Alcohol and Drug Addiction Withdrawal

Substance use disorder, or addiction, is a chronic disease characterized by the compulsive use of substances despite experiencing significant negative consequences.¹The continued use of drugs or alcohol over time changes the brain’s functioning and reinforces substance using behavior.² This can make it difficult for people to stop using substances, as when one stops taking substances or significantly reduces their intake, they may experience uncomfortable withdrawal symptoms.^1,4 These withdrawal symptoms can make it difficult to quit using substances. Luckily, effective detox treatment exists to help you overcome withdrawal symptoms and begin working towards recovery.

What is Withdrawal?

Withdrawal is the physiological manifestations of dependence after a substance has been removed.¹⁶ In other words, the physical, affective, and cognitive symptoms that occur after chronic use of a  substance that was present in the body is reduced or eliminated.¹ Each type of substance has its own set of symptoms that characterize the withdrawal syndrome for that particular type of substance.¹The symptoms that occur often cause distress and may include unpleasant and, in the case of certain substances, life-threatening physiological symptoms.^1,4

Alcohol Withdrawal

Alcohol withdrawal is a manifestation of alcohol dependence and occurs when someone discontinues or significantly decreases their alcohol intake, especially after a period of prolonged heavy alcohol use.³ Symptoms of alcohol withdrawal may be mild, such as restlessness, stomach discomfort, or headache; or moderate, such as shakiness, insomnia, and increased sensitivity to light, sound, and touch. Severe symptoms of alcohol withdrawal are experienced by less than 10% of individuals and may include seizures and a constellation of symptoms known as delirium tremens.^1,3

Severe symptoms of alcohol withdrawal can be life-threatening and require medical attention, so people at risk of experiencing severe alcohol withdrawal symptoms can benefit from medical detox services. Medical detox refers to interventions aimed at reducing harm and the adverse health consequences associated with severe withdrawal symptoms. It may include monitoring a person’s symptoms and overall health and administering medications.^{3, 4}

If moderate to severe alcohol-related withdrawal symptoms are not treated, there is a possibility that seizures or delirium tremens, a form of severe alcohol withdrawal, will occur.⁵ The single best predictor that a person will experience severe withdrawal symptoms is if they have already experienced alcohol withdrawal seizures as a result of previous withdrawal.⁴

Symptoms of Alcohol Withdrawal

Alcohol withdrawal symptoms can appear as soon as 6 hours after someone has had their last drink, and may include the following:^{1, 2, 4}

• Sweating.
• Increased heart rate.
• Shakiness or tremors of the hands.
• Sleep difficulties.
• Nausea or vomiting.
• Hallucinations (e.g., seeing, hearing, or feeling things that are not there).
• Restlessness.
• Anxiety.
• Seizures.

Delirium tremens is a severe state of alcohol withdrawal with accompanying delirium (significant changes in cognition, awareness, and changes in consciousness) and is characterized by significant confusion and agitation, extremely high body temperature, tachycardia (or fast heart rate), and hallucinations (visual, tactile, or auditory).⁵

Benzodiazepine Withdrawal

Benzodiazepines are a class of CNS depressants substances that are primarily prescribed to treat anxiety and insomnia.⁶ Benzodiazepines and other CNS depressants calm an overly excited central nervous system functioning, resulting in decreased alertness, slowed breathing, and decreased blood pressure.⁷ Long-term, regular use of benzodiazepines, even when used as directed by a doctor, may result in needing to take higher doses to feel the effects of the drug. Continued use can lead to dependence, which manifests as withdrawal symptoms.⁶

As with alcohol, which is also a CNS depressant, benzodiazepine dependence can result in dangerous, life-threatening withdrawal symptoms, including the potential for seizures, when a person stops using them or significantly reduces their dose.⁸ A person at risk of experiencing moderate to severe benzodiazepine withdrawal symptoms can benefit from medical detox.⁴

Symptoms of Benzodiazepine Withdrawal

Benzodiazepine withdrawal symptoms vary based on typically depends on the type of benzodiazepine that they were taking.¹ The length of time benzos were taken for and the dosages taken may also influence the severity of potential withdrawal symptoms.¹ Withdrawal symptoms may appear within 6 to 8 hours following a reduction of benzodiazepines symptoms may not appear for approximately 1 week.¹

Symptoms of benzodiazepine withdrawal may include the following:^{1, 8}

• Increased heart rate or palpitations.
• Sweating.
• Hand tremors.
• Nausea or vomiting.
• Anxiety.
• Hallucinations.
• Delusions.
• Seizures.
• Dizziness.
• Confusion or disorientation.
• Restlessness.
• Irritability or agitation.

