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Drug Detox Withdrawal: Symptoms, Causes and Treatment

This article was reviewed for medical accuracy by Dr. Takeesha Roland-Jenkins.

Managing the symptoms of withdrawal is an important aspect of recovery, and although it may seem counterintuitive, decreasing your use of drugs or alcohol too quickly or quitting cold turkey can cause unintended consequences, including drug detox withdrawal symptoms and even death [1]. For this reason, we’ve provided a guide on the withdrawal stage, as well as its symptoms, causes, and treatment.

Drug Detox Withdrawal 

Many substances cause withdrawal symptoms once you begin to lower your use or start the detox process. In particular, these substances include [2]:

Alcohol Withdrawal 

Alcohol is known as a “depressant” or a “downer” because it has a depressive effect on your body when you consume it [2]. When it enters your body, your brain functions become impaired and nerve signals change. Moreover, when you consistently consume alcohol for a long period of time, your central nervous system begins to adjust  to it, and your body works harder to keep your brain in an “awake state” in order to maintain communication between your nerves. Once you stop consuming alcohol, your brain remains in this adjusted state, leading to withdrawal symptoms. 

Symptoms can include [3]: 

  • anxiety
  • shaky hands
  • headache
  • nausea and vomiting
  • insomnia
  • sweating
  • seizures
  • hallucinations alongside confusion, racing heart, high blood pressure, fever, and heavy sweating

Ordinarily, alcohol withdrawal comes in three stages. The first stage, often the least severe, appears about eight hours after you stop drinking (although it may appear after only a few hours in some people) and includes symptoms such as headaches, anxiety, stomach pains and nausea. The second stage usually manifests after one day but can take up to three days. Symptoms include increased blood pressure, body temperature, and respiration, irregular heart rate, mental confusion, sweating, irritability, and heightened mood disturbances [3]. Finally, the most severe stage, stage three, can cause you to experience hallucinations, fever, and seizures [3]. In general, your symptoms will subside within a week, although the actual duration may vary.

In order to determine if you suffer from alcohol withdrawal, your doctor will evaluate the longevity of your alcohol use, amount consumed, and reasons for quitting. Alcohol withdrawal can have deadly consequences, so it’s important to seek help if your symptoms are severe. However, you can overcome your withdrawal period with a supportive environment and healthy lifestyle choices.

Benzodiazepine Withdrawal 

Benzodiazepines, also referred to as “benzos”, are prescription medications used to treat anxiety disorders, panic disorders, and insomnia. However, because these drugs are known to cause dependence, doctors often only prescribe them for short-term use [4]. The benzodiazepine detoxification process can be very strenuous, leading to severe symptoms such as [5]:

  • agitation and irritability
  • panic and anxiety
  • insomnia and sleep difficulties
  • tremors
  • sweating
  • headaches
  • poor concentration
  • sensory distortions
  • nausea
  • heart palpitations
  • high blood pressure
  • muscle pain and stiffness
  • depression

When you stop using these medications, seek out a medical professional right away. Withdrawal symptoms often occur 24-72 hours of stopping use, and symptoms can last for several weeks or months. However, doctors can help manage the side effects by slowly reducing your dosage, thereby giving your body time to adjust to lower and lower doses. Sometimes, they may even prescribe a slow release benzodiazepine to help reduce symptoms as well [6]. 

Stimulant Withdrawals 

Stimulants affect your body in the opposite way as depressants do. They create a state of heightened focus, alertness, and energy, as well as an increase in heart rate, breathing and blood pressure [7].

Stimulants include [7]:

  • cocaine
  • amphetamines (used to treat attention deficit hyperactivity disorder, or ADHD)
  • methamphetamines

Stimulant withdrawal causes symptoms that are the opposite of the stimulant’s effects. Symptoms include [8, 9]:

  • depression, lethargy, and low energy
  • anxiousness and agitation
  • sadness
  • intense cravings for the stimulant
  • exhaustion, both physical and mental
  • insomnia 

Although these symptoms aren’t life-threatening, they can still cause extreme discomfort. Most physical symptoms begin within a day of stopping use, while longer-lasting symptoms, such as depression, can last up to five months.

