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Withdrawal is an inescapable part of overcoming dependence or addiction to alcohol or drugs. This incontrovertible fact likely deters many individuals struggling with addiction who might otherwise enter treatment. Yet, what many people – including the families of those who are addicted – don’t know is that the medical professionals in drug and alcohol rehab facilities utilize medication-assisted treatment (MAT) to help alleviate withdrawal symptoms and reduce cravings during detox. While many withdrawal symptoms can be brief in duration and intensity, others may persist longer. As to how long withdrawal symptoms last, they can and do vary depending on the substance, among other factors.
WHAT ARE WITHDRAWAL SYMPTOMS?
Withdrawal symptoms are the physical and psychological changes that occur in those who attempt to quit using drugs and alcohol. Many withdrawal symptoms appear simultaneously upon cessation of the substance, while others may occur after a few days or weeks of quitting. Depending on the drug used, or combinations of drugs and alcohol (polydrug use), symptoms may overlap or be difficult to differentiate by a substance. In addition, other factors that influence the number, frequency, and intensity of withdrawal symptoms include the age of the user, duration, dose and quantity used, physical and mental health before and during substance use, and the presence of any co-occurring mental disorder, such as depression.
The changes the body goes through once chronic or heavy alcohol consumption suddenly stops are known as alcohol withdrawal. The symptoms of alcohol withdrawal follow a predictable pattern, although not all symptoms will occur in every person who stops drinking. What typically happens is that alcohol withdrawal symptoms start to improve within 5 days, but some individuals experience symptoms for a more prolonged period that may last weeks.
Specific Alcohol Withdrawal Symptoms and Timeline
According to Drugs.com, some of the symptoms of alcohol withdrawal and their duration include:
- Tremors – Called the shakes, tremors or trembling usually begins 5-10 hours after the last drink. These tend to peak around 24-48 hours. Other symptoms commonly occurring around the same time include anxiety, increased blood pressure, rapid breathing and pulse, hyper-alertness, insomnia, irritability, nausea, nightmares (or vivid dreams), and vomiting.
- Seizures – Brought on by alcohol withdrawal, seizures may happen 6-48 hours after the last drink was consumed, and may occur over several hours. Experts say the risk peaks at 24 hours.
- Hallucinations – Beginning within 12-24 hours after the last drink, alcoholic hallucinosis, or hallucinations due to alcohol withdrawal, may last up to 2 days.
- Delirium tremens – Also called DTs, delirium tremens, one of the more severe symptoms of alcohol withdrawal, most often begins 2-3 days after the last consumption of alcohol. It may, however, be delayed a week or more. Peak intensity of DTs is generally 4-5 days after the last drink. During DTS, the individual experiences dangerous shifts in their breathing, temperature control, and circulation. This may cause dangerous heart racing, dramatically increased blood pressure and dehydration. Since delirium tremens may temporarily reduce blood flow to the brain, other symptoms that may occur include anger, confusion, disorientation, disturbed sleep, drenching sweats, hallucinations, irrational beliefs, loss of consciousness, and nervousness.
Benzodiazepines belong to the class of drugs known as tranquilizers. While generally used to treat anxiety and insomnia, benzodiazepines (called “benzos” for short) can also be abused and result in dependence or addiction. Brand names of benzos include Ativan, Klonopin, Valium, and Xanax.
Specific Benzodiazepine Withdrawal Symptoms and Timeline
When withdrawing from benzodiazepines, users can expect to experience any of a number of physical and psychological symptoms. These symptoms generally appear and begin to dissipate during the detox period that typically lasts 6-8 days.
Physical benzodiazepine withdrawal symptoms:
- Blurry vision
- Heart palpitations
- Heightened sensitivity (sensory)
- Muscle/joint pain/muscle twitching
- Pins and needles sensation
- Shaking and tremors
- Stomach discomfort
Psychological benzodiazepine withdrawal symptoms:
- Cognitive difficulties
- Obsessive negative thoughts
- Panic attacks
- Rapid mood swings
- Suicidal thoughts
WITHDRAWAL FROM OPIATES
Whether the substance of abuse or addiction is a natural opiate (such as morphine), semi-synthetic opiate (such as hydrocodone, oxycodone and heroin), or a synthetic opiate (including tramadol, methadone and fentanyl), withdrawal from opiates involves a number of symptoms that may be either short-term in duration or lasting somewhat longer.