Heroin and Opioid Withdrawal

Opioid medications are prescribed for moderate to severe pain relief.⁹ They are powerful medications for pain relief but can also induce feelings of euphoria at high doses. Heroin is an illicit opioid with similar properties and effects but currently has no medical use in the U.S

Opioids can produce uncomfortable, although not usually life-threatening, withdrawal symptoms when someone with an opioid dependence ceases or stops using them.^{4, 9} All opioids produce similar signs and symptoms, but there can be a great deal of variance in the severity of the symptoms, the onset of the symptoms, and the duration of the symptoms depending on the opioids used.⁴ Additional factors that can influence opioid withdrawal symptoms involve the amount of time the substance was used, how much the substance was used, and the time between doses.⁴

Medical detox may be beneficial for those struggling with opioid withdrawal, largely due to the medications that may be prescribed to help manage withdrawal symptoms.⁴ Methadone and buprenorphine may be prescribed to reduce physical withdrawal symptoms.¹⁰

Symptoms of Opioid Withdrawal

Opioid withdrawal can vary depending on the type of opioid substance consumed, the dosages consumed, how long the opioids were being used, and how long the intervals between dosages. General timelines can also vary greatly between substances. For example, symptoms of heroin withdrawal typically begin 6 to 12 hours after last use, whereas withdrawal symptoms for some prescription opioids do not appear until 2 to 4 days after the last use.¹

Symptoms of opioid withdrawal include the following:^{1, 4}

• Dysphoria.
• Nausea or vomiting.
• Muscle soreness or spasms.
• Watery eyes.
• Runny nose.
• Enlarged pupils.
• Sweating.
• Yawning.
• Insomnia.
• Diarrhea.
• Increased heart rate, blood pressure, or body temperature.
• Increased respiratory rate.
• Goosebumps.
• Fever.

Stimulant Withdrawal

Stimulants are drugs that increase activity in the central nervous system.¹¹ Prescription stimulants can be used to treat attention-deficit hyperactivity disorder (ADHD) and certain sleep disorders like narcolepsy.¹¹ They also come in illicit forms, such as cocaine and crystal methamphetamine.¹¹

Effects of stimulants include improved attention and concentration, increased physical energy and mental alertness, and feelings of euphoria (or a “rush”).¹¹ Stimulant withdrawal usually does not produce medically dangerous symptoms, but it can result in significant psychological distress, notably severe depressive symptoms.^{1, 4}

Symptoms of Stimulant Withdrawal

Symptoms of stimulant withdrawal may include the following:^{1, 4}

• Feeling tired or weak.
• Having vivid, distressing dreams.
• Sleep changes, such as sleeping too little or too much.
• Increased appetite.
• Slowed movements.
• Anxiety.
• Paranoia.
• Irritability.
• Depressed mood.

Marijuana Withdrawal

Cannabis (other common names include marijuana, pot, and weed) is a psychoactive substance that can alter a person’s senses, perception, and mood.¹² Chronic use of cannabis can lead to the development of cannabis use disorder and addiction.¹² People who use cannabis for a long duration may find it difficult to reduce or quit their cannabis use as a result of withdrawal symptoms.¹²

Symptoms of Marijuana Withdrawal

Cannabis withdrawal symptoms generally occur 24 to 72 hours after the last use and last approximately 1-2 weeks; however, sleep disturbances may last for a month or more.¹

Symptoms of cannabis withdrawal syndrome include the following:^{1, 12}

• Feeling irritable, angry, or aggressive.
• Anxiety or increased nervousness.
• Depressed mood.
• Sleep difficulties, including insomnia or having distressing dreams.
• Eating less or weight loss.
• Agitation or restlessness.
• At least one uncomfortable physical symptom, including headache, stomach or abdominal pain, shakiness, fever, chills, or sweating.

What is Drug Detox?

Detoxification, commonly referred to as “detox”, is the elimination of a substance from the body, and professional detox programs are available to help medically manage the acute and potentially dangerous withdrawal symptoms when someone stops using drugs or alcohol.¹⁴

Medically managed detox is an important first step in substance use treatment. Alone, it is not typically sufficient to support long-term abstinence. Residential, inpatient, outpatient, and aftercare rehab treatment that includes individual or group counseling and medication management can give people the skills and support they need to achieve lasting recovery.^14,15

If you’re looking for drug or alcohol detox or rehab, there are options available to you. The SAMHSA treatment locator is a powerful tool that can help you find nearby or out-of-state detox and rehab facilities. You may also consider calling AAC’s addiction helpline. Our professionally staffed helpline can help you find answers about the detox process, locate nearby rehab facilities, and verify your insurance coverage for detox treatment. Don’t delay critical care; call us today at .