When a person develops a dependence to a particular substance, such as drugs or alcohol, they will experience symptom of withdrawal should they reduce or stop using alcohol or drugs.1 The symptoms and their severity depend on the type of substance used and can vary widely, from a mild headache to fatal seizures. Great care should be taken with withdrawal because, based on the drug, it may be dangerous—but you will get through it and begin your journey toward recovery.1
Withdrawal is characterized by various physiological symptoms following discontinuation or reduction of extended use of alcohol or drugs.2 The time to symptom onset, duration, and intensity of withdrawal symptoms are highly variable and depend on many factors: the substances used, and the frequency, amount and duration of use.2,3
Withdrawal symptoms are typically uncomfortable and some may be quite distressing, and in cases of severe dependency to alcohol or benzodiazepines, for example, severe withdrawal symptoms like seizures may even be life-threatening. In some cases, medication can help to make withdrawal more comfortable and safer.1 The avoidance of even mild to moderate withdrawal symptoms often motivate a person to return to using drugs or alcohol.
Drug or alcohol withdrawal symptoms are highly variable, and in general, the symptoms of withdrawal are usually opposite of the substance’s pharmacological effects. In general, the symptoms that characterize withdrawal are similar in each given class—for example, as opioids, withdrawal symptoms experienced when discontinuing hydrocodone and oxycodone will be similar but will likely differ substantially to withdrawal symptoms experienced after prolonged use of a stimulant like cocaine. For any withdrawal syndrome, however, the duration, intensity and time to onset will vary depending on the particular drug, duration used and the degree to which the body and brain has adapted to the substance.17
Alcohol withdrawal symptoms range from mild and uncomfortable to severe and potentially lethal. Symptoms may start as soon as 6 hours to as late as 24 hours after the last drink and typically last 4 to 5 days. Withdrawal symptoms may come and go during this time and may vary in intensity.9,10
The risk of experiencing severe symptoms such as life-threatening seizures is higher for individuals who have previously experienced moderate to severe alcohol withdrawal symptoms.9
Mild to moderate symptoms of acute alcohol withdrawal may include:9-12
Complicated or severe alcohol withdrawal symptoms need prompt medical attention as they can lead to fatal consequences. These include:
Individuals experiencing more severe symptoms or who have previously experienced complicated alcohol withdrawal usually will undergo alcohol detox in a supervised medical setting. When the risks of withdrawal complications are significantly high—such as with someone who experienced seizures during a previous alcohol withdrawal experience inpatient medical withdrawal management is necessary.9
Withdrawal symptoms from benzodiazepines and other sedative-hypnotic drugs resemble those of alcohol withdrawal. Like alcohol withdrawal, symptoms may vary considerably in time of onset or intensity as withdrawal progresses.18
Withdrawal from short-acting benzodiazepines (e.g., Ativan, Xanax, Restoril) typically begin within 6-8 hours after the last dose and peak around the second day and then begin to improve on the fourth or fifth day. Withdrawal effects as a result of taking long-acting benzodiazepines (e.g., Valium, Librium) may not develop for more than a week. They tend to peak during the second week, and improve during the fourth or fifth week.14
In general, withdrawal symptoms may include:3,13
Although not likely to be as life-threatening as those associated with alcohol withdrawal, medical complications such as seizures and delirium are possible with severe benzodiazepine withdrawal. Medical supervision during detox can help to keep people safe and comfortable, and inpatient management may be required for extreme cases of benzodiazepine withdrawal.9
Acute opioid withdrawal may result in some intensely uncomfortable symptoms when attempts are made to quit or cut back on continued opioid use.9 People at risk of severe symptoms may benefit from a supervised medical detox, performed with the guidance and support of a medical professional.
The timeline of opioid withdrawal may vary depending on the individual and the types of drugs taken.9,14,15
Commonly experienced opioid withdrawal symptoms may include:16,17
Stimulant withdrawal involves withdrawing from drugs including amphetamines, cocaine, methamphetamines, or medications including such as methylphenidate or Ritalin. While stimulant withdrawal may be unpleasant, it is not usually life-threatening.
Symptoms may begin as soon as drug usage has stopped, and some symptoms may last up to 2 weeks.18
Symptoms of stimulant withdrawal may include:18
Those going through stimulant withdrawal typically do not experience life-threatening symptoms, and medication management of the withdrawal is usually not necessary. Still, there is a possibility of an increased emotional risk for those going through withdrawal. One possibly symptom of stimulant withdrawal is intense depression, so this symptom should be monitored in order to avoid risks concerning suicidal thoughts or attempts.18
In addition to the symptoms associated with stopping use of a specific drug or of alcohol, other important factors that may influence the seriousness, onset, and length of the withdrawal syndrome include:5,8
Medically supervised detox may be a good first step for a person looking to free themselves from a drug or alcohol addiction. Medical supervision and support can help provide a sense of safety and comfort, and also may also help prevent relapse.
In certain cases, medical detox is highly encouraged in an effort to minimize the risk of potentially life-threatening severe withdrawal symptoms like seizures, marked agitation, and delirium, such as that which may occur during withdrawal from alcohol and benzodiazepines.9 Potentially severe, relapse-prompting withdrawal is also a significant risk for people with pronounced opioid dependence.9
Medically managed detox is likely to be strongly encouraged for people who have a history of severe or complicated withdrawal, have had multiple withdrawal experiences, or are at risk of severe alcohol, sedative-hypnotic, and/or opioid withdrawal.9