Addiction Withdrawal: Symptoms, Phases, Treatment, and More

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Table of Contents

  1. What is Withdrawal?
  2. Symptoms of Withdrawal by Substance
  3. Withdrawal Phases
  4. How is Addiction Withdrawal Treated?
  5. What if I Know Someone Going Through Addiction Withdrawal?
  6. What Happens During Relapse?
  7. What Medications are Used in Treating Withdrawal?
  8. Recovering from Addiction Withdrawal at Avenues Recovery

What is Withdrawal?

Withdrawal is both a physical and mental reaction that someone experiences when they stop or reduce the amount of a substance they take. These substances include alcohol, prescription drugs, and recreational drugs.

The body is always trying to achieve homeostasis, a state of chemical balance. When drugs alter this balance, the body’s natural chemistry changes, too. Withdrawal is the process by which the body tries to find homeostasis once more without the presence of external substances.

In the beginning, these substances give people a “high” or “buzz”. However, over time these drugs change the chemistry of the brain and body. Soon, the body builds up a tolerance to the substance, meaning that more of it is required to feel the same initial high. Eventually it’s no longer about chasing a high and more about fueling the body’s dependence on the drug in order to stave off excruciating withdrawal symptoms. These symptoms can be life-threatening if not done under the supervision of medical or drug rehab professionals.

Symptoms of Withdrawal by Substance

Withdrawal symptoms can be both psychological and physical, but the proportion, intensity, and duration of these symptoms depends on the substance, period of abuse, and one’s unique biology.

Central Nervous System (CNS) Depressants

CNS depressants — like alcohol, barbiturates, and benzodiazepines — dampen brain activity. To compensate, the brain produces more stimulants. But when a person ceases taking a depressant drug, the nervous system is still wired to produce an abnormal amount of stimulants. Overstimulation can cause anxiety, restlessness, tremors, dizziness, insomnia, psychosis, seizures, and/or strokes.

In 5-10% of people withdrawing from alcohol, delirium tremens (DT) may present as hallucinations, shaking, confusion, and high blood pressure. If untreated, it can lead to death in 5-15% of those diagnosed, so it’s important to seek help from a drug rehab facility.

Opioids

Opioids — like oxycodone, fentanyl, and heroin — block pain receptors in the nervous system. They trigger the release of endorphins, neurotransmitters responsible for pleasure. When the rush is over, it’s easy to want to experience that feeling again through another dose. Both legal and illegal opioids are highly addictive. In fact, the U.S. Department of Health and Human Services estimates that 40% of opioid overdose deaths involve a prescription opioid.

Withdrawing from opioids causes extreme physical discomfort, including vomiting, dizziness, muscle and bone pain, insomnia, hypertension, muscle twitching, abdominal cramps, and irregular heartbeat. The withdrawal process can also lead to stress, anxiety, and depression.

CNS Stimulants

Stimulants, such as cocaine, act opposite to depressants by increasing stimulation of the nervous system. They increase dopamine levels and activate neurotransmitters responsible for alertness, energy, and attention. Thus, when a person withdraws from CNS stimulants, they feel an onset of depression, insomnia, fatigue, and/or dulled senses.

Though physical symptoms are limited, these psychological effects are often severe enough to result in relapse or suicide without the help of rehab professionals.

Regardless of the substance being abused, it is safest and most sustainable to seek assistance from rehab facilities that help mitigate the intensity of symptoms and make sure abstinence is long-lasting.

The following substances do not carry withdrawal symptoms as severe as the ones above, but it’s still a good idea to consult a doctor or other health professional before stopping use completely.

Cannabis

Withdrawal from cannabis, or marijuana, lasts 1-2 weeks after stopping use. Withdrawal symptoms are considered mild and may include:

  • mood swings
  • difficulty sleeping
  • decreased appetite
  • cravings
  • restlessness
Hallucinogens

Psychedelics — LSD, peyote, psilocybin, salvia — cause hallucinations and cognitive change. Withdrawal can result in psychological and physical symptoms:

  • cravings
  • fatigue
  • irritability
  • muscle spasms
  • loss of coordination
  • flashbacks
  • high blood pressure
  • anhedonia (the inability to experience pleasure)
Dissociative anesthetics

Dissociative anesthetics, like ketamine and PCP, detach the user from themselves and their environment. They are similar to hallucinogens in that they may result in changes in perception. Those who quit can experience any combination of these withdrawal symptoms:

  • depression
  • insomnia
  • low energy
  • loss of motor skills
  • speech problems
  • agitation
  • nausea

Withdrawal Phases

The first step, of course, is making the decision to quit: acknowledging the problem and seeking help. Often this means checking into a rehab facility or discussing treatment plans with a medical professional. These plans are necessary — the withdrawal process won’t be easy.

Withdrawal usually happens in two phases: acute withdrawal and post-acute withdrawal. CNS depressants like alcohol and benzos carry the most potential for danger during withdrawal, but all major drug withdrawal is best done in a professional setting where the client can be closely monitored.

Phase 1: Acute Withdrawal

Acute withdrawal from alcohol addiction usually starts six to 12 hours after abstinence begins. At first, people may experience insomnia, anxiety, headaches, and upset stomach. By the second day, these symptoms intensify and may result in hallucinations or seizures. Delirium tremens may present itself after 48-72 hours, the timeframe when symptoms peak. Then they begin to subside.

Acute withdrawal from benzos can vary depending on the type and degree of abuse. Generally, they take a week or longer to cycle through the acute withdrawal stage.

