Drug use and misuse remain an issue in every nation, with an estimated 5.4 percent of the global population using drugs in 2018. The United States, in particular, has a long and interesting history with drugs, going so far as to wage a “War on Drugs.” But despite its tough drug policy and harsh regulations, the United States has a high lifetime illicit drug use. According to the National Survey on Drug Use and Health (NSDUH), 13 percent of people in the United States aged 12 and older used illegal drugs in 2019. One of the consequences of drug abuse and addiction is the manifestation of withdrawal symptoms.
Drug withdrawal is a series of symptoms that the body goes through when individuals avoid or minimize their daily use of drugs and alcohol. Abrupt cessation of drugs with a high potential for addiction or dramatic reduction of dosage can result in a wide range of withdrawal symptoms that can be physical and psychological. Depending on the type of substance and your biological make-up, the severity and duration of these withdrawal symptoms can vary greatly. Withdrawal can be uncomfortable and, in some situations, harmful. Hence individuals who wish to stop using addictive substances must consult a doctor or addiction specialist before discontinuing or minimizing their drug use.
What Causes Drug Withdrawal?
The body and brain work together to maintain homeostasis or equilibrium. Drugs and alcohol affect the reward system in the brain, causing chemicals to be released. This induces a chemical imbalance in the body, forcing it to adapt to these changes by altering the natural production of certain neurotransmitters, among other things.
When someone takes a drug regularly for an extended period of time, their body may develop a tolerance and physical dependence on it. Tolerance is characterized by the need for higher doses of the drug to achieve the same effects as before. Physical dependence refers to the body’s need for the substance in order to function and prevent drug withdrawal symptoms.
Abrupt cessation or drastic decrease in substances with a high potential for dependence and addiction can throw the body off balance. This occurrence is more common in people with substance use disorders (SUDs). Symptoms that manifest during this stage can be mental and physical and vary in intensity depending on the type of drug used.
Drugs that cause withdrawals include:
- Cannabis
- Alcohol
- Antidepressants
- Barbiturates
- Hallucinogens
- Opioids
- Stimulants
- Inhalants
Prolong use of these addictive substances can cause physical and psychological dependence that can only be treated through comprehensive addiction treatment programs. Due to the unpredictable nature of drug withdrawal syndrome and its capacity to cause fatal consequences, individuals who abuse drugs are highly advised against quitting on their own.
Drug Withdrawal Timeline
The length of withdrawal is determined by the drug used and the degree of dependency on the substance. Depending on various factors and individual variations, it can take days, weeks, or even months to resolve and overcome all withdrawal symptoms.
Here is a general overview of various drugs and their typical duration of withdrawals:
Alcohol: Alcohol withdrawal symptoms appear several hours after the last drink and peak between 24 and 48 hours. The risk of seizures may remain high from 12 to 48 hours after the last drink. The potential risk of delirium tremens (DTs) remains high for up to three days after the last drink.
Short-acting opioids: Symptoms from short-acting opioids typically begin eight to 24 hours after the last dose and last for up to four to 10 days on average.
Long-acting opioids: Symptoms can develop two to four days after the last dose and fade after 10 days.
Benzodiazepines: Benzodiazepine withdrawal symptoms begin within four days after the last dose and peak within the first two weeks. In some cases, signs of withdrawal can last for months or years without treatment.
Antidepressant medications: In most cases, symptoms are mild for the first three days and may worsen on the fourth or fifth day before subsiding. Symptoms may last for up to three weeks.
Stimulants: Stimulants include prescription medications including Ritalin and Adderall, as well as diet pills, caffeine, and illegal substances such as cocaine and methamphetamine. Stimulant withdrawal symptoms appear 24 hours after the last dose and can last for two to three weeks.
Symptoms of Withdrawal
Not all substances are created equal, and not all people are the same. Different substances have different effects on people. Many variables determine the extent and severity of withdrawal symptoms. These factors include:
- The dose of drugs used
- Polydrug use
- Class of drugs used
- Duration of drug use
- Pre-existing mental or physical health conditions
- A person’s overall health
One of the most crucial factors to consider is the type of drug a person uses. Symptoms of withdrawal greatly depend upon the initial effects of the drug. For example, opioid medications are powerful pain relievers for chronic pain management, but opioid withdrawal symptoms involve hypersensitivity to pain. Benzodiazepines are a highly efficient form of anti-anxiety medications. When people stop taking benzodiazepines, they sometimes experience extreme anxiety and restlessness. These symptoms are referred to as rebound effects.
