Withdrawal symptoms occur when someone with a substance use disorder attempts to stop taking them. They are often physical in nature, with nausea, muscle aches, and headaches being common; but may also include psychological issues. Most withdrawal symptoms are uncomfortable but manageable, however, there are those that can be dangerous without medical treatment.
- Withdrawal symptoms occur due to the effect substances have on the brain after long-term sustained use when an addiction has formed. Drugs and alcohol affect the neurotransmitters that produce dopamine and serotonin; the brain chemicals that cause happiness, relaxation, and euphoria, and over time the brain stops being able to generate the required amount on its own.
- Withdrawal symptoms vary from drug to drug and can range from uncomfortable symptoms such as nausea, dilated pupils, and cravings to more life-threatening conditions such as rapid heart rate, respiratory issues, and seizures.
- Withdrawal from substances is rarely fatally lethal, but deaths from non-medically supervised withdrawal have been recorded. Substance addictions such as benzodiazepines and alcohol use disorders in particular can be dangerous as seizures are a potential withdrawal symptom.
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What are withdrawal symptoms?
Withdrawal from drugs and alcohol refers to the physical and psychological reaction your body goes through when you stop abusing substances. The symptoms of withdrawal can vary from mild to severe and some substances cause more intense symptoms than others.
Withdrawal symptoms occur due to the effect substances have on the brain after long-term sustained use when an addiction has formed. Drugs and alcohol affect the neurotransmitters that produce dopamine and serotonin; the brain chemicals that cause happiness, relaxation, and euphoria, and over time the brain stops being able to generate the required amount on its own. When you stop taking drugs the brain struggles with the lack of pleasure-giving chemicals which leads to uncomfortable and occasionally dangerous withdrawal symptoms.
What affects the severity of withdrawal symptoms?
How severe withdrawal symptoms are often depends on a variety of factors. These factors include:
- How long a person has abused substance
- The type of substance(s) abused
- The person's history of substance abuse
- Whether there is a co-occurring mental health issue
- The person's physical specifications (symptoms of withdrawal may be more severe in people with a low BMI, for example)
More severe symptoms of withdrawal tend to present themselves after long-term use and in those who have abused harder drugs such as opioids.
Common withdrawal symptoms from drugs
Withdrawal symptoms vary from drug to drug and can range from uncomfortable symptoms such as nausea, dilated pupils, and cravings to more life-threatening conditions such as rapid heart rate, respiratory issues, and seizures.
Opioid withdrawal symptoms
Opioid withdrawal symptoms are some of the most uncomfortable and difficult to get through without giving in to cravings. Many compare the experience to extreme flu-like symptoms.
Withdrawal symptoms from opioids include:
- anxiety
- depression
- insomnia
- nausea
- diarrhea
- muscle cramps and aches
- flu-like symptoms (excessive sweating, shakes, hot and cold flashes)
The intense and unpleasant nature of opioid withdrawal symptoms leads many people trying to quit to relapse. Visit here for more information on opioid withdrawal symptoms and detox.
Alcohol withdrawal symptoms
Severe alcohol withdrawal can not only be extremely uncomfortable, leading many to relapse when attempting to quit but it can also be potentially life-threatening.
Common alcohol withdrawal symptoms include:
- raised blood pressure/pulse
- intense sweating
- insomnia
- delirium tremens (tremors/shakes)
- anxiety/agitation/aggression
- nausea
- vomiting
- headaches
- seizures
Knowing how likely alcohol withdrawal symptoms are to occur in those who stop drinking is not always easy to predict. Those who have a history of polysubstance abuse, co-occurring mental health disorders, and those who have experienced alcohol withdrawal before may be at additional risk of severe symptoms. Read here to learn more about alcohol withdrawal and detox.
Stimulant withdrawal symptoms
Stimulant withdrawal symptoms may differ in severity depending on the type of substance abused and the potency, frequency, and how long it was abused. For example, someone with an Adderall addiction may have milder symptoms than those with a methamphetamine addiction.
Despite the difference in severity, most stimulants present the same withdrawal symptoms, many of which tend to be psychological symptoms:
- depression
- irritability/mood swings
- anxiety
- insomnia
- hypersomnia
- lethargy
- changes in appetite
- slowed reaction speed, problem-solving, and concentration
- cravings
- paranoia
The unpleasant symptoms of stimulant withdrawal can be difficult to overcome without professional treatment or counseling. read our stimulant withdrawal and detox guide for more information.
Benzodiazepine withdrawal symptoms
Benzodiazepines such as alprazolam (Xanax) and triazolam (Halcion) are often abused for their sedative properties and many people who take these drugs for medical purposes become addicted to them. Benzodiazepines can be difficult to quit due to their uncomfortable withdrawal symptoms. Severe benzodiazepine addictions should be treated under medical supervision as some of the withdrawal symptoms may put the user in harm if not monitored properly.
Benzodiazepine withdrawal symptoms include:
- profuse sweating
- increased aggression/agitation
- increased heart rate and blood pressure
- rebound anxiety
- insomnia and restlessness
- nausea/vomiting
- mild hallucinations
- seizures
- suicidal ideation
- palpitations
- cravings
Read our guide to fully understand the seriousness of benzodiazepine withdrawal and how best to approach detox and addiction treatment.