Specific Fentanyl Withdrawal Symptoms and Timeline
Prescribed for severe pain, fentanyl is a powerful prescription painkiller. Classified as a Schedule II controlled substance by the Food and Drug Administration (FDA), fentanyl is popular on the black market and is responsible for epidemic overdoses, addiction, and death. Indeed, fentanyl-related overdose deaths now exceed those from heroin or prescription opiates.
Withdrawal from fentanyl involves symptoms that generally start within 3-4 hours after last drug use, peak within 1-2 days and generally subside over a period of 1-2 weeks. In the case of PAWS, however, withdrawal can last months or a year or longer.
Symptoms of fentanyl withdrawal include:
- Appetite loss
- Muscle pain and cramps
Specific Heroin Withdrawal Symptoms and Timeline
Heroin withdrawal starts to set in within a few hours (6-12 hours) after the last dose was taken and typically lasts about a week. For chronic heroin users, however, withdrawal symptoms can last 3-4 weeks.
Heroin withdrawal symptoms occur in phases:
- Days 1-3 – While uncomfortable and sometimes painful, heroin withdrawal symptoms that first appear usually are temporary and peak between 2-3 days. These include agitation, aggression, anxiety, digestive problems, headaches, insomnia, irritability, lack of appetite, nausea, muscle aches and pains, panic attacks and sweating.
- Days 3-5 – Most of the intense heroin withdrawal symptoms have subsided, although remaining symptoms can include chills, cramps in the stomach, fatigue, muscle aches (minor), tremors. Note that withdrawal symptoms may last longer in some chronic heroin users or those diagnosed with heroin use disorder.
- Days 6-7 – Most symptoms have dissipated, leaving only mild discomfort.
A 2018 study reported in Drug and Alcohol Dependence found that, among people who inject heroin (PWIH), 66 percent experience skin and soft tissue infections. They delay seeking treatment out of fear of withdrawal symptoms and inadequate pain management, often due to previous negative care experiences and the stigma and prejudice associated with heroin injection use.
Specific Vicodin Withdrawal Symptoms and Timeline
Vicodin (hydrocodone bitartrate and acetaminophen) withdrawal starts shortly after cessation of drug use. How long withdrawal symptoms last depends on a number of factors unique to the individual, including how long they’ve been addicted, their drug tolerance level, psychological factors (including psychological craving), and method of detox. Full Vicodin withdrawal (except for severe cases) typically lasts 7-10 days.
Withdrawal symptoms include:
- Abdominal cramps
- Appetite loss
- Cold/flu-like symptoms
- Fatigue (severe)
- Intense psychological cravings
- Mood swings
- Post-acute withdrawal syndrome (PAWS) – a cluster of symptoms that include fatigue, mood swings, concentration problems that persist for weeks or months after initial Vicodin withdrawal
METHAMPHETAMINE AND CRYSTAL METH WITHDRAWAL
Getting off methamphetamine and crystal meth involves some rather extraordinarily painful and even dangerous withdrawal symptoms. These symptoms generally cluster and vary in frequency, duration and intensity according to whether the user is in the early or later stage of withdrawal.
Specific Methamphetamine Withdrawal Symptoms and Timeline
Methamphetamine withdrawal symptoms include:
- Increased appetite
- Lack of motivation
- Mood swings
- Red, itchy eyes
- Suicidal thoughts
Withdrawal symptoms for methamphetamine and crystal meth generally fall into the crash, cravings and recovery phases, with duration as follows:
- The crash phase generally lasts about 2 weeks. During this time, the user may experience a decline in both cognitive function and energy level.
- The phase of cravings can linger, often up to 10 weeks, and include feelings of increased depression as the meth slowly leaves the body.
- During the physical recovery phase, typically the longest and lasting 30-40 weeks, the meth user in recovery will begin to experience significantly decreased cravings and stabilization in overall physical and psychological measures.
A 2018 study reported in CNS Drugs said about 30 percent of regular marijuana (cannabis) users report withdrawal symptoms when they try to quit. Among those who are chronically dependent or in treatment, however, withdrawal symptom incidence can range from 50-95 percent. Although not life-threatening and generally not physical symptoms, withdrawal from marijuana typically involves psychological symptoms. How long they last varies from one individual to the next, but in heavy marijuana smokers, the first withdrawal symptoms begin the first day after quitting, peak between 48-72 hours, last 2-3 weeks and fade over time. Some symptoms, however, can linger for weeks to months.
