After a physical dependence to a drug has developed, people will experience withdrawal symptoms when cutting back or stopping their use. Withdrawal symptoms differ depending on the type of drug and how much and how often it was used. Most of the time, withdrawal symptoms are mild and transient, posing no significant risk to a person’s health. However, certain drug withdrawals can be serious, and even life-threatening, including severe alcohol and benzodiazepine withdrawal. [1][2]
- When a physical dependence to a drug has been formed, most people will experience withdrawal symptoms that can begin within hours or days of their last use.
- Most drug withdrawals are uncomfortable, but not dangerous. Severe withdrawals primarily from alcohol and benzodiazepines are the exception and can lead to serious and life-threatening complications.
- There are several effective treatment options for people experiencing severe withdrawal symptoms, including therapy and medications, which may help to ease cravings and withdrawal symptoms.
Why withdrawal symptoms can be dangerous
Withdrawals occur when the body is adjusting to being without a drug it has become dependent on. Most of the time, withdrawals are uncomfortable but not medically dangerous, but there are a couple of exceptions. For example, severe dependence on alcohol and to a lesser extent, benzodiazepines, can lead to serious and life-threatening withdrawals. [1] Because of this, medications are often necessary to stabilize people, which is typically done in a medically-monitored, inpatient detox setting. [3][4]
One of the most serious risks of alcohol and benzodiazepine withdrawal is seizures, particularly in individuals with long-term or heavy use. These dangers stem from how both substances affect GABA receptors; abruptly stopping or significantly reducing use disrupts GABA regulation, increasing the risk of seizures and delirium tremens (DTs). [3]
Can you die from withdrawal symptoms?
There are primarily two types of illicit drugs that can cause fatal withdrawal: alcohol and benzodiazepines. Of these, alcohol withdrawals are by far the most dangerous and potentially fatal, with mortality rates of 5-15% for severe, untreated alcohol withdrawal. [1][3] The mortality rates for benzodiazepine withdrawals are much less steep, but still require medical intervention. [4] While withdrawals from other drugs like opioids, nicotine, and cocaine are uncomfortable, they are not fatal. [1][2]
Withdrawal syndromes vs. Symptoms
Withdrawal symptoms are physical and/or psychological effects of withdrawing from a drug. During early recovery, many people will experience one or more uncomfortable symptoms of withdrawal, which often will subside on their own without medical treatment. Usually, withdrawal symptoms will begin within a day or two of stopping a drug, and will persist for a week or two. [1][2][3]
Withdrawal syndromes, on the other hand, involve a collection of withdrawal symptoms that are more likely to disrupt and interfere with a person’s life and ability to function. In many instances, treatments and medication are indicated when a person is struggling with withdrawal syndrome. Withdrawal syndromes usually begin after acute withdrawal has completed, and tend to include psychological symptoms that last for 4-6 months. [2][5]Â
Which substances have harmful withdrawal symptoms?
Any drug that is physically addictive can cause withdrawal symptoms that are difficult and uncomfortable. Most of the time, these are temporary and will subside on their own as the body adjusts to being without the substance. There are some drugs, however, that a person should not stop taking cold turkey, especially after heavy and prolonged use. These include alcohol, benzodiazepines, and certain prescription drugs like antipsychotics, which can have dangerous withdrawal symptoms. [1][2]Â
Alcohol withdrawal symptoms
When a serious physical dependence on alcohol has formed, cutting back or stopping drinking can cause severe alcohol withdrawal syndrome. Alcohol withdrawal is the most dangerous and potentially fatal type of drug withdrawal, and requires medical intervention to treat. Most of the time, alcohol withdrawal symptoms peak around 36 hours after the last drink, and last up to 10 days. [1][3]Â
Some of the symptoms of alcohol withdrawal include: [1][3][5]
- Anxiety and restlessness
- Severe agitation
- Tremors, tics, uncontrolled shaking
- Extreme changes in heart rate or blood pressure
- Extreme changes in body temperature
- Seizures and delirium tremens
- Hallucinations and delusions
- Insomnia and nightmares
- Strong alcohol cravings
Benzodiazepine withdrawal symptoms
Benzodiazepines are controlled prescription medications for anxiety and insomnia, but they are often abused for their intoxicating effects. When a person has been taking benzodiazepines for several months, it is likely that they will experience withdrawal symptoms if they cut back or stop using them. Benzodiazepine withdrawals can be serious and life-threatening in some instances, beginning 1-2 days after last use and persisting for up to a week or longer, depending on whether the medication is short or long-acting. [1][2][4]
Some of the symptoms of benzodiazepine withdrawal include: [1][4]
- Anxiety and restlessness
- Insomnia
- Irritability and agitation
- Poor memory and coordination
- Muscle tension and aches
- Seizures
Prescription medication withdrawal
There are some prescription medications that are not advisable to stop taking suddenly, or without guidance from a prescriber. These include many commonly prescribed mental health medications, including anti-anxiety, antidepressant, and antipsychotic medications. While the withdrawal from these medications is unlikely to cause medical harm, the symptoms can still be debilitating in nature. In many cases, prescribers will recommend slowly tapering off a medication to prevent or reduce the experience of uncomfortable withdrawal symptoms.
