Experiencing withdrawal from drugs or alcohol can be a challenging, uncomfortable, and potentially dangerous process, but it is one of the most important steps you take as you begin on your path toward recovery.
What is Withdrawal?
After someone becomes physiologically dependent on alcohol or drugs, they may experience certain withdrawal symptoms if they cut back or stop using those substances.1 The symptoms that they will experience, and the severity of those symptoms, depend on factors such as the length of use, the amount of use and, of course, the substance type itself. Across a range of different types of substances, withdrawal symptoms can vary greatly, from mild aches to potentially fatal seizures.
Withdrawal typically involves the onset of various symptoms following the reduction or termination of previously regular use of drugs or alcohol.2 The amount of time it takes for symptoms to arrive and, as mentioned, the duration and character of those symptoms will be influenced by the types of substances used and the frequency, amount, and length of use.2,3
While withdrawal symptoms vary, they are often uncomfortable and, in some situations (for example, in instances of significant benzodiazepines or alcohol dependence), withdrawal symptoms could be severely distressing or even life-threatening.
It is important to consider the potential for withdrawal carefully because, depending on the substance, it could present significant health risks and complicate early recovery efforts. For particularly severe or risky withdrawal syndromes, medication may help patients manage withdrawal more safely and comfortably.1
Drug and Alcohol Withdrawal Syndromes
The alcohol or drug withdrawal symptoms people may experience can vary greatly. Typically, the symptoms that characterize withdrawal are similar for each class. So, for example, the symptoms experienced during withdrawal after an individual stops the use of opioids like oxycodone or hydrocodone may be quite be similar, though that set of symptoms may be markedly different from those experienced after an individual stops using cocaine.
There are many substances of abuse associated with withdrawal syndromes; some common ones include:
- Opioid painkillers (like heroin, morphine, oxycodone and codeine)
- Marijuana and hashish
- Benzodiazepines (such as Ativan, Valium, and Xanax) and other central nervous system depressants (such as barbiturates)
- Stimulants like methamphetamine, cocaine, and Adderall.
- Club drugs such as MDMA and GHB
Alcohol Withdrawal Signs and Symptoms
Ranging from relatively mild discomfort to potentially life-threatening seizures, alcohol withdrawal symptoms may start in as little as 6 hours up to as many as 24 hours following the last drink. Symptoms may peak in severity over the course of several days before subsiding, however some symptoms may persist for days to weeks.5,6
Symptoms of alcohol withdrawal may include the following:5-7
- Trouble sleeping
- Increased body temperature
- Sweating or clammy skin
- Rapid heart rate and elevated blood pressure
- Nausea and vomiting
- Cognitive impairment
- Extreme confusion
- Marked agitation
- Tremors in the hands or arms
- Seizures (risk highest within the first 48 hours of withdrawal)
For more severe or difficult alcohol withdrawal symptoms, seek immediate medical attention as the symptoms could potentially have fatal consequences.
Those who have gone through complicated withdrawal previously (e.g., someone who experienced seizures) or who have more severe symptoms should go through detox from alcohol in a supervised medical setting. With higher risks of withdrawal complications, inpatient medical withdrawal management may be needed.5
Opioid Withdrawal Signs and Symptoms
While opioid withdrawal may result in very uncomfortable symptoms, it is not typically life threatening.8 Though they don’t often present immediate health dangers, those experiencing the characteristically unpleasant symptoms of acute opioid withdrawal may still benefit from a supervised, medically managed detox.
The timeline of opioid withdrawal isn’t easy to pin down as it varies based on the individual and the types of drugs they have taken.8-10
- Relatively short-acting opioids (such as heroin): Following the stopping of use, withdrawal symptoms may occur within 6-12 hours, with severe symptoms reaching their peak at 24-72 hours. Many symptoms resolve within a week but may last longer.
- Relatively longer-acting opioids (such as methadone): After the cessation of use, withdrawal symptoms may take 12-48 hours to appear. It may take 10-20 days for symptoms to fully resolve.
Opioid withdrawal symptoms may include:4,8
- Body aches.
- Runny nose.
- Nausea and vomiting.
- Abdominal cramping.
