Planning for withdrawal and detox naturally provokes anxiety if you or a loved one is preparing to quit drinking or using drugs. One of the questions that often arises is whether you can die during this process. The short answer: there’s a small risk with alcohol withdrawal or Benzodiazepines, typically none with other drugs. But the bigger risk is relapsing and beginning to use again. In this article, I explain what’s involved.
Understanding the Science Behind Withdrawal
Addiction and withdrawal have a lot to do with brain chemistry. The brain is wired to reward us when we do something pleasurable, such as eating or working out, which releases the neurotransmitter dopamine. Not only does it feel good, but our brain’s reward system also learns to repeat these behaviors.
And so do drugs or alcohol. Large surges of dopamine associated with drug use teach the brain to seek drugs at the expense of other, healthier goals and activities. Using alcohol or psychoactive substances brings about adaptations in the brain in the presence of those substances. Neurotransmitters which carry brain signals, and the receptors that receive them, change. Increasing amounts of stimulating neurochemicals such as noradrenaline are produced.
When alcohol or drug use is abruptly lessened or stopped, these adaptations suddenly diminish or end as the overstimulated brain is unable to rapidly readjust its chemistry. It takes time while brain systems learn to adjust their chemistry without the substance’s presence. Withdrawal symptoms then begin and the effects someone experiences are typically the opposite of those brought about by the substance.
Differences Between Drug & Alcohol Withdrawal
Withdrawal from drugs varies with the substance and duration of use. For example:
- Benzodiazepine (Benzos) withdrawal can fluctuate widely and should only be done under medical supervision. Withdrawal can bring about seizures with no prior warning as well as kidney failure.
- Opioid withdrawal is not life threatening but can be extremely uncomfortable.
Typical drug withdrawal symptoms include:
| Physical | Psychological |
| Sweating | Anxiety |
| Shaky Hands | Fear |
| Vomiting | Shame |
| Agitation | Mood swings |
| Headaches | Difficulty concentrating |
| Insomnia | Depression |
| Disorientation | |
| Dissociation |
Heavy drinkers may experience Acute Withdrawal (AW) syndrome due to chemical imbalances in the brain resulting in excessive neuronal activity. In a small percentage of cases AW can be dangerous and even life-threatening if left untreated during this period of physical, emotional and psychological adjustment. Attempting to stop cold turkey at home can be medically risky.
The most severe signs of alcohol withdrawal are:
- Spikes in heart rate and blood pressure
- Agitation
- Irritability
- Sweating
- Nausea
- Anxiety
- Tremors (“DTs: Delirium Tremens”)
- Hallucinations
- Seizures
Medically supervised detoxification (detox) involves supportive counseling together with medications that help counteract the early symptoms of acute withdrawal.
Risks of Relapsing and/or Overdosing
Benzodiazepines and alcohol are both central nervous system depressants. Stopping suddenly leads to nervous system excitation. Detox under medical supervision is designed to diminish the effects of acute withdrawal and the risk of complications such as seizures.
Withdrawal from most other drugs is not medically dangerous. However acute withdrawal can be extremely uncomfortable and trigger extreme anxiety or depression.
The danger is relapsing to avoid the unpleasantness of withdrawal and then risk subsequent overdose. During withdrawal tolerance decreases and the body is no longer accustomed to the drug and certainly not in previous doses. A tolerable dose is no longer tolerable.
How Long Does Withdrawal Last?
There are two phases to withdrawal:
Acute withdrawal: Medical withdrawal symptoms that require immediate medical attention to help keep you comfortable during this initial detox phase. Many substance users believe this phase is the main effort in getting clean but this is a fantasy.
Post-acute withdrawal: Dealing with the psychological symptoms requiring continuous therapeutic treatment to safely manage. This much longer phase of maintaining abstinence, including relapses, which are common, is where most of the work lies.
Patients, their families and staff frequently have a belief that detoxification is the key issue, whereas in fact this is a small part of the much longer road to abstinence
Detox varies with each substance. Acute withdrawal normally takes between a few days to a few weeks to complete, depending on the:
- Substance
- Severity of dependence
- Support available to the user
In addition to treatment with medicines, therapy is essential to improve outcomes and prevent relapses.
The general guidance for the acute phase of these substances is:
| Alcohol | Starts 6 hours to 2 days after last drink, peaking over 24-48 hours for up to 3-7 days. Risk of seizures from 6-48 hours after last drink. DTs in about 5% of people can start 2-3 days after last binge, lasting 2-3 days or more |
| Benzos | Starts 1 to 4 days after the last dose peaking around 14 days. Protracted withdrawal with rebound anxiety lasting months or years |
| Cocaine | Starts 90 minutes after last does for up to 4-7 days |
| Methamphetamine | Starts within 24 hours of last dose, peaking in up to 7-10 days and subsiding in to 2-4 weeks |
| Amphetamines | Starts 10-12 hours after last does, lasting 2-4 weeks or more |
| Opioids (Heroin and Fentanyl) | Starts 6 hours to 2 days after last dose, for up to 14 days |
| Methadone | A lengthy process of approximately 12 weeks. There can be less craving and withdrawal discomfort with slower tapering. |
Medical Detox Help Is Available
Participating in a medical detox program is the safest and most comfortable way to cleanse from alcohol or drug abuse. After detoxing, you may enter a residential treatment center such as we have at The Encino Recovery & Detox Center. Trained staff are equipped to offer clinical care. They will provide the support, guidance and interventions necessary for you to reach your treatment goals. Participating in residential care greatly enhances your success rate at avoiding relapses.
Sources
Drugs, Brains, and Behavior: The Science of Addiction: Treatment and Recovery. 2020. National Institute on Drug Abuse (NIDA).
What Is Withdrawal? Psychology Today.