The amount of time your symptoms last depends on the stimulant you have used. For example, depression after cocaine use can fade after a few hours [8]. However, for someone using methamphetamine, these symptoms can last much longer [9]. Furthermore, one of the greatest risks of stimulant withdrawal is suicidal ideation [10]. Because substance abuse and mental health go hand-in-hand, seeking out a doctor or therapist can be helpful in combatting this risk and getting through the process of detox.    

Nicotine and Marijuana Withdrawal 

Nicotine withdrawal, although extremely uncomfortable, poses no significant health danger. Symptoms include [11]:

  • cigarette cravings
  • feeling symptoms of depression
  • sleep difficulties 
  • irritability, grouchiness or “feeling on edge”
  • trouble concentrating
  • restlessness
  • slowed heart rate
  • weight gain from hunger return
  • shakiness 

As long as you remain smoke-free, your symptoms will continue to fade. Furthermore, the long-term damage to your heart or lungs may begin to heal. 

Even though marijuana is generally considered to be non-addictive, some studies have shown that a mental (as opposed to physical) addiction is possible [8]. Similarly to nicotine withdrawal, detox symptoms are not that severe and health risk is minimal. 

Opioid Withdrawal

Ordinarily, opioids are used to treat pain, although some opioids can be used to treat coughing and diarrhea. Opioids include [12]: 

  • codeine
  • heroin
  • hydrocodone (Vicodin)
  • hydromorphone (Dilaudid)
  • methadone
  • meperidine (Demerol)
  • morphine
  • oxycodone (Percocet or Oxycontin)

Withdrawals from opioids can be both severe and dangerous. Moreover, symptoms vary from person to person, so it’s best not to detox at home. Instead, look for a facility that provides medical detox under the supervision of a doctor and therapist.

Symptoms of opioid withdrawal include:

Early symptoms

  • altered perception of temperature (hot/cold flashes, hot/cold sweats)
  • agitation, irritability
  • anxiety
  • dehydration
  • fatigue
  • low energy
  • muscle aches
  • mental fog/confusion/lack of motivation
  • increased tearing
  • insomnia
  • restless legs
  • runny nose
  • sweating
  • yawning
  • skin-crawling
  • change in libido (abnormally high or low)

Later symptoms

  • abdominal cramps
  • diarrhea
  • dilated pupils
  • goosebumps
  • nausea
  • sneezing
  • vomiting

Treatment Programs 

Fortunately, if you suffer from withdrawal symptoms, many treatment centers offer programs that can help you feel better. In fact, there are five levels of care for substance abuse treatment [13]. 

Early intervention precedes treatment. For instance, some people are at risk of developing a substance use disorder but don’t exhibit any criteria to justify rehab. During the early intervention stage, the focus is placed on identifying your risk factors and providing education about drug and alcohol misuse. Through weekly talk therapy or counseling, the goal is to assist you in making behavioral changes to avoid addiction. 

The Levels of Care

  • 0.5: Early intervention
  • 1: Outpatient Services
  • 2: Intensive outpatient/partial hospitalization
  • 3: Residential/Inpatient services
  • 4: Medically managed intensive inpatient services

The first level, outpatient services, provides patients with the opportunity to maintain their daily lives, but with medical assistance from doctors and treatment professional (e.g., counselors, therapists, case managers) for treatment and follow up. If necessary, you will be prescribed medication following the initial intake and assessment. For example, methadone and suboxone clinics count as examples of outpatient services [14-16]. Although some of these programs include individual and group counseling, that differs from site to site. 

Level two accommodates intensive outpatient treatment and partial hospitalization. During intensive outpatient treatment,  you receive nine or more hours of treatment per week, including individual and group counseling, therapy, and medical supervision [13]. Partial hospitalization programs are the most intensive types of outpatient programs. Generally, these programs consist of a minimum of 20 hours of treatment per week. The treatment modalities may include family therapy, yoga, acupuncture, or art therapy. Patients also have access to 24-hour crisis services or the option to live on-site as well.

