What Are the Dangers of Withdrawal?
Acute withdrawal symptoms can cause a variety of physical health problems, ranging from mild flu-like symptoms to severe seizure-like activity. Protracted withdrawal symptoms, on the other hand, can lead to mental health issues, including anxiety and/or depression. That’s why withdrawal is best managed in a medical detox program. Help provided there can reduce or eliminate withdrawal symptoms.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are two types of withdrawal: acute withdrawal and protracted withdrawal.
Acute withdrawal is the initial emergence of symptoms after suddenly discontinuing the use of a substance. These symptoms tend to be opposite of the effects of the substance, making them different between substances.
SAMHSA’s article “Protracted Withdrawal” from the publication Substance Abuse Treatment Advisory lists the length of the acute withdrawal period for various substances:
- Alcohol: 5-7 days
- Benzodiazepines: 1-4 weeks, or 3-5 weeks if reducing dosage gradually
- Cannabis: 5 days
- Nicotine: 2-4 weeks
- Opioids: 4-10 days; methadone may be 14-21 days
- Stimulants: 1-2 weeks
Symptoms that last beyond this period, or reappear after this period, are then labeled as protracted withdrawal (commonly known as post-acute withdrawal, chronic withdrawal, or extended withdrawal). Protracted withdrawal is the lesser studied of the two types of withdrawal, but it can often be a major factor in the incidence of relapse.
Symptoms of Acute Withdrawal for Various Substances
Though symptoms of acute withdrawal will differ between substances, it is generally known that these symptoms will be opposite the effect of the substance. Withdrawal symptoms are often dangerous for individuals, and they are best managed by medical professionals. The symptoms of acute withdrawal for various substances are as follows:
- Anxiety and tremors
- Increased heart rate
- Increased blood pressure
- Delirium tremens (in less than 5 percent of individuals)
- Double or blurry vision
- Body pains
- Nausea and diarrhea
- Disorientation and dizziness
- Dry mouth
- Fever or chills
- Decreased muscular control
- Shortness of breath
- Loss of appetite
- Anxiety and tension
- Night sweats
- Nightmares or strange dreams
- Irritability and irrational rage
- Weight gain
- Muscle aches
- Nausea, vomiting, and diarrhea
- Fever or chills
- Runny nose
- Teary eyes
- Increased appetite
- Slow thoughts
- Slow, or lack of, movement
There may be other symptoms in each individual case of withdrawal, depending on the severity of the addiction, the existence of other diagnoses, and the rate at which use of the substance was discontinued.
During the acute withdrawal phase, medication may be prescribed to assist with withdrawal symptoms, though this is not always the case. It is recommended that this phase be overseen by a medical professional, especially in cases of severe addiction, or these symptoms can become dangerous. In cases of alcohol, benzo, or opiate detox, medical detox is always required.
The majority of the symptoms of protracted withdrawal are psychological in nature, due to the fact that long-term substance abuse can alter the brain in various ways. According to the National Institute on Drug Abuse, addictive substances stimulate the reward circuit in the brain, causing a flow of feel-good chemicals, like dopamine, to users.
In the early stages of addiction, using a substance causes overstimulation of the system or an overproduction of dopamine, which results in euphoria or feeling “highâ€. However, over time, the brain can lose its ability to produce such chemicals on its own, resulting in a shortage. Individuals who struggle with addiction will find that they require more of a substance to achieve the same feeling, or to experience pleasure at all, due to the reliance of the brain on the substance.
It is these alterations in the brain that produce protracted withdrawal, or post-acute withdrawal syndrome (PAWS). Long-term aftereffects of substance abuse, according to SAMHSA, can include any of the following:
- Anxiety and irritability
- Difficulty focusing on tasks, concentrating, and making decisions
- Reduced enjoyment of previously pleasurable activities (anhedonia)
- Problems with sleep and increased fatigue
- Reduced libido
- Substance cravings
- Impaired executive control
- Physical symptoms that are otherwise unexplainable
These symptoms make individuals particularly vulnerable to relapse due to their increased duration. Some of these symptoms can several months, some a year, and some several years. Often, when transitioning from inpatient recovery to outpatient recovery, it can be helpful to create a plan for the first few days following discharge, in the event that such symptoms occur. Individuals should not attempt to overburden or overstress themselves immediately, as this can exacerbate PAWS symptoms and increase the desire for relapse.
Other ways to combat PAWS symptoms include developing a new system of positive coping mechanisms, exercising regularly, and joining recovery groups.
It can be dangerous to undergo the process of withdrawal without professional help. Quitting “cold turkey”after substance addiction can be deadly in some cases due to the severity of some acute withdrawal symptoms. For example, rapid alcohol detox can cause seizures, delirium tremens, heart attacks, and strokes, all of which are dangerous and sometimes deadly. Because alcohol is known as a depressant, an individual’s body will adapt to the relaxation effect over time, and sudden withdrawal can cause the body to go into “overdrive,”potentially causing any of these symptoms.
Of particular concern is the incidence of delirium tremens, which, while uncommon, is severe in its onset. Individuals can experience tremors or convulsions, hallucinations, anxiety, disorientation, palpitations, sweating, or even hyperthermia, on top of other acute withdrawal symptoms. This condition is a medical emergency and must be treated immediately.
Aside from the incidence of severe acute withdrawal symptoms, which can cause physical health problems and require hospitalization, protracted withdrawal can lead to mental health problems. Individuals previously diagnosed with mental health disorders can experience a reemergence of symptoms if the substance was used in an attempt to treat the existing condition.
For example, users of benzodiazepines often struggle with anxiety and sometimes depression. Eighteen percent of Americans suffer from an anxiety disorder, and of those, 22 percent are classified as severe. Benzos are often an effective treatment option for these disorders when used appropriately. In an effort to manage that anxiety, some people may abuse benzodiazepines. This abuse can, however, lead to the reemergence of anxiety symptoms once use of the medication is stopped. Even if a mental health diagnosis was not treated with the addictive substance, the coexistence of such a diagnosis can alter the withdrawal process in particular, perpetuating PAWS symptoms. For this reason, withdrawal programs need to be specialized for each individual, and detox can be dangerous to undertake alone.
There are many resources for those in recovery, especially those suffering from post-acute withdrawal syndrome.
Though the process of withdrawal can be difficult, symptoms do eventually subside, and there is plenty of support offered for individuals going through recovery. While chances of relapse can increase during withdrawal phases, there are healthy mechanisms that can assist with symptoms and foster overall wellbeing.