instances, they may be severe and cause irreparable damage or even death if not properly addressed.

Why Does Drug Withdrawal Happen?

When you take a drug, your body will react to it and make changes in order to maintain your health. When you abuse a drug, your body adapts to the drug’s constant presence in your system, and it will produce more or less of certain chemicals depending on which drug you’re abusing.

These counterregulatory mechanisms do not change overnight, and consistent abuse of a drug ultimately creates a dependence upon it. If you are dependent on a drug and stop taking it, your body will not be able to adapt fast enough, which causes withdrawal symptoms.

For example, the brain of someone who is addicted to heroin will produce less dopamine than someone who does not take the drug. If the person stops taking heroin all of a sudden, their body will still produce less dopamine and they are not getting any from heroin. This imbalance is what can cause withdrawal symptoms.

Should You Go Through Withdrawal at Home?

Drug withdrawal can be a tough and painful experience. It can also be dangerous, resulting in serious medical complications including seizure, coma and death in some instances (alcohol withdrawal). Finding yourself in an unfamiliar place while going through withdrawal symptoms may seem uncomfortable, leading some to consider going through withdrawal symptoms at home.

While your withdrawal symptoms may end up being mild, there is the possibility that you find yourself experiencing moderate or even severe symptoms. Depending on which drug a person is experiencing withdrawal from, severe symptoms can include seizures, psychosis, and hallucinations. In extreme cases, they may cause death.

It is always advised to go through withdrawal in the presence of medical personnel. A medical facility can ensure that a person is properly cared for during the withdrawal process, and professionals can adjust treatment based on the severity of each patient’s individual symptoms. 

While going through withdrawal at home may initially seem appealing, it can lead to unforeseen and potentially deadly consequences. It is recommended that you only attempt drug withdrawal while under the supervision of a medical professional.

Withdrawal From Different Drugs

When it comes to withdrawal, symptoms, recovery time, and recommended medications can change drastically depending on what drug a person is dependent on. 

Alcohol

Alcohol use disorder is one of the most common substance use disorders in the world. Alcohol withdrawal symptoms can range from minor to extremely severe.

Some common symptoms include the following:

• Anxiety
• Sweating
• Nausea
• Throwing up
• Diarrhea
• Tremors
• Dehydration
• High blood pressure 
• High heart rate
• Difficulty sleeping

In more serious cases, alcohol withdrawal can cause seizures, hallucinations, drastic changes in temperature and blood pressure, or severe anxiety. Without proper treatment, extreme cases may lead to death.

Common medications that are prescribed to patients going from alcohol withdrawal are thiamine supplements as well as other multivitamins. In moderate or severe cases, patients are prescribed benzodiazepines to reduce anxiety and control involuntary muscle spasms.

Alcohol withdrawal symptoms generally last from 2 to 10 days.

Opioids

While heroin is one of the most known opioid drugs, other opioids such as morphine, OxyContin, and codeine are also commonly abused. With consistent use, physical dependence can form, and stopping use will lead to withdrawal symptoms.

Some common symptoms of opioid withdrawal include the following:

• Anxiety
• Sweating
• Nausea
• Throwing up
• Diarrhea
• Runny nose
• Tearing up
• Goosebumps
• Muscle pain

Supportive care is common during mild opioid withdrawal. This may include proper hydration, a nutrient-rich diet, rest, and meditative techniques. 

For more moderate to severe cases, people may be prescribed the following medications:

• Clonidine: This medication helps to relieve many of the symptoms of withdrawal.
• Buprenorphine: This form of medication-assisted treatment (MAT) helps to alleviate withdrawal symptoms and cravings for stronger opioids. This is often the preferred choice for treatment of opioid use disorder, often in the form of Suboxone in which buprenorphine is combined with naloxone.
• Methadone: If someone has abused long-acting opioids, including methadone itself, for long periods, this medication may be recommended. It can alleviate withdrawal symptoms and cravings for more opioids.
• Codeine phosphate: Like methadone, it can help to alleviate withdrawal symptoms and opioid cravings.