Specific Marijuana Symptoms and Withdrawal Timeline
There are four specific marijuana symptoms that are quite common when users try to quit:
- Intense Craving — The most common marijuana withdrawal symptom is intense craving, reported by more than 75 percent of marijuana smokers.
- Mood Swings — The second most common symptom of marijuana withdrawal is mood swings, reported by slightly more than 50 percent of those trying to quit. Mood can swing from euphoria to anger to depression, along with reported irritability, anxiety, aggression, loss of concentration, nervousness, and restlessness. Symptoms typically start to decrease 2-3 weeks after quitting, although they can last up to 3 months or longer.
- Sleep Problems — Insomnia and sleep difficulties are the third-most-common withdrawal symptom, reported by 46.9 percent of marijuana users trying to quit. Sleep problems can last for a few days or up to a couple of weeks, although some former users say they have occasional sleeplessness months after quitting. A 2014 study reported in The American Journal on Addictions showed that sleep problems and vivid dreams actually increased over time among chronic cannabis smokers, indicating intrinsic sleep problems.
- Headaches – Former marijuana users who’ve quit report headaches that last from a few weeks to a couple of months. Headaches usually start 1-3 days after quitting, peak between 2-6 days, and fade after 2 weeks, although they can persist for several weeks to months after quitting. A 2012 study reported in Clinical Neurology and Neurosurgery found that 18 percent of psychoactive substance abusers reported headache as a result of using the substance or during withdrawal. Cannabis was the most commonly-used substance (80.5 percent). Researchers commented that “the younger start and longer duration of cannabis use caused the higher incidence of headache” in this study.
Precipitated withdrawal is a rapid and intense onset of opiate withdrawal symptoms that are triggered by certain medications used for MAT in overcoming opiate dependence and addiction, such as suboxone (which combines buprenorphine and naloxone) and naltrexone. Precipitated withdrawal symptoms may be severe, even requiring hospitalization in some cases.
Common precipitated withdrawal symptoms include:
- Abdominal cramps
- Altered consciousness levels
- Anxiety, agitation that may be severe
- Body aches
- Diarrhea (severe)
- Dilated pupils
- Increased heart rate
- Low blood pressure
- Muscle cramps
- Vomiting (excessive, projectile)
The cause of precipitated withdrawal is starting MAT too quickly after the last dose of opiates. Symptoms begin to develop within 1-2 hours after the first dose of suboxone. They generally resolve in a few hours, although symptoms may last longer than a day. With naltrexone, precipitated withdrawal can occur in minutes and last up to 48 hours. Naloxone withdrawal symptoms are generally short in duration, lasting an average of 30 minutes to an hour.
For more about exercise, addiction and recovery, check out these articles:
How Long Does Precipitated Withdrawal Last?
Clinical Neurology and Neurosurgery. “Headaches related to psychoactive substance use.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22424726
CNS Drugs. “A Systematic Review of the Efficacy of Cannabinoid Agonist Replacement Therapy for Cannabis Withdrawal Symptoms.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30361897
Drug and Alcohol Dependence. “Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis users.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20510550
Drug and Alcohol Dependence. “Negative experiences of pain and withdrawal create barriers to abscess care for people who inject heroin. A mixed methods analysis.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30055424
Drugs.com. “Alcohol Withdrawal.” Retrieved from https://www.drugs.com/health-guide/alcohol-withdrawal.html
National Alliance of Advocates for Buprenorphine Treatment. “Precipitated Withdrawal. What it is. How to avoid it.” Retrieved from https://www.treatmentmatch.org/_docs/NAABT_PrecipWD.pdf
National Institute on Drug Abuse. “Marijuana.” Retrieved from https://www.drugabuse.gov/publications/drugfacts/marijuana#ref
NIDA for Teens. “Marijuana Withdrawal is Real.” Retrieved from https://teens.drugabuse.gov/blog/post/marijuana-withdrawal-real
The American Journal on Addictions. “Cannabis withdrawal in chronic, frequent cannabis smokers during sustained abstinence within a closed residential environment.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24724880