What Is Withdrawal?
When a person stops taking a drug, in order for the effects of that drug to cease, the body must clear out the remnants of the substance in the bloodstream. This process is referred to as detox.
Because of the way drugs work in the body, the process of detox can result in some physical and psychological symptoms that are often uncomfortable. These symptoms are collectively referred to as withdrawal. The World Health Organization defines withdrawal as the physiological and psychological symptoms a person experiences as a result of detox from psychoactive substances that have been consumed at high quantities and/or over a long period of time.
Withdrawal symptoms vary based on the type of drug taken, the amount taken, how long the substance has been taken regularly, and other factors related to the individual taking the drug and the degree of abuse or addiction.
Why Do People Have Withdrawal Symptoms?
Substances work on the chemical processes in the brain, and this is part of the reason addiction forms. When a person takes a medication as recommended, it supplements the existing chemical pathways. However, when the same medication is abused, it can sometimes take over those pathways, resulting in tolerance of the substance. This then makes the person feel that more of the drug is needed to get the same effect that was previously gained with a smaller dose.
Eventually, this can lead to dependence or addiction, when the body can no longer function properly without the drug. When this happens, sometimes the body stops producing as much of the natural chemical, like dopamine, and begins to depend on the drug to maintain its functions. When the person tries to stop taking the drug, the brain sends signals to the rest of the body to get more of that substance.
Until the body can begin producing the substance on its own, the person feels the withdrawal symptoms that result from the brain sending its messages to the body to get more of the substance. This results not only in the discomforts that are caused by the body and brain not being able to complete those chemical pathways, which can cause extreme physical discomfort, but also cravings for more of the addictive substance.
Common Withdrawal Symptoms
In general, a person who is in the process of detox can expect certain withdrawal symptoms that include:
- Digestive discomfort
- Shakiness or muscle trembling
- Anxiety or irritability
- Headache and body aches
- Mood swings
- Insomnia and fatigue
These symptoms occur to varying degrees depending on the person, the degree of addiction, the amount of use, and other factors.
Withdrawal from alcohol is one of the most dangerous detox processes. The symptoms that can occur during alcohol withdrawal include:
- Anxiety or nervousness
- Shakiness or tremor
- Inability to focus and muddled thinking
- Pale skin
- Rapid heart rate
- Loss of appetite
If alcohol use has been particularly severe for an extended period, or if other personal factors are in play, the person may have dangerous withdrawal symptoms like seizures and a condition called delirium tremens (DTs) that can cause fever, hallucinations, and increased heart rate. Some of these symptoms can be severe enough to cause death. However, if medical detox is undertaken in a professional setting, many of these symptoms can be managed and controlled.
Benzodiazepines, or benzos, are commonly prescribed drugs used for many purposes; the main conditions treated by these drugs are anxiety and depression. These drugs act on the nervous system in ways similar to alcohol, and withdrawal from benzos can also be very dangerous. The symptoms of benzo withdrawalinclude:
- Upset stomach
- Anxiety and panic attacks
- Weight loss
- Heart palpitations
Severe cases of benzo withdrawal can also result in seizures and psychotic reactions. These reactions can potentially lead to death. Again, medical detox is required for benzo withdrawal.
Prescription Opiates and Heroin
Addiction to opiate drugs is more dangerous than withdrawal; however, the symptoms of withdrawal from opiate drugs can be extremely uncomfortable:
- Muscle aches
- Restless leg syndrome
- Runny nose and teary eyes
- Digestive discomfort
- Goose bumps
- Nausea and vomiting
- Agitation and anxiety
While this withdrawal process is not deadly, it can be extremely uncomfortable. A physician or reputable treatment program can help with medicines that can ease these symptoms and make the process more comfortable. As with benzodiazepines and alcohol, medical detox is required for opiate withdrawal.
