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Drug Withdrawal Symptoms and Timelines

Withdrawal symptoms are an unfortunate component of dependence. For many people, the experience of withdrawal symptoms may be a deterrent that prevents them from seeking the help they need to live a life in recovery. While drug and alcohol withdrawal symptoms may not be avoidable, getting help from a professional treatment center during detox may be able to help you effectively withdraw from substances and begin your recovery journey. This article will discuss common drug and alcohol withdrawal symptoms and provide information about the alcohol and drug withdrawal timeline and the detox process.


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Drug and Alcohol Dependence

To understand withdrawal, it is helpful to understand physical dependence. Dependence is a physiological adaptation of the body to a substance, wherein the body becomes so used to the drug being present in the system that when the individual cuts back on their use or quits, withdrawal symptoms emerge. With significant levels of physiological dependence, a person may continue to compulsively drink or use drugs to avoid unwanted withdrawal symptoms.1

Many people find it hard to stop using drugs and alcohol due to the potential discomfort or even pain associated with certain withdrawal symptoms. The withdrawal timeline varies and is dependent upon several individual factors as well as factors related to substance use, such as type of substance used, length of use, and amount of substance used.


What Are Addiction Withdrawal Symptoms?

There are various withdrawal symptoms that people may experience if they reduce or stop using alcohol or drugs. Alcohol and benzodiazepine withdrawal can be dangerous and even life threatening.

Some alcohol withdrawal symptoms include:3

  • Fatigue.
  • Irritability.
  • Mood swings, including anxiety and depression.
  • Sweating.
  • Fast heartbeat.

Stimulants can be both legally prescribed and illegally purchased. Stimulants include substances such as cocaine and amphetamines. Some stimulant withdrawal symptoms include:4

  • Muscle aches.
  • Increased sleeping and appetite.
  • Agitation.
  • Irritability.
  • Depression.

Benzodiazepines are central nervous system (CNS) depressants and are prescribed by doctors to treat a variety of conditions, primarily sleeping disorders and specific types of anxiety.4 Even though benzodiazepines are legally prescribed by medical professionals, they can be misused, and dependency can develop.4 Some symptoms of benzodiazepine withdrawal can include:4

  • Memory problems and poor concentration.
  • Irritability.
  • Muscle aches.
  • Insomnia.
  • Anxiety and restlessness.

Opioids are another class of drugs that have the potential to be misused. Opioids include legal pain medications prescribed by a doctor, such as oxycodone, hydrocodone, morphine, and codeine, or illegal substances, such as heroin. Regardless of the legal status, dependency can develop if you misuse opioids or even if you are taking opioids as prescribed.5

Symptoms of opioid withdrawal can include:4

  • Hot and cold flushes.
  • Muscle cramps.
  • Anxiety.
  • Diarrhea
  • Vomiting and nausea.

As you can see from the symptoms listed above, certain withdrawal symptoms are common amongst various classes of substances. The length of time it takes to become physically dependent on a substance varies and is based on different factors, such as the type of drug and amount used. Physical dependence can occur with the chronic use of many drugs, even drugs that are taken as prescribed by a doctor.6


When Do Withdrawal Symptoms Start and How Long Do Withdrawal Symptoms Last?

The withdrawal timeline, including onset and duration of symptoms, varies and is dependent upon factors unique to you and your history of substance use. As you will see, certain withdrawal symptoms are common among multiple substances. Alcohol withdrawal symptoms usually begin within 8 hours of your last drink; however, they can develop days later.3 Symptoms of alcohol withdrawal usually peak between 24 and 72 hours and can last for weeks.3

Amphetamines and cocaine are both stimulants, and withdrawal symptoms usually begin within 24 hours of last use and last for 3–5 days.4

For benzodiazepines, the onset and duration of symptoms depend on the type of benzodiazepine used. For example, with short-acting benzodiazepines, the symptoms usually begin within 1–2 days after last use and last anywhere from 2–4 weeks.4 With long-acting benzodiazepines, you can usually expect symptoms to begin within 2–7 days of the last dose and last from 2–8 weeks or longer.4

Withdrawal from opioids is usually not life-threatening. However, the symptoms can be incredibly uncomfortable.4 Similar to benzodiazepines, the onset and length of opioid withdrawal depends on the type of opioid ingested—whether it’s long-acting or short-acting. With long-acting opioids such as methadone, the onset of withdrawal usually occurs within 12–48 hours after last use, and symptoms usually last 10–20 days.4

