Drug and Alcohol Withdrawal

Drug and alcohol withdrawal can lead to various symptoms that can be treated in different ways. Find out how different methods are used for common addictions.

Drug and alcohol withdrawal can be confusing and overwhelming. There are many questions and variables to consider when it comes to the withdrawal process. You may wonder what drug withdrawal is, or how to get help with withdrawal. You could also be curious about how long alcohol withdrawal lasts or how long opiate withdrawal lasts.

Substance withdrawal can have various symptoms. As a general rule, both drug withdrawal and alcohol withdrawal make people uncomfortable. Sometimes withdrawal symptoms can even be dangerous. Withdrawal can even create setbacks in recovery. It is therefore essential to know what to expect so you can seek the help you need to safely get through withdrawal and recover from substance use.

What is Withdrawal?

You may be surprised to learn that withdrawal can be defined in two ways:

1. You experience typical withdrawal symptoms for the substance you stopped taking
2. You are taking a substance to avoid symptoms that occur if you stop taking it

To understand withdrawal, you need to first understand the way alcohol and drugs impact your brain. Your brain is full of nerve cells that send chemical messages to one another. When you drink or take drugs, the chemical signals in your brain changes in response to those substances. Sometimes your brain ends up with more of certain chemicals and sometimes it will end up with less. The exact chemicals depend on the substance consumed.

Over time, your brain gets used to the chemical signals being changed by the substances. Your body then learns to expect the substance you are taking. When your body gets used to the presence of the substance, this is called dependence. When you suddenly quit taking the substance, your brain is caught off guard. As a result, you start to feel uncomfortable symptoms. These symptoms are withdrawal symptoms. Different substances cause different chemical changes in the brain. Therefore, the exact signs of drug withdrawal depend on the substance you were using.

It is important to note that dependence does not mean addiction. For example, a doctor may prescribe an antidepressant to treat depression. You may need this drug, and it is a valid prescription drug. All the same, after your brain gets used to the antidepressant and starts to expect it, your brain is now dependent on the drug. If you stop taking the drug suddenly, you will likely have withdrawal symptoms. But this does not mean that you are addicted to the antidepressant.

Withdrawal Symptoms

Drug withdrawal symptoms often depend on the substance used. Since different substances impact different brain chemicals, the withdrawal process and symptoms vary. Common withdrawal symptoms include:

• Alcohol withdrawal: mood changes, tremor, hallucinations
• Benzodiazepine withdrawal: anxiety, trouble sleeping
• Opioid or heroin withdrawal: muscle aches, sweating, goosebumps
• Cocaine withdrawal: feeling restless, depressed, or tired

How Long Does Withdrawal Last?

Withdrawal symptoms can last different amounts of time depending on the substance:

• Alcohol withdrawal symptoms: may last for weeks
• Benzodiazepine withdrawal symptoms: may last for weeks or months
• Opioid or heroin withdrawal symptoms: may last for anywhere from four to 20 days, depending on the opioid. Short-acting opioids like Percocet may cause withdrawal that lasts from four to 10 days. However, longer-acting opioids like methadone may cause withdrawal that lasts for almost three weeks.
• Cocaine withdrawal symptoms: may last for months

Dangers of Withdrawal

Some substances, like alcohol, can be dangerous to try to stop taking on your own without help. The dangers of alcohol withdrawal include:

• Seizure
• Hallucinations
• Delirium tremens

Withdrawal from chronic, heavy alcohol use can be deadly. Even if you feel only mild alcohol withdrawal symptoms at first, they can rapidly worsen and become dangerous. The alcohol withdrawal timeline can also vary from person to person, with symptoms starting within hours for some people, and not starting for days in others. For these reasons, it is important to only detox from alcohol use under medical supervision.

Similarly, withdrawal from benzodiazepines can be dangerous and can lead to a seizure. Therefore, it is safest to detox from benzodiazepines under medical care.

