Drug & Alcohol Withdrawal Symptoms and Treatment

Many people with addiction experience withdrawal when they quit or reduce their substance use.¹

This page will discuss withdrawal, how withdrawal occurs, the common symptoms of withdrawal, and how withdrawal can be treated and managed effectively through medical detox.

What Is Withdrawal?

Withdrawal refers to a group of symptoms that occur when a person stops or reduces their use of a substance on which they have developed a physiological dependence.¹

To further explain withdrawal, it helps to first understand dependence. Dependence is a physiological adaptation of the body to chronic substance use, wherein the patient begins to need the substance to function normally.² Being dependent on a drug does not—by itself—mean that a person is addicted; however, dependence is one of 11 indicators of a substance use disorder (the clinical term for addiction) for non-prescription substances.³

Once someone has adapted to function with the substance in question, abstaining from using the substance or using less of it forces the brain and body to attempt to re-balance themselves. This process of readjustment is characterized by many unpleasant mental and physical disturbances known as withdrawal symptoms.⁴

Symptoms of Withdrawal

Withdrawal symptoms will vary according to the type of substance, the severity of someone’s dependence, and other factors. Generally, the symptoms of withdrawal are the opposite of the effects of the drug.⁵

These symptoms can be stressful, unpleasant, and at times dangerous.⁵

Drug Withdrawal Symptoms

Within each classification of drugs (e.g., opioids, benzodiazepines, and stimulants) there are patterns of symptoms that commonly occur during withdrawal. These constellations of symptoms are known as a drug’s withdrawal syndrome.

Opioids—a class of drugs that includes heroin, fentanyl, and many prescription painkillers (e.g., OxyContin, Vicodin)—can result in withdrawal symptoms that are highly unpleasant and uncomfortable, though seldom life-threatening. Common opioid withdrawal symptoms include:³

• Dysphoria (i.e., feeling depressed or discontent)
• Nausea and vomiting.
• Muscle aches.
• Tearing eyes and runny nose.
• Diarrhea.
• Yawning.
• Insomnia.
• Gooseflesh.
• Sweating.
• Fever (i.e., raised body temperature).

Benzodiazepines include prescription drugs like Valium, Klonopin, Xanax, and Ativan, which are generally prescribed for insomnia and anxiety.¹ Benzo and sedative, hypnotic or anxiolytic withdrawal can be dangerous without medical support.⁵ When people go through withdrawal from benzodiazepines or other sedatives they may experience symptoms such as:³

• Autonomic hyperactivity (e.g., increases in heart rate, blood pressure, respiratory rate, body temperature, and sweating).
• Hand tremor.
• Insomnia.
• Nausea or vomiting.
• Muscle aches.
• Psychomotor agitation.
• Anxiety.
• Visual, auditory, or tactile hallucinations.
• Seizures.

Withdrawal from stimulants, which includes meth, prescription amphetamines, and cocaine, can result in such symptoms as:^3,5,6

• Depressed, down, or dysphoric mood.
• Fatigue.
• Anxiety.
• Anhedonia (loss of desire for pleasurable activities).
• Sleeping too much or too little. Sleep may also be accompanied by vivid, unpleasant dreams.
• Increased appetite.
• Psychomotor agitation.
• Slowed heart rate.
• Drug cravings.

Alcohol Withdrawal Symptoms

Alcohol withdrawal will result in such symptoms as:^3(52),5

• Restlessness.
• Sweating.
• Anxiety.
• Insomnia.
• Shakiness (i.e., hand tremor).
• High blood pressure.
• Rapid pulse, or increased heart rate.
• Loss of appetite.
• Nausea or vomiting.
• Sensitivity to lights or sounds.

Severe alcohol withdrawal can result in visual, tactile, or auditory hallucinations and potentially life-threatening seizures and a condition known as delirium tremens (DTs⁾.⁵ DTs can be life-threatening and consists of extreme confusion, delirium, and other changes in consciousness or cognitive disturbances that may include hallucinations and be accompanied by psychomotor agitation, sweating, and fever.³

What Causes Withdrawal?

Withdrawal occurs when a person is dependent on a substance, and they either stop or cut back on the intake of the substance, resulting in a series of symptoms.⁴

Withdrawal symptoms are the body’s normal physiological adaptation to a medication or drug and this can occur as a result of taking certain prescription medication or as a result of chronic alcohol and drug use.³ For example, someone that has been prescribed opioids for chronic pain may experience withdrawal when they stop taking their pills.

Average Drug and Alcohol Withdrawal Timelines

There are general timelines for each type of substance, however, these timelines can vary greatly depending on the individual. Alcohol withdrawal, for example, typically lasts several days. In contrast, benzodiazepine withdrawal may take weeks.¹

However, symptoms of “protracted withdrawal” (also called “protracted abstinence”) may also occur after chronic use of certain substances. These symptoms commonly include depression, anxiety, insomnia, and restlessness. They may wax and wane over a period of weeks or months.^1,5

Withdrawal Timeline for Heroin and Opioids

In general, the withdrawal timeline for heroin starts at about 8-12 hours after the last dose of heroin and lasts for around 3-5 days. However, withdrawal timelines for longer-lasting opioids like methadone start about 36-48 hours after the last time it is taken and will peak around 3 days and continue for about 3 weeks.⁵

Opioid withdrawal symptoms that may linger include cravings, memory problems, insomnia, irritability, and diarrhea; these can wax and wane over time and last for several weeks or months after cessation.

