Drug Withdrawal Symptoms, Timelines, and Treatment (2023)

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  • Alcohol Withdrawal

    People with significant alcohol dependence may be at risk of severe withdrawal and should not attempt to quit alcohol “cold turkey” because of the increased likelihood of seizure development or other withdrawal-associated complications. For many, alcohol withdrawal is uncomfortable, but in some instances, it can also prove life-threatening if not appropriately managed through medical detox efforts.

    Alcohol is a central nervous system depressant, or CNS depressant, and abruptly quitting or slowing use after developing dependence can result in potentially dangerous nervous system excitation as the body restores equilibrium. Alcohol withdrawal symptoms may arise within hours of the last drink. Still, some of the more serious risks remain a factor for several days.

    Symptoms of Withdrawal for Alcohol

    Individuals who are dependent on alcohol may experience some of the following distressingalcohol withdrawal symptomswhen trying to quit:2,9

    • Elevated blood pressure
    • Racing pulse
    • Sweating
    • Insomnia
    • Tremors
    • Anxiety
    • Agitation
    • Headache
    • Sweating
    • Nausea/vomiting
    • Hallucinations
    • Seizures

    It is not always that straightforward to predict who is at the highest risk for severe withdrawal and withdrawal complications. However, the likelihood of experiencing significant withdrawal increases with the average quantity and frequency of drinking. People with certain concurrent medical issues, a history of polysubstance use, and those who have experienced previous episodes of alcohol withdrawal may be at additional risk.

    While alcohol withdrawal can start within the first few hours after the last drink, delirium tremens may not start until a few days later, and appear suddenly, making alcohol withdrawal safest when monitored around the clock by medical professionals.

    (Video) Heroin Withdrawal Symptoms and Timeline

    Heroin & Opiate Withdrawal

    Heroinbelongs to the opioid class of drugs. Opioids work by attaching to and activating opioid receptors throughout the body. Opioid receptor activation is associated with a subsequent release of dopamine in the brain, which serves to reinforce the continued use of opioid drugs for their pleasurable effects.10

    Opioids are a widely abused and highly addictive class of drugs. Some degree of opioid dependence may develop after short periods of use, even when taken according to a prescription, in the case of prescription painkillers.

    Opioid medications, when used under the supervision of a medical doctor, successfully alleviate physical pain caused by injury, illness, or surgery. Misuse of these drugs can greatly increase the risk of someone becoming physiologically dependent on them.

    Symptoms of Withdrawal for Opioids

    The acuteopioid withdrawal syndromemay include several characteristic symptoms, such as:8,11

    • Nervousness or anxiety.
    • Trouble sleeping.
    • Frequent yawning.
    • Nausea.
    • Diarrhea.
    • Flu-like symptoms.
    • Muscle cramps/body aches.
    • Runny nose.
    • Excessive sweating.
    • Hot and cold flashes.
    • Goosebumps.

    Although withdrawal from heroin and other opioids is rarely associated with life-threatening complications, enduring the sometimes markedly unpleasant symptoms can present unnecessary challenges to recovery. The mere discomfort of withdrawal—which some describe as mimicking a bad case of the flu—can lead to immense physical and psychological distress.11

    Left unmanaged, opioid withdrawal can easily drive someone toward immediate relapse, which can derail recovery attempts.

    (Video) Drug Withdrawal Symptoms and How to Manage It During Detox

    Benzodiazepine Withdrawal

    Benzodiazepines, or “benzos” as they are sometimes referred to, are a class of drugs that effectively treat anxiety, panic disorder, and certain types of seizure disorders.

    These medications are CNS depressants and work on the brain by increasing activity at receptors for the inhibitory neurotransmitter gamma-aminobutyric acid (GABA). This increase in GABA activity also increases inhibition of brain activity, producing a drowsy or calming effect that may be medically beneficial.12

    Some widely prescribed benzodiazepines include:

    • Xanax.
    • Ativan.
    • Klonopin.
    • Valium.

    Symptoms of Withdrawal for Benzodiazepine

    Potential symptoms ofbenzo withdrawalmay include:

    • Anxiety.
    • Agitation.
    • Sweating.
    • Increased heart rate.
    • Trouble sleeping.
    • Nausea and/or vomiting.
    • Hallucinations.
    • Seizures.

    When used as prescribed under the care of a physician, benzos can help many people manage anxiety, panic, and certain other conditions. However, misuse increases the risk of developing significant dependence on these drugs.

    Cocaine Withdrawal

    Cocaineis an exquisitely addictive stimulant drug that influences the brain’s reward center by blocking the removal of dopamine from the synapses.13This effect in the brain reinforces cocaine use and lays the groundwork for eventual compulsive patterns of use. In turn, this can drive the development of physiological dependence to the drug.