Withdrawal from other substances may not be as dangerous. For example, withdrawal from stimulants like cocaine often leads to discomfort which is not dangerous. However, some people recovering from cocaine use may struggle with depression, which puts them at risk for suicide.

Likewise, although opioid and heroin withdrawal can be very uncomfortable, it is rarely dangerous. For adults and teens, the dangers of opioid withdrawal are mainly related to the risk of relapse. If you are in opioid withdrawal, you will likely have cravings for the drug. The problem is that during the time you’re sober, your tolerance to the drug decreased. So the amount of the drug you used to take to get high might then be a deadly dose. This occurrence is a leading cause of overdose deaths.

For babies whose mothers used opioids or heroin while pregnant, withdrawal itself can be more dangerous, leading to drug withdrawal seizures in some cases. Babies born to mothers who used opioids or heroin while pregnant often need to be weaned from the drugs to avoid withdrawal symptoms.

How to Get Help with Withdrawal

Many resources are available to help you through withdrawal. The Substance Abuse and Mental Health Services Administration (SAMHSA) runs a substance abuse hotline (1-800-662-HELP) that can answer any questions you have about substance withdrawal and treatment. Additionally, professional treatment facilities, like The Recovery Village provide patients with medical detox and safe withdrawal spaces.

Medical Detox

Medical detox is only the first step in quitting substance use. In medical detox, your withdrawal symptoms are treated as your body gets used to functioning without the substance. However, without additional help after the withdrawal phase is over, the risk of relapse is high. Therefore, medical detox should be used with other services to provide the patient with the best chance of long-term success. These services may include therapy or social work.

Medications Used During Drug Detox

Medications, if any, used during medical detox depend on the substance you were using:

• Alcohol detox: benzodiazepines are the standard among drugs used for alcohol withdrawal
• Benzodiazepine detox: long-acting benzodiazepines are commonly used
• Opioid and heroin detox: methadone, buprenorphine, and clonidine are commonly used drugs used for opiate withdrawal and heroin withdrawal
• Cocaine and stimulant detox: there is no standard detox medication for cocaine or stimulant withdrawal

Drug and Alcohol Tapering

In some cases, tapering off alcohol or tapering off drugs may be an option to avoid withdrawal symptoms. Tapering is usually done when the substance you are using is prescribed to you. Because prescription drugs are highly regulated, doctors can be sure of the exact substance they are prescribing and tapering. Doctors can then have confidence that the taper will be safe and effective.

Tapering may be done for prescribed drugs like opioids and benzodiazepines. However, street drugs are not usually tapered because many of them contain impurities and may have different amounts of drugs added into them. Some street drugs are even laced with other substances. Doctors often recommend you stop street drugs without a taper, and seek medical help for withdrawal and alcohol detox.

Drug and Alcohol Addiction Treatment

Substance abuse treatment is most effective if it has several different components. Regardless of whether you need alcohol abuse treatment or drug addiction treatment, the following areas should all be addressed to give you the best chance of success at sobriety:

• Therapy, either individual or in a group
• Social help, for example with housing, parenting or job issues
• Medical help, for any problems like depression that might be linked to your substance use
• Medication-assisted treatment, if appropriate

Medication-Assisted Treatment

Medication-assisted treatment is one strategy to help reduce cravings or relapse risk. The substance you used will be the main factor doctors use to determine if this is an option for you:

• Alcohol medication-assisted treatment: naltrexone, acamprosate, and disulfiram may be used.
• Benzodiazepine medication-assisted treatment: there is no standard medication for addiction to benzodiazepines.
• Opioid and heroin medication-assisted treatment: methadone and drugs that contain buprenorphine like Subutex, Bunavail, Suboxone and Zubsolv may be used.
• Cocaine and stimulant medication-assisted treatment: there is no standard medication for drug addiction to cocaine or stimulants.

Managing drug and alcohol withdrawal can be complex and difficult. Trained professionals at The Recovery Village are available to help you navigate the challenging task. Contact The Recovery Village today to learn more about how we can help you live a healthier, sober life.

Editor – Thomas Christiansen

With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more