When a person has binged on a stimulant drug like cocaine or methamphetamine, the resultant withdrawal is referred to as coming down or a crash. The symptoms of withdrawal from stimulants occur in stages, and include:
- Emotional agitation
- Aggression or quick temper
- Intense craving for the drug
- Lack of focus
After these phases are over, the person can enter into a long period of depression, fatigue, lack of mental and physical energy, and possibly suicidal thoughts. While withdrawal from stimulants is not deadly on its own, people who have come down from stimulants may attempt to harm themselves. As a result, medical detox is often recommended.
Timelines for Withdrawal
A person’s specific timeline for withdrawal depends on several factors, including the length of time the drug was taken, the heaviness of use, the person’s individual constitution, and whether or not more than one drug is involved, among other things.
The basic measure through which the timelines for withdrawal from particular drugs are determined is the drug’s half-life; this is the amount of time it takes for half of the quantity taken to be eliminated from the body.
For example, the half-life of Xanax, or alprazolam, is about 11 hours, on average. This means that it takes about 11 hours for half of the drug to be cleared from the system. So for a person who has been taking Xanax long enough to build up an effective concentration in the body, it can take 1-4 days for the drug to clear the system completely. Still, withdrawal symptoms could potentially continue at a lesser level for a month after drug intake has been stopped.
Timelines for Specific Drugs
Though timelines vary according to individuals, there are general withdrawal timelines for specific substances.
- Alcohol: The first, relatively mild symptoms begin within 6-12 hours of the last drink, and hallucinations may appear 12-24 hours after the last drink. Seizures, which are a very severe reaction, can occur in as little as two hours after the last beverage, but may take up to 24-48 hours to appear. If DTs does occur, it can begin up to 48-72 hours after ceasing alcohol intake.
- Benzos: Different benzos have different half-lives. For example, with its half-life of 11 hours on average, alprazolam clears relatively quickly from the system, while the half-life of clonazepam is 30-40 hours. This means that withdrawal symptoms for Xanax may begin within hours of taking the last dose, while for Klonopin, it might take a few days for the first symptoms to begin. Again, individual circumstances have a lot to do with the timeline, such as how long the person has been taking the medication, the dosage that has been taken, and other personal health factors. It can take a month or two for symptoms to fully clear, but some psychological and physical symptoms can last for six months to a year or more after ceasing use.
- Opiates: Symptoms generally start between 12 and 30 hours after the last exposure to the drug. Early symptoms include anxiety, aches and pains, insomnia, fatigue, and sweating. These may grow worse over time and new symptoms like stomach pain, chills, and digestive issues may arise. The symptoms can last several weeks. Sometimes long-term replacement medications are given to mitigate withdrawal symptoms.
- Stimulants: Withdrawal symptoms generally start within 36 hours of stopping these drugs, and they can last a few weeks, following the stages described above.
Again, these timelines can vary depending on the person involved. People who smoke, who have liver or kidney disease, or with other health factors may have longer withdrawal timelines.
Concerned about treatment costs? Call now for a FREE insurance and payment consultation.
Doctor Recommendations for Managing Withdrawal
Because of the complications that can arise from withdrawal symptoms, most doctors and addiction treatment professionals recommend that a person undertake detox with the support of a doctor or rehab program that can monitor the symptoms, provide medications that can ease the symptoms on an as-needed basis, and protect the individual from severe symptoms or self-harm.
In some cases, there are also medications and other treatments that can be introduced during and after detox and withdrawal that can help reduce cravings and prevent relapse to use of the drug. These treatments include:
- Supportive agents that prevent cravings and help manage withdrawal
- Aversive agents that make taking the drug of abuse uncomfortable
- Therapy such as Cognitive Behavioral Therapy to help a person learn to manage cravings
- Family and interpersonal therapy to help manage supporting relationships
- Self-help and mutual support groups that can be continued after treatment
By following a doctor-recommended plan designed to manage the individual’s particular psychological and physical issues and needs, experts agree that the person is more likely not only to get through withdrawal comfortably, but also to continue in recovery after treatment is over.
In 2011, approximately 21.6 million people had a substance abuse disorder, but only 2.3 million got treatment at a specialized treatment facility. This includes detox treatment.
