How to Deal With Withdrawal


Every day, people all across the United States make the powerful decision to stop abusing drugs and alcohol.

For many, recovery begins with detox and withdrawal from the substances they were abusing. Withdrawal from drugs or alcohol can happen when a person stops using these substances in order to allow the body time to clear itself of drugs.1

Withdrawal symptoms and experiences vary for every person, and depends on:2

  • What substances the person had in their system.
  • How long they’ve been using.
  • The person’s initial health.
  • How they are choosing to withdraw—whether in a facility or on their own.

Withdrawal can be overwhelming but understanding what to expect may help those withdrawing from substances manage the process and prepare them for the rest of their recovery journey.

After a patient completes detox, they’re ready to begin rehabilitation. Through further treatment and aftercare, an individual develops behavioral changes that help them avoid relapse.3

Detoxing by Yourself vs. Getting Support

Man After Sleepless NightWith different types of substances withdrawal symptoms can range from mild discomfort to very severe and potentially life-threatening.4 For certain substances, medically supervised detox is common early on in recovery. Depending on the substance and severity of abuse, detoxing alone may be risky, particularly if dangerous withdrawal symptoms are left unmonitored. The temptation to relapse may also be greater when detoxifying outside a facility.5

However, there are a couple of different methods for managing withdrawal symptoms under supervision. The level of care required is dependent on many factors, and a specially trained medical clinician will assess the patient’s situation before recommending the appropriate amount of supervision.

In some cases, mild withdrawal symptoms may be manageable at home or out of the doctor’s office, provided the individual receives support from trained clinicians before and while undergoing withdrawal.2

Depending on the patient’s situation and medical history, they may be prescribed medication to lessen withdrawal symptoms or it may be recommended that they receive inpatient or outpatient detox.2

Outpatient detoxification programs require patients to travel to a hospital or treatment facility daily. There, doctors will evaluate the patient and administer detoxification treatment. Evaluation includes:2

  • Physical examination.
  • Laboratory tests.
  • Learning the patient’s medical history.

During outpatient detoxification, staff may provide medication to the patient to help manage cravings and withdrawal symptoms.2

Inpatient detox programs are typically used for patients expected to undergo moderate to severe withdrawal symptoms. The process of evaluation and administering detoxification treatment is similar to outpatient detoxification. However, with inpatient detox, patients remain at the facility throughout the entire detoxification process. This allows medical professionals to:5

  • Monitor a patient’s withdrawal symptoms 24/7.
  • Immediately respond to potential emergencies.
  • Restrict the patient’s access to substances and prevent them from relapsing as they detox.

General Timelines for Withdrawal

The experience of withdrawing will vary greatly depending on several factors. Circumstances that may affect the severity and length of withdrawal symptoms include:2

  • The patient’s general physical and mental health history.
  • For how long and the degree to which the individual has been abusing substances. This includes:
    • The frequency of doses they are used to taking.
    • The amount of medication with each dose.
    • The length of time the patient has been abusing the substance.
    • Whether the patient abused other substances in conjunction with their drug of choice.

According to the Substance Abuse and Mental Health Services Administration, successful detoxification consists of 3 parts:2

  • This involves a comprehensive approach—everything from testing the concentration of substances in the patient’s bloodstream to analyzing their psychological well-being.
  • This is the process in which medical professionals supervise the patient’s return to a healthy, substance-free state.
  • Fostering entry into treatment. The patient must be prepared to follow through with continued care. It’s important to understand that detoxing from drugs or alcohol is only the first stage of addiction treatment and is not sufficient long-term substance abuse treatment.2

Read on to learn about the withdrawal timelines of some commonly abused substances.