Another factor to consider is the severity of withdrawals. Some people only experience mild discomfort during the withdrawal period, while others are traumatized by severe withdrawal. The wide range of unpleasant symptoms commonly associated with this condition include:
- Congestion
- Fatigue
- Irritability
- Changes in appetite
- Changes in mood
- Runny nose
- Sweating
- Shakiness
- Sleeping difficulties
- Muscle cramps and pain
- Nausea
- Restlessness
- Tremors
- Vomiting
- Abdominal cramping
More intense withdrawal symptoms such as seizures, hallucinations, delirium may also occur in some instances. In general, signs of withdrawal can be categorized as:
- Physical symptoms
- Behavioral symptoms
- Gastrointestinal
- Sleep Problems
- Psychological symptoms
- Cognition
Dangers of Drug Withdrawal
Sometimes symptoms are more than just minor inconveniences; they can be fatal. When a person’s body becomes dependent on drugs, the abrupt disruption can be more harmful than expected.
Opiates, heroin, and methamphetamine are powerful drugs that cause some of the more serious life-threatening symptoms. During withdrawal, extreme delusions and hallucinations can cause an individual to harm themselves or others. Some patients can also have withdrawal-induced seizures. And as such, certain withdrawals can be extremely complicated to manage without professional medical help.
The intensity of symptoms increases when individuals use massive doses of drugs for an extended period of time. When someone who has been using heroin for a few years decides to quit, they are more likely to have severe symptoms.
Another danger associated with withdrawal is drug overdose, which can result in fatal consequences. Overdoses can occur when a person takes higher doses than usual, combines other drugs to enhance their effects, or takes their usual dose after a duration of abstinence. According to the Centers for Disease Control and Prevention (CDC), 70,630 people died due to a drug overdose in the United States in 2019.
How to Manage Drug Withdrawal?
The management of the withdrawal process involves receiving support, care, therapy, and medications to alleviate symptoms and prevent complications. Depending on the clinical scenario, the following laboratory tests are recommended in cases of potential withdrawal:
- CBC
- Comprehensive metabolic panel
- Urinalysis
- Serum glucose
- Arterial blood gas analysis
- Prothrombin time
- Toxicology screening
- Cardiac biomarker measurements
Some substances enable people to avoid using them immediately and treat their symptoms on their own. For example, one can quit caffeine independently by avoiding their morning coffee and dealing with caffeine withdrawal symptoms until they fully subside. However, abrupt cessation of drugs such as benzodiazepines or alcohol can be harmful, so contact your doctor for medical care before formulating a detox strategy.
Detoxification or medically-assisted detox allows the body to rid itself of drugs. Detox is used to safely manage withdrawal symptoms after someone ceases taking alcohol or drugs. Each person’s detox experience is unique. The type of drug used and how long it was used affect the duration and intensity of detox.
Medically assisted detox programs utilize medications to minimize the risks of withdrawals. Some medications used to treat symptoms during detox include:
- Buprenex (buprenorphine)
- Valium (diazepam)
- Ativan (lorazepam)
- Methadone
- Catapres (clonidine)
- Librium (chlordiazepoxide)
Certain medications can help alleviate specific symptoms. Anti-anxiety medications, antipsychotics, anticonvulsants, among other medications, are used to relieve nausea or sleep disorders.
Other than the use of medications, patients can also utilize coping strategies and therapeutic options to manage withdrawals, including:
Healthy diet: Make an effort to consume healthy, well-balanced meals. Eating sugary, fried, or fatty foods can aggravate your symptoms.
Exercise: Try to engage in physical exercise every day. Stretching, cycling, swimming, and other exercises can make you feel better.
Sleep well: Although withdrawal may often cause sleeping problems, try to get enough rest. Work on developing a daily sleep routine and healthy sleeping habits.
Stay hydrated: It’s critical to remain hydrated throughout the process, especially if you’re having flu-like symptoms like nausea and vomiting.
Stress management: Activities like yoga and meditation can also assist you in dealing with your symptoms.
If you wish to stop using addictive substances, reach out to a physician or addiction specialist for support and guidance. Many addiction treatment facilities all across the U.S specialize in helping individuals achieve sobriety and maintain prolonged recovery.