In 2011, there were 250,596 drug-related emergency room visits for people seeking detox. Some of these involved requests for detox without a precipitating emergency, while others involved people already experiencing withdrawal symptoms. Approximately 28 percent of these visits were for alcohol.
Nearly 60 percent of people going to the ER in search of detox received some follow-up care, including admission to the hospital, referral to detox services, or direct transfer to another facility.
In one study of people who were admitted to a hospital with alcohol withdrawal syndrome, more than 71 percent of them presented with the DTs, and 6.6 percent died. The chances of surviving alcohol withdrawal in these cases depended on the severity of symptoms upon admission to the emergency room.
The prevalence of DTs among people with any alcohol-related disorder stays relatively constant. Over a period between 2001 and 2005, it decreased only slightly, from 6.7 percent to 4.9 percent, as reported in a study from 2008.
- Nausea or vomiting
- Stomach pain
- Loss of appetite
- Shakiness or muscle trembling
- Headache and body aches
Depending on the drug involved, other symptoms may occur, such as paleness, clumsiness or diminished muscle control, muscle spasm or stiffness, goosebumps, yawning, and runny nose or eyes.
There are also psychological symptoms, such as fatigue and insomnia, agitation, anxiety, aggression or violence, paranoia, mood swings, and depression. These symptoms should not be ignored as they can cause a person to have cravings for the drug and relapse.
Even something as simple as a hangover from a single night of binge drinking is actually the body’s response to withdrawal. Addiction is not necessary for a person to go through detox. All that is required is that the person has consumed more of the substance than the body is able to handle at one time.
It may sometimes seem that one person who has been taking a substance doesn’t have the same severity of withdrawal symptoms as another. However, this may be because that person’s individual circumstances enable the body to manage the substance differently. Factors that may affect the level of withdrawal that results from detox include:
- How long the person has been taking the drug
- The dosage taken and how often
- Body weight and size
- Health factors, such as liver disease and other metabolism issues
- Age, race, and gender
Many people may think that it should be easy enough to detox at home with the help of friends or family. In the case of severe withdrawal symptoms, friends or family simply may not have the training to intervene. They also may not have the time to commit to the consistent monitoring of the withdrawal process to manage some of the more uncomfortable symptoms.
The safest and most comfortable way to detox, recover, and maintain recovery from drug abuse or addiction is to get professional help from a research-based rehab center. These professional centers can provide the 24/7 monitoring, medical support, and therapy that can help a person who is struggling with drug abuse or addiction to manage cravings and avoid relapse. If a person has been abusing alcohol, opiates, or benzodiazepines, medical detox is always required.
Other medications that can be used to treat withdrawal symptoms can be prescribed by a doctor at a detox or rehab program. Drugs like methadone and buprenorphine can help manage withdrawal from heroin addiction; however, they carry their own risks and must be managed by a doctor.
It’s important to remember that medically assisted detox is not in itself a treatment for drug addiction. Further treatment after withdrawal is key to changing the habits that can cause relapse.
There are some claims that procedures like anesthesia-assisted detox or “rapid opiate detox” can prevent these symptoms. However, this claim has not been substantiated through research, and there is no evidence that these methods reduce withdrawal timelines. In fact, these methods can be dangerous, especially if performed outside a hospital. In some cases, they have resulted in death.
The reliable way to detox safely and with the highest degree of comfort is with support from a professional detox and rehab program, with the help of a medical professional.
Detox from benzos and alcohol may result in more severe issues, however. Withdrawal from these drugs can result in symptoms that are life-threatening, such as seizures and delirium tremens. Even low-dose, long-term benzo use can result in these severe symptoms, so it’s very important to undertake detox with medical support.
If a person is addicted to both benzos and opiates, the symptoms of opiate withdrawal can be significantly worse than if detoxing from opiates alone.
- Delirium tremens, which can manifest as hallucinations, seizures, stupor, deep sleep for more than a day, delirium, and body tremors
While withdrawal symptoms may sometimes make a person feel ill enough to fear the results of the process, the symptoms will eventually resolve with continued abstinence from the substance of abuse, and the person will be ready to move to the next stage of treatment.