The early withdrawal symptoms for opioids can begin as soon as a few hours to a few days after last use. Symptoms vary based on type but usually include agitation, anxiety, dysphoria, insomnia, and fever. The total period of acute withdrawal lasts anywhere from four to 14 days.

These timelines and symptoms vary further according to each individual’s biology. Sometimes, people take more than one drug and must deal with a combination of withdrawal symptoms. For example, evidence suggests that withdrawal symptoms are worse in patients who are dependent on both opiates and benzos.

Phase 2: Post-Acute Withdrawal Syndrome (PAWS)

Acute withdrawal usually manifests as both physical and psychological symptoms. On the other hand, post-acute withdrawal syndrome is primarily psychological, longer-term, and less predictable.

Depending on the drug and period of abuse, PAWS can last a few weeks to a few years. And even among users of the same drug, the timeline and symptoms of PAWS is highly variable. These fluctuations are continued signs that the brain is trying to reach homeostasis.

PAWS is characterized by ups and downs — periods of stability and calm punctuated by sudden emotional turmoil that may threaten to send people into relapse. Sometimes these moments of emotional stress are set off by triggers or situations that remind the person of who they were when they were using.

The unpredictability of PAWS is just one of many reasons why it’s a good idea to get inpatient care. The support of a rehab facility helps patients strengthen the progress they’ve made up to this point and helps prevent a backslide into relapse. If relapse does occur, a rehab clinic provides continued support and encouragement in what can be a vulnerable, frustrating time in the journey to sobriety.

How is Addiction Withdrawal Treated?

Quitting cold turkey can be dangerous, especially when it comes to alcohol, benzos, and opioids. That’s why a good inpatient detox program is crucial for people to withdraw safely and sustainably.

An ideal detox program provides a safe, comfortable place with 24-hour care and supervision. A medical team will be able to assess whether to administer medications to ease symptoms and cravings. With drug detox, this is a delicate process that must be monitored with care.

In some cases, outpatient treatment may be preferable for those recovering from certain substances. Mental and physical assessments should determine the suitability of this approach.

It’s hard to do all this alone. After detox, it’s a good idea to join a residential program in order to be around others who share the same addiction struggles. Support from family and friends is crucial to maintaining sobriety.

What if I Know Someone Going Through Addiction Withdrawal?

If you live with or know someone going through withdrawal, take the following into consideration:

  • understand that detox is not a permanent cure and there is a chance of relapse
  • be educated on the typical effects and withdrawal symptoms of the specific substance in order to know what to expect (withdrawal symptoms usually get worse before they get better)
  • be patient and open to conversation
  • when spending time together, try to distract the individual from their withdrawal symptoms through conversation, shared activity, etc.
  • provide emotional support

What Happens During Relapse?

Relapse occurs in three stages: emotional, mental, and physical. In total, it can take weeks or months — it isn’t sudden.

Emotional relapse is when someone begins coping poorly with their emotions. They may experience anger, anxiety, and/or bad sleeping habits as a result of lack of support. These emotions may be similar to those they experienced during prior addiction.

Mental relapse is when the person begins thinking about using again. It’s an internal struggle between the part of the person who wants to stay sober and the part that craves using again. A warning sign that someone might be in this stage is romanticizing the period of drug use.

Physical relapse occurs when the person actually uses or drinks again. This can be a single drink or dose (a slip) or spiral into a full relapse.

Relapse can happen at any time — weeks, months, even years after sobriety. Addiction is a chronic condition, and the fight against it is ongoing. Common risk factors include exposure to triggers, stress, interpersonal problems, peer pressure, and lack of social support. Thus, early intervention is key.

What Medications are Used in Treating Withdrawal?

In the withdrawal process, medication is not the first line of defense. However, in treating severe or potentially life-threatening symptoms (like seizures and strokes), certain medications will help. They should be used carefully and only when patients can be constantly monitored.

The following help treat the symptoms of alcohol withdrawal:

  • FDA-approved benzodiazepines
    • Chlordiazepoxide (Librium)
    • Clorazepate (Tranxene)
    • Diazepam (Valium)
    • Oxazepam (Serax)
  • Anticonvulsants: to prevent seizures
    • Carbamazepine (Tegretol) 
    • Gabapentin (Neurontin) 
    • Oxcarbazepine (Trileptal) 
    • Valproic Acid (Depakene)
  • certain barbiturates
    • Phenobarbital

To help treat opioid withdrawals, medical professionals commonly administer these medications:

  • Clonidine
  • Lofexidine (Lucemyra)
  • Robaxin (Methocarbamol)

Recovering from Addiction Withdrawal at Avenues Recovery

At Avenues Recovery in Prince Frederick, MD, you will receive expert care by medical professionals and staff with backgrounds in addiction recovery. We provide various levels of care for clients in all stages of recovery — including Intensive Outpatient (IOP) and Outpatient (OP) therapy — but all treatment is based on evidence and personalized needs.

We recommend our 60-day extended care program to assist clients through the hardest periods of withdrawal. Our casual, modern facility feels like a home, an ideal place to nourish the body, mind, and spirit. It features spacious accommodations, advanced amenities, and beautiful grounds. Everyone’s journey is different, which is why care is individualized and flexible. But the core values of our treatment are life skills, wellness, nutrition, social acceptance, financial responsibility, and family.

All our treatment programs are designed to help people get back on their feet and into society. Our clients’ strength and resilience is the reason we do what we do.

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Brooke Abner,

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