March 17, 2019

How Long Do Withdrawal Symptoms Last?

Even with medication-assisted treatment, withdrawal from chemical addiction is no fun. Physical and mental effects may include severe pain, vomiting, panic attacks, racing pulse or even seizures. Detoxing under professional care is important, not only for the treatment of symptoms and administering of any medication needed but for counseling to manage emotional stress. There are at least two serious dangers apart from any physical risks:

The person in withdrawal may become suicidal. People with addiction disorders are at high risk of suicide, to begin with, and the physical and emotional pain of withdrawal can make the “quick escape” of death look particularly attractive.
The person may give up on detox and take more drugs to relieve the pain. With the body weakened and having already lost some of its drug tolerance, and with the person’s judgment impaired, overdose risk is seriously high. In the United States, 70,000 people died from an overdose in 2017 alone.

Professional caregivers can provide reassurance to patients struggling with panic, suicidal impulses or “will this ever end” stress. On the last point, the answer seems obvious to anyone whose head is clear: of course “this too shall pass.” For someone in the throes of agony, though, even a few minutes can feel like forever.

NOT AN EXACT SCIENCE

Unfortunately, the most experienced detox doctor is still hard put to answer the foremost question in many patients’ minds: How long will it really be before I start feeling better? The question can come up before withdrawal as well as during it, and it’s impossible to say, “You’ll feel miserable for exactly 72 hours, then the worst will be over.” The closest to a comprehensive answer to the question, “How long do withdrawal symptoms last?” is “From four days to two weeks.” A detox specialist who knows what drugs are involved can narrow the estimate further, but how long symptoms last in any individual case is affected by a variety of additional factors:

The client’s overall physical and mental condition
The length of time the client has had the addiction
The level of dependence
The amount of the typical drug dose
The use and nature of the medication-assisted treatment
The psychosomatic effect (what the client expects to happen)

In addition, if “withdrawal symptoms” are considered to include resurgent drug cravings, bouts of depression and other psychosomatic reactions, they may recur periodically for a year or more. Over 75 percent of people in addiction recovery may develop some level of post-acute withdrawal syndrome (PAWS), characterized by cognitive impairment, mood swings, increased sensitivity to stress, sleep difficulties and increased relapse risk.

The good news is, there are ways to reduce how long withdrawal symptoms last. Or at least to make them more bearable.

REDUCING HOW LONG ACUTE WITHDRAWAL SYMPTOMS LAST

Again, anyone needing to detox from addiction should go to a professional treatment center. Private “cold turkey” detox magnifies emotional pains through isolation, can be physically dangerous and leaves the detoxer without quick access to help should anything go wrong. The expense doesn’t have to be a barrier: most health insurance plans provide for some detox coverage, and a good treatment center will do all it can to help work out a payment plan.

Besides which, a detox center offers professional help reducing intensity and duration of symptoms, whether through formal medication-assisted treatment or just providing comfortable facilities and hands-on care. They may not be able to tell you exactly how long your withdrawal symptoms will last, but they can give you a fair idea of what to expect. And that in itself can ease anxiety and alleviate the intensity of some symptoms.

If your center recommends medication-assisted treatment, don’t be afraid to discuss the pros and cons. MAT may mean that symptoms are reduced in intensity but increased in duration: that isn’t always an advantage to clients who would rather get things over with quickly. Also, many withdrawal-assistance medications are potentially addictive themselves, and, if not managed with care, could lead to new addiction disorders. On the other hand, some drugs—benzodiazepines, for example—can produce such severe withdrawal symptoms that medication-assisted treatment (which sometimes just means tapering off the addictive drug) is nearly always the best choice.

Other hints for lessening acute withdrawal symptoms in both intensity and duration:

Get as clear an advance picture as you can of what to expect, but don’t count on it going “by the book.” Worrying about whether everything is going “right” will only increase stress and probably intensify symptoms.
Know meditation and relaxation techniques that can help reduce pain. If you think relaxing music or white noise would help, don’t hesitate to ask about options.
Keep as comfortable as possible. Wear pajamas that don’t itch or scratch. Use as many or as few pillows as you need. Prop yourself up if you feel nauseated or have any difficulty breathing. Stay in bed until your treatment providers give you the go-ahead to get up: your body needs all its strength to ride out the worst of withdrawal.
Stay well hydrated, especially if experiencing vomiting or diarrhea. Your treatment providers will advise you on what to drink and how much at a time. Never gulp anything, even water, on a queasy stomach.
If you need an extra blanket or someone to talk with, don’t hesitate to ask the staff. That’s what they’re there for.
Tell a staff member immediately if you start to experience suicidal thoughts, think you’re losing your grip on reality or feel you’re going to have a seizure. Also tell staff if you can’t hold food and drink down (you may need intravenous hydration or feeding) or have special concerns about any other symptom for any reason.
Remember: the pain won’t last forever.