    (Video) Alcohol Withdrawal: Timeline

    When someone abruptly stops using cocaine, they may experience a severe, negative change in their mood. A dependent user may experience cocaine withdrawal within the first day of their last use, and their withdrawal symptoms could last weeks.

    Symptoms of Withdrawal for Cocaine

    Cocaine withdrawalis rarely physically dangerous, but may include several distressing psychological symptoms, such as:

    • Depressed mood.
    • Ongoing tiredness or lethargy.
    • Insomnia or hypersomnia.
    • Anxiety.
    • Irritability.
    • Paranoia.
    • Increased appetite.
    • Problems with concentration.
    • Slowed thoughts and movements.
    • Intense drug craving.

    Withdrawal Treatment: When Is Drug Detox Necessary?

    There are certain factors to consider when deciding whether someone should seek medical detox to manage withdrawal.

    Withdrawal can be challenging—and sometimes dangerous—for someone who is first getting sober. If you’re thinking of getting sober, it’s recommended that you seek guidance from a medical professional, who may recommend a medical detox. This way, once withdrawal symptoms appear, they can be managed appropriately by trained medical staff. Withdrawal management is a large part of the medical detox process. It refers to the medical and psychological care of patients who are experiencing withdrawal symptoms as a result of stopping or significantly reducing use of the drug with which they developed a dependence.11

    With many substances, medical detox provides the safest, most comfortable setting for withdrawal management. While in detox, patients can safely rid their bodies of the toxic influence of substances under the care of medical professionals, who can monitor vital signs, such as high body temperature or high blood pressure, and administer medications to prevent or manage severe symptoms.

    The goal of detox is to reach a state of safety and a comfortable level of mental and physical stability. Someone addicted to alcohol, opioids, benzodiazepines, and other sedatives commonly benefit from undergoing medical detox to safely manage withdrawal with the fewest number of adverse consequences. Many facilities also offersame-day admission detoxfor cases that need attention sooner rather than later.

    (Video) Opioid Withdrawal

    How Long Does Detox Last?

    Most patients will complete a drug detox program in a couple days to a week. How long drug detox lasts depends upon a variety of factors, including which drugs someone used, how much of the drug was used, how long the person has been using, as well as the person’s overall health. Typically, detox is the first step of treatment, and patients will enter rehab and therapy to learn coping and recovery techniques.

    What Are The Medications Used In Drug Detox?

    To stabilize someone in withdrawal from certain substances at the start of a longer-term treatment for substance use disorders (SUDs), medical professionals may administer different medications to ease symptoms and decrease the risk of complications.

    For example, some medications that may be used during opioid detox include:11

    • Clonidine: A medication used to lessen certain symptoms of opioid withdrawal, including anxiety, tremor, sweating, and chills.
    • Lofexidine: A recently approved medication in the same class as clonidine used similarly to reduce certain opioid withdrawal symptoms.14
    • Buprenorphine: An FDA-approved partial opioid antagonist medication used to treat opioid use disorder (OUD) that controls cravings and lessens withdrawal symptoms.
    • Methadone: A long-acting, full opioid antagonist medication used to stabilize and maintain people in recovery from OUD.

    Medications for alcohol and sedative withdrawal management may include:

    • Benzodiazepines, which are commonly administered for the management of acute alcohol withdrawal, for seizure prophylaxis, and other symptomatic management, before being tapered off throughout the detox period.9
    • A relatively long-acting benzodiazepine (e.g., diazepam) will first be substituted for the benzodiazepine previously used if the individual has benzodiazepine dependence. Then, it will be tapered slowly to ease withdrawal over a more extended amount of time.8

    Different drugs have varying withdrawal timelines, symptoms, and risks. Treatment must be individually tailored to treat withdrawal from the specific drug, or drugs, to which someone has developed dependence.

    One of the primary goals of medical detox is to facilitate continued, longer-term treatment efforts after the withdrawal period has been successfully managed. Detox, though often hugely important, is not a substitute for additional rehabilitation efforts. Comprehensive rehab care can take place in a residential/inpatient or outpatient setting, depending on individual needs. No matter what the setting, formal substance use treatment commonly begins with a period of detox, followed by ample behavioral therapeutic interventions and continued medical care, as needed.

    (Video) Opioid withdrawal timeline



    How long do medication withdrawal symptoms last? ›

    Withdrawal symptoms typically persist for up to three weeks. The symptoms gradually fade during this time. Most people who quit taking their antidepressants stop having symptoms after three weeks. There are many factors that affect how long withdrawal symptoms last.

    What does it feel like to be in withdrawal from drugs? ›

    Fatigue and lethargy are common symptoms caused by many substances because of the toll drugs take on the body. Sweats, shakes, clammy skin, tingles, and feeling cold are other examples. Muscle pains and spasms are seen when withdrawing from drugs like opiates or muscle relaxers.

    What happens during the withdrawal stage? ›

    Withdrawal can result in a wide range of physical and psychological symptoms. Physical withdrawal symptoms may include: Nausea, diarrhoea and vomiting. Shaking and shivering.

    What type of medication can have withdrawal symptoms if not stopped gradually? ›

    Stopping some medications abruptly — like beta blockers, benzodiazepines, and antidepressants — can lead to withdrawal symptoms.

    What are moderate withdrawal symptoms? ›

    Common symptoms of withdrawal may include:
    • Trembling and tremors.
    • Muscle pain or aches.
    • Hunger or loss of appetite.
    • Fatigue.
    • Sweating.
    • Irritability and agitation.
    • Depression.
    • Anxiety.
    Sep 14, 2022

    What medication is taken for withdrawal? ›

    Medications used in the treatment of withdrawal symptoms include opioid agonists such as methadone and buprenorphine (a partial agonist), as well as alpha-2 adrenergic agonists such as clonidine and lofexidine.

    Which substances have the most severe withdrawal symptoms? ›

    Drugs that are addictive cause difficult withdrawal symptoms and cravings, making it hard to stop taking them.
    Some of the hardest drugs to quit are:
    • Heroin and prescription painkillers.
    • Cocaine.
    • Methamphetamine & Crystal Meth.
    • Benzodiazepines.
    • Nicotine.
    • Alcohol.
    Jan 11, 2023

    What do withdrawals look like? ›

    Withdrawal symptoms can affect how the body works. Fatigue and lethargy are typical symptoms caused by many addictive substances—so are clammy skin, feeling cold, shakes, sweats, and tingles or tremors. Muscle pains and spasms are particularly common when withdrawing from opiates or muscle relaxers.

    Does withdrawal symptoms go away on its own? ›

    While withdrawal symptoms are very unpleasant and painful, they usually begin to improve within seventy-two hours. Within a week, there should be a significant decrease in the acute symptoms.

    How do you deal with withdrawal symptoms? ›

    Here are 10 ways to get through your withdrawal symptoms with a minimal amount of discomfort:
    1. Attend a medical detox program. ...
    2. Exercise regularly. ...
    3. Eat balanced and nutritious meals. ...
    4. Stay hydrated. ...
    5. Stick to a structured sleep schedule. ...
    6. Join a support group.
    Sep 15, 2022

    What are the different types of withdrawal behavior? ›

    Withdrawal Behaviors in the Workplace

    Examples of these behaviors are absenteeism, lateness/tardiness, leaving the job, internal job transfer, and turnover.

    Does withdrawal affect anything? ›

    Withdrawal usually means the course remains on the transcript with a “W” as a grade. It does not affect the student's GPA (grade point average). Although students may be reluctant to have a “W” on their transcript, sometimes “W” stands for Wisdom.

    What happens when you suddenly stop taking a drug? ›

    Drug and alcohol withdrawal symptoms tend to be a combination of both physical and mental symptoms and may include: Nausea and vomiting. Headaches. High temperature and/or chills.

    Which of the following drugs can cause a life threatening withdrawal syndrome? ›

    Benzodiazepines, which are a class of drugs such as Xanax, Valium, Klonopin, and Ativan, are depressants that can cause fatal withdrawal symptoms.

    Which type of medication is indicated to help the patient manage withdrawal symptoms? ›

    Benzodiazepines have the largest and the best evidence base in the treatment of alcohol withdrawal, and are considered the gold standard. Others, such as anticonvulsants, barbiturates, adrenergic drugs, and GABA agonists have been tried and have evidence.

    What is the most severe form of withdrawal syndrome? ›

    The most severe type of withdrawal syndrome is known as delirium tremens (DT). Its signs and symptoms include: extreme confusion. extreme agitation.

    What are the 4 levels of addiction? ›

    There are four levels of addiction: physical, emotional, mental, and spiritual. We will discuss each level in-depth and provide tips for overcoming addiction. Most people who try drugs or engage in risky behaviors don't become addicted.

    What are rebound withdrawal symptoms? ›

    What Do Withdrawal Symptoms Look Like?
    • Nausea.
    • Vomiting.
    • Dizziness or confusion.
    • Loss of muscle control.
    • Loss of appetite.
    • Trouble sleeping.
    • Anger or irritability.
    • Tremors.
    Jun 8, 2015

    How long do withdrawals take? ›

    The duration of physical withdrawal is typically three to five days; however, emotional withdrawal can be much longer. Some symptoms can be present for many months. Withdrawal symptoms can range widely and include depression, anxiety, anorexia, insomnia, and even suicidal thoughts or death.

    What are the two types of withdrawals? ›

    According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are two types of withdrawal: acute withdrawal and protracted withdrawal.

    What are the two most important symptoms of substance dependence? ›

    Signs of dependence include: Tolerance to or need for increased amounts of the drug to get an effect. Withdrawal symptoms that happen if you decrease or stop using the drug that you find difficult to cut down or quit.

    What chemical is released when you are addicted? ›

    Instead of a simple, pleasurable surge of dopamine, many drugs of abuse—such as opioids, cocaine, or nicotine—cause dopamine to flood the reward pathway, 10 times more than a natural reward. The brain remembers this surge and associates it with the addictive substance.

    What part of the brain is affected by withdrawal? ›

    The Withdrawal/Negative Affect Stage and the Extended Amygdala. When used over the long-term, all substances of abuse cause dysfunction in the brain's dopamine reward system.

    How do you test for withdrawals? ›

    The general approach to the evaluation of withdrawal is to treat subjects for a period of 2 to 3 weeks and then evaluate the occurrence of withdrawal syndrome for a sufficiently long time after drug discontinuation (at least 1 week).

    How long do cold turkey withdrawal symptoms last? ›

    The symptoms of withdrawal can start within 8-24 hours after last use. Major withdrawal symptoms typically peak between 24-48 hours after the last dose and may last up to 10 days. However, some individuals may experience persistent withdrawal symptoms longer, for many months.

    Can you reverse withdrawals? ›

    Reverse withdrawal is a function that allows consumers to change their mind about withdrawing funds from their gambling account by cancelling a withdrawal of part or all of their funds before the transfer to their bank or wallet is completed.

    Can you have withdrawal symptoms after 3 days? ›

    Most people who develop DTs do so between 48 to 72 hours after they stop drinking. That makes the first few days after you quit drinking the most critical and dangerous time of the withdrawal period. It's important that you seek medical care during this phase, especially if you're presenting with symptoms of DTs.

    What is the progressive model of withdrawal behavior? ›

    The most common model is the progressive model, which posits that withdrawal manifestations occur in progression, starting with relatively mild forms of psychological withdrawal, such as occa- sional lateness, moving to more severe forms such as absence, and ending with the most severe forms such as intent to leave ...

    What is withdrawal personality? ›

    Withdrawn behavior is avoiding or not seeking out social contact. People who withdraw may actively avoid spending time with other people. Or, they may not put any effort into seeking out social interactions. Some withdrawn people don't mind being with other people but don't feel particularly driven to seek out others.

    What are the three withdrawals? ›

    The 3 types of withdrawals include:
    • Savings.
    • Taxation.
    • Imports.

    Is withdrawal worse than failure? ›

    Croskey notes that dropping a class is better than withdrawing, but withdrawing is better than failing. “A failing grade will lower the student's GPA, which may prevent a student from participating in a particular major that has a GPA requirement,” Croskey says.

    What does it mean for your brain to go through withdrawal? ›

    Withdrawal is the combination of physical and mental effects a person experiences after they stop using or reduce their intake of a substance such as alcohol and prescription or recreational drugs.

    Is withdrawal a positive or negative? ›

    In this context, marks of withdrawal, lack of involvement, or inactivity are interpreted as signs of passivity or as residual or negative symptoms, which are often associated with a negative prognosis.

    What are the side effects of stopping medicine? ›

    1. Ask your doctor if you can take the medicine with food.
    2. Eat several smaller meals a day rather than two or three large meals.
    3. Try peppermint candy or gum. Peppermint can help settle your stomach.
    4. Eat bland foods, such as dry crackers or plain bread. Avoid fried, greasy, sweet, and spicy foods.

    How long does it take to taper off medication? ›

    While it is sometimes possible to withdraw over a few weeks, it can be safer to do so over several months so that your body has a good amount of time to adjust. For some people who have been on medication for many years, withdrawing very slowly over a few years can also be helpful.

    Do medication side effects ever go away? ›

    Some side effects go away over time as your body gets used to a new drug, so your doctor may recommend you stick with your current plan for a little longer. In other cases, you may be able to lower your dose, try a different drug, or add another one, like an anti-nausea medicine, to your routine.

    Is it better to go cold turkey or slowly? ›

    Being free of the harmful substance sooner

    By going cold turkey, a person's body can begin to recover immediately from the damage the substance was causing. In quitting gradually, people are continuing to ingest the harmful substance in their body for a longer time, which may lead to more damage.

    How long does withdrawal irritability last? ›

    Studies have found that the most common negative feelings associated with quitting are feelings of anger, frustration, and irritability. These negative feelings peak within 1 week of quitting and may last 2 to 4 weeks (1).

    What medication is best for withdrawal? ›

    Opioid withdrawal management using buprenorphine

    Buprenorphine is the best opioid medication for management of moderate to severe opioid withdrawal. It alleviates withdrawal symptoms and reduces cravings.


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