Substance Withdrawal Symptoms Withdrawal Timelines
Alcohol Symptoms of alcohol withdrawal include:6
– Depression.
– Anxiety.
– Mood swings.
– Nausea and vomiting.
– Tremors.
– Rapid heart rate.
– Fever.
– Seizures.
– Severe confusion.
Withdrawal symptoms usually begin within 8 hours of abstaining from alcohol. They generally peak around 24-72 hours with resolution of many symptoms occurring at 4-5 days, however milder withdrawal symptoms may continue for several weeks.6
Amphetamines (e.g., methamphetamine) Physical and mental symptoms may include:7
– Fatigue.
– Insomnia or hypersomnia.
– Nightmares.
– Physical agitation.
Acute withdrawal from methamphetamine may include intense psychological effects that begin within a few hours to several days after stopping use. Depending on the extent of use, symptoms may resolve within 1-2 weeks of detoxification, and usually subside after 3 weeks, though cravings and depression can persist for 5 weeks and sometimes longer.7
Benzodiazepines Symptoms of benzodiazepine withdrawal include:8
– Insomnia.
– Tremors.
– Agitation.
– Nausea.
– Hallucinations.
– Seizures.
With short-acting drugs (such as Ativan, Xanax, and Restoril), patients often begin to suffer withdrawal symptoms within 6-8 hours, which continue worsening until the second day. Patients usually begin showing improvement on the fourth or fifth day.
With longer-acting benzodiazepines (like Valium and Librium), patients often will not feel any withdrawal symptoms for a full week or longer. Symptoms will peak around 2 weeks and begin to lessen by the fourth or fifth week.8
Opioids Opioid withdrawal symptoms may include:9
– Tachycardia (fast heart rate).
– Nausea.
– Anxiety.
– Hypertension.
– Fever.
– Diarrhea.
– Muscle cramps and spasms.
– Abdominal pain.
People undergoing heroin detoxification can typically expect to experience withdrawal symptoms beginning between 8-12 hours following their final dose. These symptoms generally subside within 3-5 days.9

Methadone withdrawal symptoms usually begin 36-48 hours after the last dose and peak around 3 days. It generally takes 3 weeks or more for symptoms to fully subside.9

Those withdrawing from long-acting opioids (such as morphine and oxycodone tablets, or fentanyl and buprenorphine patches) may not show symptoms until 36 hours after their last dose. Symptoms typically peak between 72-96 hours and gradually subside for 14 days.9

Cocaine Cocaine withdrawal symptoms include:10
– Anxiety.
– Increased appetite.
– Depression.
– Malaise.
– Nightmares.
Withdrawal from prolonged cocaine use is not typically marked by quite as intense physical symptoms as many other substances. However, the crash after abstaining from cocaine begins within a few hours after use and withdrawal (particularly the psychological symptoms) may continue for weeks or months depending on the level of dependency.10

What to Expect from Detox Facilities

Detoxification at a facility is not always required for patients suffering from substance use disorder, and a complete assessment will help to determine the level of care each patient requires. However, it may be a good way forward to ensure a patient’s safety in the case where withdrawal symptoms are expected to be severe.2

Detox at a quality facility should involve:2

  • Around-the-clock medical supervision to make certain the patient remains safe as their body adjusts to the reduction of the toxic substance.
  • Medication to help the withdrawal process should the patient become uncomfortable or experience dangerous side effects (if necessary).
  • Psychological support from substance abuse treatment specialists.
  • Treatment for mental health and underlying physical conditions to facilitate the detox process.

At Sunrise House, patients are given private rooms and are monitored 24/7 during medical detox. Beds are fitted with EarlySense technology to monitor heart rate and vital signs so that medical staff is immediately alerted to any critical changes that may occur during detoxification. Give us a call at 973-862-4820 to learn more about what we can offer you during detox and the rest of your recovery journey.

Sources

  1. National Institute on Drug Abuse. (2020). Types of treatment programs.
  2. Center for Substance Abuse Treatment. (2015). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45. Rockville, MD: U.S. Department of Health and Human Services.:
  3. National Institute on Drug Abuse. (2020). Principles of effective treatment.
  4. Shah, M. & Huecker, M.R. (2020). Opioid withdrawal. Treasure Island (FL): StatPearls Publishing.
  5. Hayashida M. (1998). An overview of outpatient and inpatient detoxificationAlcohol Health and Research World, 22(1), 44–46.
  6. U.S. National Library of Medicine (2020). Alcohol withdrawal.
  7. Hellemann, G., London, E. D., Miotto, K., Nestor, L., Rawson, R., & Scanlon, G. (2010). Withdrawal symptoms in abstinent methamphetamine-dependent subjectsAddiction105(10), 1809–1818. 
  8. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  9. Substance Abuse and Mental Health Services Administration. (2020). Medications for opioid use disorder. a Treatment Improvement Protocol (TIP) Series No. 63. Rockville, MD: Substance Abuse and Mental Health Services Administration. Department of Health and Human Services.
  10. MedlinePlus. (2020). Cocaine withdrawal.



About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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