You may be familiar with the terms “detox” or “withdrawal” from school, the media or conversations with loved ones or friends. Detox is the process of removing all drugs or alcohol from the body.
The withdrawal process is extremely challenging for people suffering from substance abuse and alcohol abuse disorder. Detox (detoxification) varies with the individual and with the substance being withdrawn. In this article, I look at the process and timelines for withdrawal from various substances.
What Does The Detox Process Look Like?
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. May 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.
There are typically three steps in the detox process:
Evaluation: A comprehensive assessment to understand your current and past physical and psychological history. This step also includes testing for the presence of addictive substances.
Stabilization: This is the core of acute withdrawal detox. The focus is to manage acute intoxication of alcohol or drug withdrawal in a safe, supervised in-patient detox setting. Medication-Assisted Treatment may be used during this phase to manage physical withdrawal symptoms.
Preparation for Long-Term Recovery: In the post-acute phase, your treatment team will help you develop a personalized care plan. The goal is to support and encourage continued treatment for successful long-term recovery outcomes.
In the worst-case situation, a user attempts to detox on their own and either experiences health complications or relapses shortly, beginning the whole cycle again. The recommended way to break this cycle is to enter into supportive residential treatment.
Symptoms of Withdrawal
During detox, it is common to experience symptoms of drug withdrawal. These can cause intense pain and discomfort. They vary with the substance but generally include:
| Physical Symptoms | Psychological Symptoms |
|---|---|
| Sweating | Anxiety |
| Shaky Hands | Fear |
| Vomiting | Shame |
| Headaches | Mood swings |
| Insomnia | Difficulty concentrating |
| Seizures | Depression |
| Disorientation | |
| Dissociation | |
| Hallucinations |
Detox Timeline
The length of detox is different for each individual. Generally, it takes from a few days to a few weeks or more. There are many factors that can affect the length of withdrawal including:
- Substance of abuse
- Duration of use
- Route of administration (snorting, smoking, injecting, etc.)
- The severity of the addiction
- Family history of addiction
- Level of willingness to change
- Current level of family/social support
- Presence of co-occurring medical or psychiatric conditions
- Risk of developing severe withdrawal symptoms
- History of previous relapses
- History of previous withdrawals
Length of Detox by Substance
The general guidance for the acute phase of these substances is:
- Alcohol: 3-7 days
- Benzos: 14 days
- Cocaine: 4-7 days
- Methadone: A lengthy process of approximately 12 weeks. There can be less craving and withdrawal discomfort with slower tapering.
- Opioids (Heroin and Fentanyl): 14 days
Detox Withdrawal Timelines For Common Substances
Alcohol Withdrawal Symptom Timeline
The symptoms of alcohol withdrawal vary greatly depending on the individual. While this is most often influenced by the frequency and duration of drinking, sometimes other factors are at play too. These may include brain chemistry, co-existing health or substance abuse problems.
6-8 Hours After Drinking
- Headaches
- Anxiety
- Vomiting
- Mood Swings
- Irregular Heartbeat
- Irritability
12-48 Hours After Drinking
- Increased blood pressure
- Fever
- Confusion
- Heart Palpitations
48-72 Hours After Drinking
This period of non-drinking can become extremely severe for some people, especially if they develop Delirium Tremens (DTs). DTs are a severe state of alcohol withdrawal that puts the sympathetic nervous system into overdrive. It can cause symptoms such as:
- Fever
- Seizures
- Hallucinations
- Uncontrolled muscle spasms
- Cardiac arrest
Only 5-10% of people with alcohol use disorder experience Delirium Tremens (DTs). It’s unknown who will develop DTs which is why it’s so important to detox in a safe, monitored process.
Benzos (Xanax, Klonopin, Valium, or Librium) Timeline
Benzodiazepine withdrawal has a risk of death if not properly medically managed. A general withdrawal timeline is:
- 24-78 hours after last use: Physical symptoms of withdrawal start to show.
- 2 weeks after last use: Physical symptoms of withdrawal reach their peak and start to subside
- Weeks to months after use: Psychological withdrawal symptoms start to subside.
Cocaine Timeline
Cocaine has a relatively short half-life so leaves the system quite quickly. A general withdrawal timeline follows:
- In the first 90 minutes: Earliest withdrawal symptoms should appear.
- Days 1-3: Symptoms increase in severity
- Days 4-7: Symptoms start to decrease in severity and slowly become more manageable
- Days 8-10: Most symptoms disappear. Some linger
- Days 11-14: Usually feels much better. Many only have passing cravings
Methamphetamines Timeline
Meth withdrawal can involve psychological sensations such as auditory and visual hallucinations with strong cravings lasting several weeks. A typical withdrawal timeline follows:
- 12-72 hours after last use: Physical withdrawal symptoms at their highest
- 2 -10 days after last use: Physical symptoms begin to subside. Psychological symptoms begin
- 1 week – 1 month after last use: Minor physical symptoms remain while psychological symptoms remain pronounced
- 1 month – 3 months after last use: Physical symptoms end while psychological symptoms begin to decrease
Opioids (Heroin, Vicodin, Codeine, Oxycodone, or Fentanyl timeline
Most patients are transferred to a substitute opioid prescription such as methadone or buprenorphine. This provides stabilization on a controllable drug, dose, and regimen. Detoxification is defined as a process completed in up to a 28 day period as an inpatient, or up to 12 weeks in the community.
Here is a general timeline for heroin, one of the most difficult drugs to stop using:
- 6-12 hours after last use: Physical heroin withdrawal symptoms begin to show
- 12-48 hours after last use: Physical symptoms reach their peak
- 2 weeks after last use: Physical symptoms subside
- Weeks to months after last use: Psychological symptoms begin to subside
Treatment Support During and After Recovery
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.
Typical therapy approaches include:
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Trauma-focused Cognitive Behavioral Therapy (TF-CBT)
- Acceptance and Commitment Therapy (ACT)
- 12-Step Program
- Somatic Experiencing and Body Work
- Mindfulness Meditation
- Exposure therapy
Sources
Diaper AM, Law FD, Melichar JK. 2014. Pharmacological strategies for detoxification. Br J Clin Pharmacol. Feb;77(2):302-14. doi: 10.1111/bcp.12245. PMID: 24118014; PMCID: PMC4014033.
Physical Detoxification Services for Withdrawal From Specific Substances. 2006. Treatment Improvement Protocol (TIP) Series, No. 45. Rockville (MD): Substance Abuse and Mental Health Services Administration (US).
