The term “detox” is frequently discussed in the media and is well-known to a lot of people. It is the usual term for the discontinuation of addictive substances or behaviors, such as alcohol, opiates or gambling.
Drug withdrawal, also called detoxification or detox, is the important initial stage in the path toward recovering from substance abuse. The foundational phase is crucial for clearing the way for healing and recovery by eliminating toxins from the body. And it creates a foundation for more intensive treatment options
The length of drug withdrawal can differ significantly for each person, affected by various factors like:
- Type of drugs used
- Duration of use
- Age
- Individual health conditions
- Presence of co-occurring mental health disorders
- Method of withdrawal
Phases of Drug Withdrawal
There are two primary dimensions to withdrawal:
Physical dependence: When the body has come to rely on drugs to feel normal because it’s used to functioning with the drug in your system. So if the drug isn’t taken, withdrawal symptoms will start to appear.
Psychological dependence: occurs when an individual feels the drug is necessary for their everyday performance. They may believe they require it for certain occasions, such as being sociable at a gathering or relaxing after work, or they may feel they need it constantly.
Understanding these factors, and the variables mentioned earlier, is key for tailoring the withdrawal process to each person’s unique needs and planning for a more effective and sustainable recovery.
Detoxification, the process of clearing substances from the body and overcoming dependence, is the first goal of drug withdrawal in the journey to recovery. It typically unfolds in three distinct stages:
- Withdrawal onset (acute withdrawal)
- Peak symptoms
- Subsiding symptoms
Each stage is characterized by different challenges and symptoms, and understanding these can provide insight into the journey towards sobriety.
Dangerous health consequences—even life-threatening complications—may arise if detox isn’t done in a supervised setting. So detoxing at home is generally not recommended.
Stage 1: Withdrawal Onset
Timeline: Hours to a few days after the last substance use
The first stage begins hours to a few days after the last intake of the substance, depending on the type of substance and the individual’s metabolism. This stage focuses primarily on physical symptoms which may often be mild but signal the beginning of detox.
- For alcohol, withdrawal symptoms can start as early as two hours after the last drink,
- For opioids, symptoms might not appear until 8-12 hours after the last use.
Symptoms include:
- Anxiety
- Restlessness
- Headache
- Nausea
- Insomnia
- Sweating
- Muscle ache
- Increased heart rate
These symptoms are the body’s immediate response to the absence of the substance it has grown accustomed to.
Stage 2: Peak (Acute) Symptoms
Timeline: 1-3 days after last use
This is where individuals often experience the most discomfort, with acute symptoms reaching their peak. The duration and intensity of peak symptoms can vary significantly based on the substance involved, previous usage patterns, and individual health factors.
- For alcohol, peak symptoms can include severe tremors, hallucinations, and even seizures, typically occurring within 24 to 72 hours post-last drink.
- Opioid withdrawal, on the other hand, peaks around 72 hours after the last dose, with symptoms such as muscle aches, severe abdominal pain, and high blood pressure.
- Benzodiazepine withdrawal can be especially prolonged, with peak symptoms sometimes not appearing until 1-2 weeks after cessation and lasting for an extended period.
Stage 3: Subsiding Symptoms
Timeline: Days to weeks after the last use
In the final stage of withdrawal, symptoms gradually begin to lessen in intensity and frequency. This phase can last from a few days to several weeks. The exact timeline varies greatly among individuals and is influenced by the specific substance, length of use, and personal health.
During this stage, the acute physical symptoms start to fade, but psychological symptoms may persist, such as:
- Anxiety
- Depression
- Cravings
These lingering symptoms can be challenging, but they generally decrease over time as the body and brain continue to adjust to the absence of the substance.
Typical durations for this stage include:
- Alcohol: 5-7 days
- Opioids: 7-10 days
- Benzodiazepines: several weeks to months
- Stimulants: 1-2 weeks
Post-Acute Withdrawal Syndrome (PAWS)
Post-acute withdrawal syndrome, or PAWS, occurs as the brain recalibrates after active addiction. These symptoms typically involve more of the psychological and emotional aspects of withdrawal. Depending on the duration and intensity of the addiction, this secondary withdrawal syndrome can occur a few weeks into recovery or a few months later. Even though PAWS is a temporary condition, the symptoms can become a driving factor in relapse, even for those fully committed to staying sober.