Here are some of the most common withdrawal symptoms associated with common prescription medications: [6][7][8]
- Antipsychotics: Antipsychotic withdrawals can include common symptoms like nausea, vomiting, dizziness, anxiety, and insomnia.
- Antidepressants: Antidepressant withdrawals can involve flu-like symptoms, electric shocks in the head, nausea, vertigo, insomnia, and mood and anxiety disturbances.
- Stimulants: Stimulant withdrawal symptoms can include anxiety, tension, irritability, trouble focusing, fatigue, and depressive symptoms.
Withdrawal and co-occurring mental health disorders
According to research, a high number of individuals struggle with both an addiction and a mental health condition. This is called having a ‘co-occurring’ disorder, and can complicate the process of addiction recovery in a number of ways. People with co-occurring mental health conditions may require more intensive treatment to ensure their stability and safety during detox and withdrawal, and may also need more support during the recovery process.
Withdrawal and suicidal ideation
Some people dealing with substance withdrawal experience severe mental health symptoms, including a worsening of mood and the onset of depression or anxiety. At the extreme, individuals experiencing mental health symptoms during the discomfort of withdrawal may contemplate suicide. Having thoughts of suicide indicates a mental health emergency requiring immediate assessment and treatment by a licensed professional.Â
How severe withdrawal symptoms are managed in treatment
Severe withdrawal symptoms can often be relieved in treatment, which often involves therapy, medication, or a combination of both. The exact prescribed treatment for withdrawals depends on the substance used and the specific symptoms a person is experiencing. More severe withdrawals often need to be treated in inpatient settings to help medically stabilize the person, before discharging them and referring them to an outpatient level of care. [1]
Medication-assisted treatment
Medication-assisted treatment involves the use of prescribed addiction medicines that can help reduce cravings and withdrawals. Medication-assisted treatment is most commonly used for the treatment of opioid use disorder, and typically involves the use of suboxone or methadone. These medications bind to opioid receptors in the brain to reduce the experiencing of uncomfortable cravings and withdrawals.
Medically supervised detox
Medically supervised detox is provided in inpatient settings that provide 24-hour medical monitoring and treatment. This level of care is used to stabilize people experiencing severe withdrawal from drugs like benzodiazepines or alcohol. Medications are typically given to help the patient remain as stable, calm, and comfortable as possible during the detox process. After about a week, most patients are able to be discharged to an outpatient level of care.
Counseling and relapse prevention
Counseling involves talk therapy with a licensed therapist, counselor, or social worker. This type of service can be provided in groups, individual sessions, or family sessions, depending on the type of therapy being provided. Counseling can help people in recovery come up with a relapse prevention plan, learn and practice new coping strategies, and manage difficult emotions that come up during addiction recovery.
Long-term effects of severe withdrawal symptoms (PAWS)
People who have used a substance for long periods of time may experience a protracted withdrawal or post-acute withdrawal syndrome (PAWS). With most withdrawals, the physical symptoms will abate within a week or two, but the psychological effects may linger. The specific symptoms of PAWS depend on the person and their drug use patterns, but can include several weeks or months that involve some of the following symptoms: [5]
- Feeling irritated or agitated
- Feeling anxious or depressed
- Insomnia or trouble sleeping
- Inability to focus
- Lack of energy and feeling fatigued
- Feeling restless
- Having strong drug cravings
Getting help for substance withdrawal symptoms
Substance withdrawal is uncomfortable and difficult, and can involve a mix of physical and psychological symptoms. During withdrawal, most people also experience strong cravings, which, combined with the discomfort of withdrawal symptoms, can significantly increase the risk of relapse. With treatment, it is possible to overcome addiction and establish lasting freedom from drugs or alcohol. Often, treatment options like medications are available that can help reduce cravings and painful symptoms of withdrawal.