REDUCING HOW LONG POST-ACUTE WITHDRAWAL SYMPTOMS LAST

Physical withdrawal may be the worst part for sheer intensity, but it’s far from the whole of the withdrawal experience. Many people have successfully “detoxed,” rushed back to their old lives and old stresses, and found out the hard way that old drug-use temptations were as strong as ever, even without physical illness from missed doses. While you may not be able to avoid post-acute withdrawal symptoms altogether, you don’t have to let them lead you back into addiction or make your life constantly miserable.

To improve the odds against serious PAWS problems, stay in residential treatment for two or three months post-detox. If you can’t manage that, enroll in intensive outpatient care where you will be at a facility several hours a day, several days a week. This is the “psychological detox” period which comprises therapy, support groups, active planning for relapse prevention, and generally learning to live and cope without drugs. If you skip it, you’ll have little but your own willpower to defend against relapse temptations, and anyone who’s had an addiction disorder knows how undependable willpower can be.

Even after you formally complete treatment, temptations to relapse may recur when least expected (common triggers include the sight or smell of a drug, unexpected stress, happier periods that tempt you to let your guard down, new responsibilities, and anniversaries or special events your memory associated with drug use). And some addiction-created reactions remain in the brain for life. So stay in regular touch with a support group and therapist, and get your family and friends involved in helping keep you sober. If your treatment center has an alumni program for clients, by all means, take advantage of it.

Other hints for reducing post-acute withdrawal symptoms and staying sober for life:

Maintain an overall healthy lifestyle. Lack of sleep, a junk-food diet, a sedentary routine and pushing yourself too hard can all reduce physical and mental resilience, which are the best allies against relapse cravings.
Keep as far from temptation as you can. Avoid places, routes, and acquaintances you associate with drug use. Plan for stressful situations in advance. If “getting money” meant “buying drugs” to you, reduce that temptation by having new income deposited directly into your bank (and consider having a trustworthy friend watch your bank cards so you’ll be fully accountable for what you spend).
Replace negative coping strategies with positive ones. (If you don’t, nature which abhors a vacuum will press you to fill the hole with familiar habits.) Besides relaxation techniques and time management, nonstressful leisure activities are a proven help: now is the time to join that book club, rediscover an old hobby or resume that household “date night” tradition.
Set long-term goals that are worth staying sober for. Talk with a counselor about reviving long-buried dreams and making plans to work toward them.
Make sure your regular doctor knows about your problem. He or she can advise you on general health practices, and will also need to know what prescription drugs might trigger a relapse.
Have someone you can call quickly for support if you start to experience intense drug cravings or severe mood swings. If you feel physically ill or have suicidal thoughts, call a doctor or emergency number right away.

Finally, resolve to live proactively and avoid the victim mentality. As with the answer to how long withdrawal symptoms last, you have more control than you think over the answer to how easy it is to stay sober!

SOURCES:

Goldberg, Joseph, medical reviewer (2018, October 16). “Depression and Diet.” WebMD.com. Retrieved from https://www.webmd.com/depression/guide/diet-recovery#1
Lopez, German (2019, February 26). “A New Study Shows America’s Drug Overdose Crisis Is By Far the Worst Among Wealthy Countries.” VOX.com. Retrieved from https://www.vox.com/science-and-health/2019/2/26/18234863/drug-overdose-death-america-international-study
Oquendo, Maria (2017, April 20). “Opioid Use Disorders and Suicide: A Hidden Tragedy.” National Institute on Drug Abuse. Retrieved from https://www.drugabuse.gov/about-nida/noras-blog/2017/04/opioid-use-disorders-suicide-hidden-tragedy-guest-blog
Semel Institute for Neuroscience and Human Behavior (2019). “Post-Acute Withdrawal Syndrome (PAWS).” University of California at Los Angeles. Retrieved from https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS
Substance Abuse and Mental Health Services Administration (2018, February 7). “Medication-Assisted Treatment (MAT).” Retrieved from https://www.samhsa.gov/medication-assisted-treatment

For related information on addiction withdrawal, see the following articles: