Drug Withdrawal Symptoms, Timelines, and Treatment
According to the Centers For Disease Control, in 2017 more than 11% of Americans ages 12 and over used illicit substances within the month before being surveyed.1
Many abused drugs are associated with the development of significant physiological dependence—especially when consumed in large amounts and for a consistent period. When someone becomes dependent on a substance, they may be at risk of experiencing unpleasant withdrawal symptoms when trying to stop using their drug of choice.
The severity and duration of withdrawal from substance dependence are contingent upon many factors, including the amount of a drug that someone used and how frequently they used it. Unfortunately, withdrawing from drugs is often a profoundly uncomfortable experience that can stall or otherwise complicate recovery efforts. In some instances, unmanaged withdrawal can be dangerous and may require medical care to keep a person safe during their detox period.
Continued abuse of drugs or alcohol interferes with the motivation and reward chemistry and circuitry, resulting in drug cravings and dependence.
Detoxing from one substance may result in different withdrawal symptoms and health risks that evolve over varying time frames when compared with another type of drug. With different types of substances, some withdrawal symptoms can be uncomfortable yet seldom immediately dangerous, while others may be very severe and potentially life-threatening.
For certain types of substances, medical detox is commonly an early part of recovery. As part of a typical medical detox protocol, a team of doctors and nurses can help manage a patient’s withdrawal process to alleviate their discomfort and minimize any risk of dangerous symptoms or withdrawal complications.
What Is Withdrawal?
When someone drinks alcohol or uses certain drugs on a repeated basis, their brain adjusts to the presence of this substance. They become physiologically dependent on their substance of choice and utterly reliant on it to function and feel “normal.”
In people who develop significant levels of dependence, withdrawal from drugs is often an inevitable response to the sudden absence of a drug’s declining concentration. Withdrawal symptoms may develop when a substance-dependent person quits a substance “cold turkey” or substantially reduces how much they are using. During withdrawal, the body is attempting to reach a new state of homeostasis as it dispels the user’s drug of choice. This can result in large fluctuations in brain chemicals and may accompany significant mental and physical health repercussions.
Drug withdrawal may include a combination of physical, mental, and emotional symptoms — some of which can prove dangerous if left unmanaged.
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How Long Does Withdrawal Last?
The precise duration of withdrawal is influenced by which particular substance someone used as well as the magnitude of their dependence on the substance. It may take days, weeks, and – in some cases – months to reach complete resolution of all withdrawal symptoms, depending on various factors and individual differences.
Drug Withdrawal Timelines
A general overview of certain drugs and their characteristic withdrawal timeline is as follows:
- Short-Acting Opioids (such as heroin and certain prescription painkillers): Short-acting opioid withdrawal symptoms generally begin 8-24 hours after last use and last an average of 4-10 days.
Longer-acting opioids (such as methadone): For methadone and other longer-acting opioids, it may take 2-4 days for withdrawal symptoms to emerge. Withdrawal will likely fade within a period of 10 days.2
Benzodiazepines (such as Xanax, Valium, Klonopin, Clonazepam and Ativan): Withdrawal from benzos begins within 1-4 days, peaking in severity in the first 2 weeks. Protracted withdrawal can last months or years without treatment in some cases3.
- Alcohol: The first signs of alcohol withdrawal may appear within several hours after the last drink and peak over the course of 24-48 hours. A risk of seizures may remain high for anywhere from 12 hours to 48 hours after, with certain other risks, such as delirium tremens (DTs), remaining a concern for as long as 3 days after the last drink.5
Heroin & Opiate WithdrawalHeroin belongs 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.6 Opioids are considered 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.
Acute opioid withdrawal syndrome may include several characteristic symptoms, such as:3,7
- Nervousness or anxiety.
- Trouble sleeping.
- Frequent yawning.
- Flu-like symptoms.
- Hot and cold flashes.
- Runny nose.
- Excessive sweating.
- Muscle cramps/body aches.
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 the flu— can lead to immense physical and psychological distress.7 Left unmanaged, opioid withdrawal can easily drive someone toward immediate relapse, which can derail recovery attempts.
Benzodiazepine WithdrawalBenzodiazepines, 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. According to Harvard Health, doctors also prescribe benzodiazepines to treat muscle spasms and tremors.8
These medications are central nervous system depressants, or CNS depressants, and work by increasing inhibitory nerve cell signaling in the brain to help manage certain conditions.4
Some widely-prescribed benzodiazepines include:
When used as prescribed under the care of a physician, benzos can help many people manage anxiety, panic, and certain other conditions. However, if someone misuses benzodiazepines to experience their euphoric effects, their risk of developing a dependence on these drugs escalates.
Cocaine WithdrawalCocaine is an exquisitely addictive stimulant drug that influences our brain’s reward center by blocking the removal of dopamine from the synapses.9 This reinforced 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.
When someone abruptly stops using cocaine, they may experience a severe rebound effect 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.
Cocaine withdrawal is rarely physically dangerous, but may include several distressing psychological symptoms, such as:
- Depressed mood.
- Psychotic episodes.
- Thoughts of self-harm.
- Ongoing tiredness or lethargy.
Stimulant withdrawal is unlike withdrawal from most other substances, as there is a lack of many physical symptoms. As a result, withdrawal from cocaine is usually not considered to be life-threatening. Mental health professionals trained in substance abuse and dependency may best treat drug cravings and emotional turmoil associated with withdrawal.
Although many people don’t think of alcohol as a drug, it is actually the most prevalently consumed addictive substance in the U.S. 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 (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. If you are dependent on alcohol, you may experience some of the following distressing symptoms if you try to quit:10
- Delirium Tremens
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 for an additional few days, and appear suddenly, making alcohol withdrawal safest when monitored around the clock by a medical professional.
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 a challenging, and sometimes dangerous, time for someone who is first getting sober. If you’re thinking of getting sober, it’s recommended that you seek medical professionals’ guidance, who may recommend a medical detox. This way, once your 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 going through drug withdrawal.8
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 medical professionals’ care. These medical professionals may 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.
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:7
- Clonidine: A medication used to lessen the moderate symptoms of opioid withdrawal, including sweating, vomiting, chills, and insomnia.
- Buprenorphine: An FDA-approved partial opiate antagonist medication used for mild-to-severe opioid use disorder that controls cravings and lessens withdrawal symptoms.
- Methadone: A long-acting, full opioid agonist medication used to stabilize and maintain people in recovery from opioid use disorder (OUD).
Medications for alcohol and sedative withdrawal management:
- For the management of acute alcohol withdrawal, benzodiazepines are commonly administered for seizure prophylaxis and other symptomatic management, before being tapered off throughout the detox period.8
- With some types of benzodiazepine dependence, a relatively long-acting benzodiazepine (e.g., diazepam, chlordiazepoxide) will first be substituted for the benzodiazepine having been previously used. Then, it will be tapered slowly to ease withdrawal over a more extended amount of time.8
Different drugs have varying timelines, symptoms, and risks. Treatment must be individually tailored to treat withdrawal from the specific drug, or drugs, that someone is dependent on.
One of the primary goals of medical detox is to facilitate continued, longer-term treatment efforts after the withdrawal period have been successfully managed. Detox, though often hugely important, is not a substitute for additional rehabilitation efforts, which will include ample behavioral therapeutic interventions and any continued medical care.
Residential, or inpatient, substance abuse treatment often provides the most comprehensive care, and medical detox is the ideal choice for helping make withdrawal from drugs as comfortable as possible.
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- Centers for Disease Control (2017).Faststats, Illegal Drug Abus.
- Elsevier (2017), Opioid Withdrawal Clinical Key.
- Professor C Heather Ashton, DM, FRCP 2004 (2004). Comprehensive Handbook of Drug & Alcohol Addiction 2004.
- Department of Health, Australian Government (2004). The Cocaine Withdrawal Syndrome.
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- National Institute on Drug Abuse (2020). Prescription Opioids Drugfacts.
- World Health Organization, (2009).Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.
- Harvard Health Publishing (2019).Benzodiazepines (And the Alternatives).
- National Institute on Drug Abuse (2016).How Does Cocaine Produce Its Effects?
- Harvard Health Publishing (2019). Alcohol Withdrawal.