For short-acting opioids such as heroin, the onset of symptoms is usually 8–24 hours after last use, and symptoms generally last anywhere from 4–10 days.4


How to Deal with Withdrawal Symptoms

Understanding how to deal with withdrawal symptoms can help ease the withdrawal process. Detox is the process by which drugs and alcohol are effectively and safely eliminated from the body.7 Many treatment facilities offer formalized detox programs that include a variety of medical interventions to help maximize your comfort level and ensure a safe detoxification process as you go through withdrawal.

Medically managed detox is a component of detox that utilizes the benefits of medication to help you safely detox as well as mitigate the severity of withdrawal symptoms to help you achieve long-term recovery.7 It is important to understand that, for many people, detox alone is the first step in substance abuse treatment. Certain medications have been approved to help treat the symptoms of withdrawal during detox.


Types of Medication Used to Help with Addiction Withdrawal

While withdrawal symptoms may be uncomfortable and unavoidable, formalized detox can help. Fortunately, the Food and Drug Administration (FDA) has approved certain medications to help reduce the severity of withdrawal symptoms, and they may be included as part of your detox plan. Medications approved by the FDA to help treat the symptoms of withdrawal include:8,9

  • Buprenorphine. Used in the detox from opioids, this medication decreases and eliminates withdrawal symptoms, including cravings, by blocking and activating opioid receptors in the brain.
  • Methadone. Also used in opioid withdrawal, methadone prevents and reduces withdrawal symptoms, including cravings, through activation of the opioid receptors in the brain.
  • Acamprosate. Used in alcohol detox, acamprosate decreases withdrawal symptoms by normalizing brain systems disturbed by chronic alcohol use.

Can You Avoid Withdrawal When Detoxing?

As previously mentioned, withdrawal symptoms range in severity from mild to moderate to severe. The type of substance used, amount, and duration of use can shape your withdrawal experience.8

Certain risks can occur when you try to withdraw on your own and as a result, detox is often managed under the supervision of a doctor in a drug detox program.7

You may not be able to avoid symptoms of drug withdrawal or alcohol withdrawal; however, medications may be used during the detox process to help manage the pain and discomfort and reduce symptoms.


What to Expect from Rehab Centers When Detoxing from Drug or Alcohol Addiction

If you are considering stopping your use of substances but are hesitant because of the potential withdrawal symptoms that could occur, you may want to consider detoxing at a rehab center. It is important to note that the relapse potential during the detox period can be significantly high. For some individuals, the discomfort associated with withdrawal symptoms may trigger the desire to use drugs and alcohol in order to stop withdrawals and as a result, it is usually recommended to undergo detox in a supervised setting to reduce the relapse potential.2

Detox can take place in an inpatient or an outpatient setting and a formalized assessment with a licensed medical or addiction specialist can help determine which treatment method is best for you.8 Inpatient and outpatient detox programs vary in the intensity. Outpatient treatment allows individuals to live at home while receiving treatment and are often more appropriate for individuals with strong support systems.7

The severity of symptoms, as well as your medical history, can also influence whether inpatient or outpatient detox is suitable for you. Keep in mind that mild to moderate withdrawal symptoms can potentially be managed on an outpatient basis. However, if you have a history of seizures or other medical issues, inpatient detox may be best suited for you.8 It is important to discuss any medical issues with your doctor before starting the detox.


Sources

  1. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition)-Is there a difference between physical dependence and addiction?
  2. U.S. Department of Health and Human Services. (2016). The neurobiology of substance use, misuse, and addiction.
  3. U.S. National Library of Medicine. (2020). Alcohol withdrawal.
  4. National Library of Medicine. (n.d.). Clinical guidelines for withdrawal management and treatment of drug dependence in closed settings.
  5. National Institute on Drug Abuse. (n.d.). Opioids.
  6. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition)- Is there a difference between physical dependence and addiction?
  7. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition).
  8. Gupta M, Gokarakonda SB, Attia FN. (2022). Withdrawal syndromes. Treasure Island (FL): StatPearls Publishing.
  9. National Institute on Drug Abuse. (2014). Principles of adolescent substance use disorder treatment: A research-based guide-Addiction medications.

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