The first level of residential treatment, level three, involves living at a center for an amount of time dictated by your doctor (and insurance company). This treatment level is typically for patients who are unable to function fully in their daily lives and need additional support during recovery. Finally, the highest level, level 4, includes 24-hour treatment and ongoing clinical monitoring to prevent relapse and reteach skills that will allow patients to thrive after treatment.

If you or someone you know is experiencing alcohol or drug detox withdrawal symptoms, it’s important to receive treatment from the appropriate level of care. Better yet, before dependency sets in, look for early intervention services to prevent addiction when there is a risk. 

We can help you

At The Blackberry Center, you will have the opportunity to begin the journey to lifelong recovery in our state-of-the-art facilities.

If you or one of your loved ones are struggling with addiction, we can help. We use a personalized approach to addiction treatment. Our focus is on treating the disease, not the symptoms. We put our patients first every step of the way.

Our substance abuse-only treatment programs include detox, residential and PHP.  Our on-site rehab programs focus on a comprehensive recovery approach. They address your physical, mental and spiritual needs for optimal wellness.

Your needs are unique. We treat you as such.

Reach Out For Help Today

We welcome you to The Blackberry Center. From support groups to individual therapy treatment options, we are here to fight the addiction battle with you.

Reach out to us online today. You can also call us at 407-449-8410.

References

  1. Drake S, Larney S, Farrell M. Yes, people can die from opiate withdrawal. Addiction. 2017;112(2):199-200.
  2. Gudin JA, Mogali S, Jones JD, Comer SD. Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgrad Med. 2013;125(4):115-30.
  3. Trevisan LA, Boutros N, Petrakis IL, Krystal JH. Complications of alcohol withdrawal: pathophysiological insights. Alcohol Health Res World. 1998;22(1):61-6.
  4. Jann M, Kennedy WK, Lopez G. Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. J Pharm Pract. 2014;27(1):5-16.
  5. Pétursson H. The benzodiazepine withdrawal syndrome. Addiction. 1994;89(11):1455-9.
  6. Ait-Daoud N, Hamby AS, Sharma S, Blevins D. A Review of Alprazolam Use, Misuse, and Withdrawal. J Addict Med. 2018;12(1):4-10.
  7. McCabe SE, West BT, Schepis TS, Teter CJ. Simultaneous co-ingestion of prescription stimulants, alcohol and other drugs: a multi-cohort national study of US adolescents. Hum Psychopharmacol. 2014; Hum Psychopharmacol. 2015;30(1):42-51.
  8. Schierenbeck T, Riemann D, Berger M, Hornyak M. Effect of illicit recreational drugs upon sleep: cocaine, ecstasy and marijuana. Sleep Med Rev. 2008;12(5):381-9.
  9. Comer SD, Hart CL, Ward AS, et al. Effects of repeated oral methamphetamine administration in humans. Psychopharmacology (Berl). 2001;155:397-404.
  10. Brick J. Handbook of the medical consequences of alcohol and drug abuse. New York, NY: The Haworth Press; 2004.
  11. Zhang L, Samet J, Caffo B, Bankman I, Punjabi NM. Power spectral analysis of EEG activity during sleep in cigarette smokers. Chest. 2008;133(2):427-32.
  12. Kosten TR, et al. The neurobiology of opioid dependence: implications for treatment. Science & Practice Perspectives. 2002; 1:13-20.
  13. Proctor SL, Herschman PL. The continuing care model of substance use treatment: what works, and when is “enough,” “enough?”. Psychiatry J. 2014;2014:692423.
  14. Brigham GS, Amass L, Winhusen T, et al. (2007) Using buprenorphine short-term taper to facilitate early treatment engagement. J Subst Abuse Treat 32: 349-356.
  15. Collins ED, Horton T, Reinke K, et al. (2007) Using buprenorphine to facilitate entry into residential therapeutic community rehabilitation. J Subst Abuse Treat 32: 167-175.
  16. Bell JR, Butler B, Lawrance A, et al. (2009) Comparing overdose mortality associated with methadone and buprenorphine treatment. Drug Alcohol Depend 104: 73-77.

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