Benzodiazepine Withdrawal Signs and Symptoms
Withdrawing from benzodiazepines and other sedative-hypnotic drugs produces symptoms similar to those of alcohol withdrawal. As with alcohol withdrawal, time of onset or intensity of symptoms varies considerably as the withdrawal process progresses.11
When withdrawing from relatively short-acting benzodiazepines (e.g., Xanax and Ativan), symptoms often begin as early as 6-8 hours after the last use and peak in intensity sometime around the second day. Symptoms improvement typically begins on the fourth or fifth day of withdrawal.9 For longer-acting benzodiazepines (e.g., Valium, Librium), withdrawal symptoms might not occur for more than 7 days. Symptoms typically peak in the second week and improve in the fourth or fifth week.9
Benzodiazepine withdrawal symptoms may include:12
- Rapid pulse.
- Hand tremors.
- Sleep disturbances.
Though the risk of death from pure benzodiazepine withdrawal is lower than that associated with alcohol withdrawal, symptoms may still be quite severe with a possibility of medical complications including delirium and seizures. Obtaining medical supervision while detoxing can help keep patients comfortable and safe. Inpatient treatment may be necessary for those experiencing extreme withdrawal.13
Stimulant Withdrawal Signs and Symptoms
Stimulant withdrawal occurs when users withdraw from drugs including cocaine, methamphetamine, amphetamines, and medications like Ritalin. Although it may be unpleasant, stimulant withdrawal is not typically life-threatening.
Stimulant withdrawal symptoms may include:11,13
- Sleep disturbances (insomnia followed by hypersomnia).
- Increased drug craving.
Symptoms may begin to develop very shortly after the last use of these drugs. Though many symptoms will subside with several days of stimulant abstinence, some may persist for several weeks.11,13 Many of the symptoms of stimulant withdrawal are not immediately-life threatening, and there are no medications specifically approved for stimulant detox. However, there is a chance of an increased emotional risk for those dealing with withdrawal. Intense depression is a possible symptom, and this symptom should be watched so that risks of suicidal thoughts or attempts are avoided.11
While there are specific symptoms someone may experience when they quit drinking or using a certain drug, there are additional factors that may influence the onset, the length, and seriousness of a withdrawal syndrome. These factors include:12,13
- How the drug was used. Snorting, injecting, or smoking the drug may result in more serious and difficult withdrawal syndromes than may occur from taking the drugs orally.
- How often and how long the substance was used. People who have used a substance for a longer period of time or have taken larger doses may experience more severe symptoms over a longer period of time.
- If additional substances are used. Using a drug in combination with alcohol or other drugs may result in more symptoms or more extreme and challenging symptoms.
- Metabolism and psychological makeup differences. Detox may be experienced at different rates and individuals may have more or less sensitivity to different physiological effects from withdrawal.
The Next Step
There are many risks to health and wellbeing associated with alcoholism and drug abuse. Though substance use disorders are chronic conditions, they are treatable. Many people benefit from treatment and are able to avoid or improve the cumulative health and personal problems that stem from an unchecked alcohol or drug addiction.”
Depending on the abused substance, medical detox and withdrawal management may be the most appropriate start to ongoing treatment efforts. Medical detox is necessary for those who may experience high-risk withdrawal symptoms—like those experienced during alcohol and benzodiazepine withdrawal.13 Opioid dependence also poses a risk of potentially serious, relapse-prompting withdrawal, and individuals could benefit from medical detox. 13 Effective withdrawal management can keep you safe and comfortable in early recovery, and is an important component of many rehabilitation programs.
- National Institute on Drug Abuse. (2019). Frequently Asked Questions.
- Gupta, M., Gokarakonda, S.B., Attia, F.N. (Updated 2020 Jul 2). Withdrawal Syndromes. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.
- National Institute on Drug Abuse. (2017) Tolerance, Dependence, Addiction: What’s the Difference?
- Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
- Medline. (2019). Alcohol withdrawal.
- Rogawski M. A. (2005). Update on the neurobiology of alcohol withdrawal seizures. Epilepsy Currents, 5(6), 225–230.
- National Institute on Alcohol Abuse and Alcoholism. (2001). Alcohol alert: Cognitive impairment and recovery from alcoholism.
- U.S. National Library of Medicine. (2020). MedlinePlus: Opiate and opioid withdrawal.
- Substance Abuse and Mental Health Treatment Services Administration. (2020). TIP 63: Medications for Opioid Use Disorder.
- S. Food and Drug Administration. (2019). FDA identifies harm reported from sudden discontinuation of opioid pain medicines and requires label changes to guide prescribers on gradual, individualized tapering.
- Center for Substance Abuse Treatment. (1999). Treatment for Stimulant Use Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 33: Chapter 5—Medical Aspects of Stimulant Use Disorders.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington D.C.: American Psychiatric Association.
- Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.