Cannabis withdrawal symptoms
People who abuse cannabis (marijuana) in very small amounts or who haven’t abused the drug for a long period of time will likely only experience mild withdrawal, with physical symptoms such as headaches, mild nausea, and restlessness. Those with a history of chronic marijuana abuse or addiction will likely experience more severe forms of withdrawal. Marijuana withdrawal symptoms can also vary depending on the age and sex of the individual.
Common cannabis withdrawal symptoms include:
- Headaches
- Restlessness and trouble sitting still
- Nausea or GI problems
- Increase or decrease in appetite
- Increased anxiety and irritability
- Fatigue or feeling tired or drained
- Trouble focusing and concentrating
- Increased anxiety, depression, or irritability
More severe withdrawal symptoms that occur in heavy users include muscle pain/cramps, depression, insomnia, and cannabis withdrawal syndrome. Read here to learn more about marijuana withdrawal, detox, and treatment.
How long does withdrawal take?
The exact duration of withdrawal symptoms varies between different substances and the magnitude of dependence or addiction. for most substances, withdrawal symptoms will present themselves within 48 hours and last anywhere from 72 hours to 2 weeks (though in some instances they can last months).
Here is a general time frame of withdrawal symptoms by substance:
Alcohol
Onset: In severe cases, alcohol withdrawal symptoms can present within a few hours of a person's last drink.
Peak: Alcohol withdrawal symptoms often peak between 24 and 72 hours. This is when symptoms are at their most intense and when most people quitting will relapse.
Dissipate: Most alcohol withdrawal symptoms will fade after four days, but they can last over a week.
Benzodiazepines
Onset: initial symptoms such as anxiety and sweating may present within 4 days of last use.
Peak: The most severe symptoms can begin anywhere in the first two weeks of cessation and will often last for several days or a week.
Dissipate: Benzo withdrawal symptoms can take a long time to wear off fully and may lead to post-acute withdrawal symptoms which can last years.
Stimulants
Onset: Due to their rapid onset of effects on the brain, stimulant withdrawal can start within a couple of hours of last use in some cases.
Peak: Stimulant withdrawal normally peaks between 2 to 4 days after the last use and this is when sufferers are most at risk of relapse due to intense cravings.
Dissipate: Stimulant withdrawals also fade quickly, meaning most people will be over the worst of them in less than a week.
Opioids
Onset: Withdrawal from short-acting opioids like heroin will often start to show symptoms within 24 hours while long-acting opioids like methadone can take up to 4 days to present.
Peak: the worst withdrawal symptoms for both short and long-acting opioids will often appear between 4 and 7 days.
Dissipate: Opioid withdrawal will often wear off after 10 days but some psychological symptoms may last for a couple of weeks.
What is post-acute withdrawal syndrome (PAWS)?
Post-acute withdrawal syndrome (PAWS) refers to the phenomenon of withdrawal symptoms presenting themselves and/or persisting for long after the initial withdrawal timeline. The term was first used to describe people who experienced prolonged withdrawal after discontinuing benzodiazepine therapy but is now used to describe protracted withdrawal symptoms in all forms of addiction recovery (often referred to as post-acute withdrawal symptoms or protracted withdrawal).
While the symptoms of protracted withdrawal are nuanced they commonly include a feeling of being unable to find joy or happiness in everyday activities that used to inspire these feelings before substance abuse. This is due to the effects substances have on the brain on a molecular, neurocircuitry, and cellular level. After a period of extended substance abuse, these elements of the brain change, and the natural reaction to positive stimuli without substances becomes dulled. This state, referred to as anhedonia, can persist long into recovery from substance abuse and may require therapy and counseling to overcome.
Can withdrawal be harmful?
Withdrawal from substances is rarely fatally lethal, but deaths from non-medically supervised withdrawal have been recorded. Substance addictions such as benzodiazepines and alcohol use disorders in particular can be dangerous as seizures are a potential withdrawal symptom.
Alcohol withdrawal also includes delirium tremens, a condition that is characterized by uncontrollable shakes and tremors which if left untreated can develop into severe seizures.[2] It is estimated that only 5% of people experiencing alcohol withdrawal will develop delirium tremens, though 15% of people who get the symptoms die without treatment.[2]
Another potentially life-threatening risk of untreated withdrawal is relapse. This is particularly true of opioid use disorders, as sustained abstinence can decrease the user's tolerance to the drug. If they relapse there is a much higher chance of fatal overdose as their body will not be able to handle previously manageable levels of opioids. The risk of relapse and experiencing uncomfortable withdrawal symptoms is significantly reduced with a medically supervised detox, sticking to an addiction treatment program, and lifelong recovery management.
Managing withdrawal with detox and rehab
Some withdrawal symptoms may be possible to overcome without treatment; such as for those with mild substance use disorders or low physical dependence. However, many are so uncomfortable and/or harmful that they need to be monitored by doctors and addiction specialists.
Seeking professional support through an inpatient or outpatient rehab facility greatly increases the chances of a full recovery as well as mitigating severe withdrawal symptoms.
Rehab treatment for substance use disorders often starts with drug detoxification, whereby patients go through substance cessation and withdrawal under careful medical supervision and additional medication where necessary.
Detox can be draining but is easier with dedicated treatment and once patients are physically able they can begin their treatment program. If you or someone you care about is suffering from a substance use disorder and can't get passed the withdrawal process then speak to an addiction specialist today and seek help.