Withdrawal Timeline for Alcohol

The withdrawal timeline for alcohol typically begins about 6 to 24 hours after the last drink.⁵

The typical course of alcohol withdrawal results in a peak of symptoms at about 36-72 hours and can last from 2-10 days. However, anxiety, depression, sleep problems, and fatigue can persist for weeks or months after a person stops using alcohol.¹

Withdrawal Timeline for Cocaine and Meth

In general, withdrawal from stimulants begins 24 hours after the last use and lasts for 3 to 5 days.^1,5 However, the withdrawal from chronic, regular meth use may last for longer periods of time.⁶

Protracted or post-acute withdrawal may start with a 2-week period where a person feels extremely tired, has unstable moods, struggles with cravings, and has an increased appetite.⁶ This may be followed by a period of weeks to months where a person feels fatigued, lacking mental energy, depression, and anhedonia (i.e., lack of ability to feel pleasure).⁵

Withdrawal Timeline for Benzodiazepines

For benzos, the withdrawal timeline starts around 1-2 days after the last dose for short-acting benzos (e.g., Halcion, Restoril) and lasts around 2-4 weeks. With long-acting benzos (e.g., Tranxene, Valium, Xanax), the first signs of withdrawal start 2-7 days after the last dose and continue for 2-8 weeks.¹

Protracted or post-acute withdrawal is more likely to be experienced following the use of benzodiazepines than any other substance. Some people have reported having protracted withdrawal symptoms for years after the last use of benzos.

Protracted withdrawal from benzodiazepines can include:

• Irritability.
• Anxiety.
• Depression.
• Tinnitus.
• Problems with learning and/or memory.

How to Treat Drug and Alcohol Withdrawal

Medical detox can help to keep a patient safe and more comfortable during withdrawal.

Detox generally has 3 stages including:⁵

• Evaluation, a thorough assessment to learn critical information to outline a treatment plan.
• Stabilization, which is a series of interventions that is designed to help you safely and comfortably get a substance out of your body.
• Facilitating entry into further treatment. Detox is often just the first step in treating addiction. Research suggests detox alone is largely ineffective at helping someone achieve long-term abstinence. Behavioral therapy and counseling can help to support recovery by teaching coping skills and repairing thought patterns.⁹

Medications for Drug and Alcohol Withdrawal

Medications are often used to help manage symptoms of withdrawal, but it depends on the type of substances involved and the severity of the symptoms.⁵

Benzo withdrawal may involve substituting one benzo with another which is easier for clinical staff to taper a person off of. This also helps reduce the likelihood and severity of seizures caused by withdrawal. In some cases, a barbiturate called phenobarbital is used as a substitute.⁵

Benzodiazepines can also help reduce the risk of seizures during severe alcohol withdrawal. Other types of antiseizure drugs may also be used during alcohol detox, and in those cases where people develop delirium or seizures, an antipsychotic drug may be needed to control these symptoms.⁵

Medications for opioid use disorders (OUD) are often used during withdrawal management to reduce or even eliminate uncomfortable symptoms of opioid withdrawal. A partial opioid agonist, buprenorphine, or a full opioid agonist, methadone, can reduce or eliminate withdrawal symptoms as well as cravings for opioids.^9,10

There are no FDA-approved medications specifically designed to treat stimulant withdrawal. However, comfort medications, such as sleep aids to manage insomnia, and other psychoactive medications such as antidepressants may be administered to ease certain symptoms.⁶

Therapy Used During Detox and Addiction Treatment

Some programs offer behavioral therapy or counseling during and after medical detox. Some common types of behavioral therapy used in addiction treatment are:

• Cognitive-behavioral therapy (CBT), which is a therapeutic approach to help people change their thinking patterns and find ways to avoid using drugs and cope with relapse triggers. CBT emphasizes changing problematic behaviors by learning new coping skills.⁹
• Motivational interviewing (MI), which is an approach designed to quickly enhance internal motivation towards change. Therapists use a structured way of asking questions and eliciting responses that engage the patient and help them become invested in their recovery.¹⁰
• Contingency management (CM). CM involves incentivizing recovery by offering prizes or vouchers for reaching milestones or meeting goals. Studies show CM is effective in keeping patients in treatment and maintaining recovery.¹¹

Are There Natural Remedies for Drug Withdrawal Symptoms?

Certain withdrawal symptoms may respond to alternative treatments (e.g., herbal remedies, mindfulness, yoga, exercise) or over-the-counter supplements and medication, but there is not a strong evidence base to support their use during medically managed withdrawal.

Additionally, substance use disorders and chronic substance use often coincide with malnutrition, and medical detox may involve increased nutrient requirements or nutritional supplements. Evaluating and addressing nutritional deficits and administering fluids is a key part of medical detox for withdrawal from many substances.⁵

Get Professional Detox Treatment at Desert Hope

If you are seeking help with addiction for yourself or helping a family member with an addiction, know that there are many different levels of rehab. If you are seeking an alcohol or drug rehab in Las Vegas for detox and withdrawal or looking to find out what types of outpatient programs might be available to help with withdrawal and detox, Desert Hope can offer you quality treatment provided by caring, compassionate, and experienced staff.

Call Desert Hope today to find out more about how to start addiction treatment, what to expect in inpatient rehab, outpatient rehab options that might work for you, as well as using insurance to pay for rehab, as well as rehab payment options. The staff at Desert Hope is available 24/7 to answer your questions about detox and rehab for alcohol or drug use disorders.