For short-acting opioids like heroin, withdrawal symptoms may last from 4 to 10 days. For long-acting opioids like methadone, withdrawal symptoms may last from 10 to 20 days.

Stimulants

Common stimulants that people suffer withdrawal from include cocaine and methamphetamine.

Some common symptoms include the following:

• Irritability
• Agitation
• Depression
• Sleeping more
• Eating more
• Muscle aches

In more serious cases, patients may experience paranoia or hallucinations. This is especially common with people who are dealing with methamphetamine withdrawal.

Patients are generally given supportive care. In more severe cases, where patients are a danger to others or themselves, they may be given benzodiazepines as a sedative. 

Stimulant withdrawal symptoms generally last 3 to 5 days.

Sedatives

Benzodiazepine is the most common sedative that is abused. Dependence can quickly form, resulting in dangerous withdrawal symptoms if use is suddenly stopped.  

Some common withdrawal symptoms include the following:

• Anxiety
• Difficulty sleeping
• Irritability
• Restlessness
• Difficulty concentrating
• Memory problems
• Muscle aches
• Muscle tension

In more serious cases, patients may experience seizures.

Patients are generally given steadily decreasing doses of benzodiazepines in order to alleviate withdrawal symptoms and eventually end the person’s dependence on the drug.

For short-acting sedatives, withdrawal symptoms may last from 2 to 4 weeks. For longer-acting sedatives, withdrawal symptoms can last from 2 to over 8 weeks.

What Other Supports Are Recommended for Drug Withdrawal? 

In all withdrawal situations, patients may lose liquids from their body due to the variety of symptoms and the fact their body is still recovering. Because of this, many patients are encouraged to drink lots of water in order to replenish the fluids they have lost throughout the course of their withdrawal.

While some patients may feel the urge to do physical exercise to aid their recovery process, it is not advised to exert yourself when going through drug withdrawal. Exercise, other than mild exercise like walking, could exacerbate withdrawal symptoms or make symptoms last longer. As always, speak with a medical professional about any activity if you are going through withdrawal.

For drugs such as opioids or stimulants, patients may experience a protracted withdrawal phase lasting up to six months for the former and two months for the latter. In these situations, patients may feel generally unwell, and they may have a strong craving for the drug from which they are withdrawing.

In these cases, therapy is crucial to build healthy habits and ensure that a person does not relapse. People who relapse after a period of abstinence are more prone to overdose, making relapse even more dangerous. 

Is Drug Withdrawal Enough? 

While drug withdrawal is a challenging process in and of itself, it is only the first step in truly addressing a substance use disorder. 

According to the World Health Organization, withdrawal management by itself is very unlikely to lead to actual abstinence from whatever substance a patient is withdrawing from. After going through withdrawal, people require further treatment, often benefiting from psychosocial interventions.

These tactics to help a patient maintain abstinence are conducted in two parts. The four parts of the first intervention are explained below:

• Drug education: This aims to educate the person on how drugs affect the brain, addiction, and how treatment works. 
• Drug refusal skills: This aims to give the patient resources to confidently refuse drugs when offered.
• Relaxation training: This aims to teach the patient how to effectively deal with anxiety and stress, so they don’t turn to drug use when things get tough.
• Release planning: This aims to reduce the chances that a person relapses when they return home after treatment.

For those with more severe dependence issues, a further four sessions are recommended:

• Motivation: This aims to motivate the person to eliminate drugs or lower the amount they are taking.
• Cognitive therapy: This aims to teach the person how to deal with the thoughts that make them turn to drugs.
• Problem solving: This aims to teach the patient effective problem-solving skills and how to identify problems.
• Craving management: This aims to teach the person how to deal with cravings for drugs.

While withdrawal is an important start to overcoming the challenges of a substance use disorder, a full treatment plan is necessary in order to truly recover. Therapy makes up the backbone of addiction treatment, and it’s through this intensive work with a therapist and often peers as well that true recovery takes hold.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More