PAWS occurs most commonly and intensely among individuals with alcohol and opioid addiction, as well as in people with addiction to:
- Benzodiazepines (or “benzos”)
- Heroin
- Medically prescribed pain medication
Symptoms of PAWS are triggered by stress or brought on by situations involving people, places or things that remind the individual of using, often changing like a roller coaster and initially even changing by the minute. As the process transitions to long-term recovery, the symptoms occur less frequently. Here are common symptoms of PAWS:
- Brain fog
- Trouble remembering
- Urges and cravings
- Irritable or hostile behavior
- Sleep problems—insomnia or vivid dreams
- Fatigue
- Issues with fine motor coordination
- Stress sensitivity
- Anxiety or panic
- Memory difficulties
- Depression
- Lack of initiative or motivation
- Impaired ability to focus
- Mood swings
- Problems with fine motor coordination
Most symptoms last for a few days at a time depending on the substance and the person. Typically, the recalibration process takes from six months to two years before the brain again produces endorphins and dopamine naturally.
In a person with an addiction to benzodiazepines, for example, lasting withdrawal symptoms (6 to 18 months) can stem from functional changes to the neuroreceptors in the central nervous system and it may not be possible to avoid or reduce the effects of PAWS.
Medication-Assisted Treatment for Withdrawal
Medication can play an important role in withdrawal. Common medications used to treat drug addiction and withdrawal include:l
Opioid:
- Methadone
- Buprenorphine
- Extended-release naltrexone
- Lofexidine
Nicotine:
- Nicotine replacement therapies (available as a patch, inhaler, or gum)
- Bupropion
- Varenicline
Alcohol:
- Naltrexone
- Disulfiram
- Acamprosate
Expert advice for managing withdrawal symptoms
There are numerous methods available to help ease withdrawal symptoms and offer assistance throughout the recovery process. Some of these are:
Self-care and lifestyle changes: Eating well with a balanced diet and getting enough sleep can help the body heal and recover.
Seeking support: Speaking with understanding friends and family members can help, and both in-person and online groups of people with shared experiences can provide guidance and emotional support.
Taking medications: If a doctor suggests this method, it is crucial to follow the prescribed dosage even once the symptoms improve.
Preventing triggers: Recognizing individuals, circumstances, and feelings that could lead to a relapse is crucial. For instance, individuals in a support group can assist someone in creating successful strategies to manage these triggers in situations where avoiding them is impossible.
Taking it one day at a time: Approaching life one day at a time is crucial in order to prevent overexertion and excessive concern about what lies ahead or what has already happened. Focusing on daily self-care and celebrating each day’s accomplishments can be more beneficial.
Mindfulness and Stress Management: Practicing mindfulness and stress management can effectively pause the stress cycle, creating room to respond rather than react. The main emphasis is on practicing breathing exercises, cultivating self-compassion, fostering authentic connections with others, and showing compassion towards them.
Therapy and Counseling
Behavioral therapies help people in drug addiction treatment modify their attitudes and behaviors related to drug use. This enables them to deal with stressful situations and triggers that might cause a relapse. They can also enhance the effectiveness of medications and help people remain in treatment longer.
- Cognitive-behavioral therapy seeks to help patients recognize, avoid, and cope with the situations in which they’re most likely to use drugs. It helps them reframe their beliefs and set realistic goals.
- Contingency management uses positive reinforcement such as providing rewards or privileges for remaining substance free, for attending and participating in counseling sessions, or for taking treatment medications as prescribed.
- Motivational enhancement therapy uses strategies to make the most of people’s readiness to change their behavior and enter treatment.
- Family therapy helps people (especially adolescents) with drug use problems, as well as their families, address influences on drug use patterns and improve overall family functioning.
- Twelve-step facilitation (TSF) is an individual therapy typically delivered in 12 weekly sessions to prepare people to become engaged in 12-step mutual support programs. Such as Alcoholic Anonymous and Narcotics Anonymous which provide social support to their treatment plans.
- SMART Recovery helps people recover from addictive and problematic behaviors, using a secular approach with self-empowering and evidence-informed programs.
- Residential treatment, also known as rehab centers, provide a supportive live-in environment for recovery with structured programs, therapy and alternative therapies. They typically offer 30-90 day programs tailored to each individual’s needs.
Withdrawal and recovery are possible but no one can do it alone. By adopting some of the strategies and tips outlined above, you can successfully recover and manage any relapses.
Sources
Drugs, Brains, and Behavior: The Science of Addiction. Treatment and Recovery. 2020. National Institute on Drug Abuse
