How Long Does Withdrawal Last?Anna Ciulla
Engaging in everyday cocktails or slamming back drinks to bolster courage, forget problems or numb out may seem harmless enough – until the consequences of such behavior start to interfere with normal life. The same applies to using prescription opiates in a manner that abuses the intent for which they were originally prescribed, doctor-shopping to continue to get a supply, reverting to street versions or heroin to stave off feeling miserable when the drugs aren’t available. Sooner or later, you may come to the decision to get off alcohol or drugs, but worry about the dreaded “withdrawal.” While it’s true that there’s some discomfort with withdrawal, with the scientific breakthroughs in medication-assisted treatment (MAT) available today, pain and discomfort can be minimized during the withdrawal process. Still, it’s understandable to ask how long does withdrawal last?
WHAT IS WITHDRAWAL?
Most people have a rudimentary idea of what withdrawal is, even if they’ve never personally experienced it before. In simple terms, discontinuance of alcohol or drugs that were regularly consumed or being abused, brings on the process of withdrawal. Anyone who is dependent on or addicted to alcohol or drugs will go through withdrawal. It’s inescapable. Yet, even if you know a few things about withdrawal, you probably have a few misconceptions as well. That’s why it’s wise to understand that withdrawal is a process that encompasses stages, it doesn’t last forever, and withdrawal symptoms and length of withdrawal will vary.
HOW DO YOU KNOW YOU’RE IN WITHDRAWAL?
Within hours of last use of alcohol or drugs, symptoms of withdrawal start to appear — regardless of the substance being abused. At first, some withdrawal symptoms may seem mild, mimicking those of the cold or flu, or an overall rundown feeling. But the number of different symptoms, frequency and severity may increase over the ensuing days to the point where they become intolerable. Along with the nonstop litany of symptoms is the advent of cravings for the substance no longer being consumed. Some cravings are mild and intermittent, while others are strong and unrelenting. There is no doubt that you’re in withdrawal once you experience hours and days of withdrawal symptoms.
CAN YOU SKIP WITHDRAWAL?
The idea that you might be able to avoid withdrawal altogether, or just skip it and be free of any trace of alcohol or drugs in your body sounds appealing. Unfortunately, this is not the way detoxing works. You cannot simply take a pill or go to sleep and expect to wake up free of alcohol and drugs. Even if you went with a potentially risky rapid detox, a process you may have seen advertised or touted as the quickest way to detox, your body would still go through withdrawal – and it may not be the best or safest choice for you. For one thing, it’s tough on your body to do so. Why take the risk of something going wrong?
Indeed, the Journal of the American Medical Association (JAMA) stated in 2005 that, “Rapid opioid detoxification with opioid antagonist induction using general anesthesia has emerged as an expensive, potentially dangerous, unproven approach to treat opioid dependence.” The report summary of the randomized trial of general anesthesia for opioid withdrawal and naltrexone induction demonstrated “no benefit of anesthesia over a safer, cheaper, and potentially outpatient alternative using buprenorphine as a bridge to naltrexone treatment.”
The American Society on Addiction Medicine (ASAM) came out with a public policy statement in 2005 that said “UROD is a procedure with uncertain risks and benefits, and its use in clinical settings is not supportable until a clearly positive risk-benefit relationship can be demonstrated.”
The National Alliance of Advocates for Buprenorphine Treatment (NAABT) further stated that with buprenorphine, patients can “transfer from the dangerous addictive drugs to the treatment medication in one day, with very little discomfort.” It’s no longer part of modern addiction treatment, says the NAABT, for the individual to suffer painful acute withdrawal for several days, which makes ultra-rapid opioid detox (UROD) an unnecessary, expensive and risky remedy.
In 2013, the Centers for Disease Control and Prevention (CDC), published data on deaths and severe adverse events associated with anesthesia-assisted rapid opioid detoxification (AAROD) in New York City in 2012. The report said that “AAROD has substantial risks, including a risk for death, and little to no evidence to support its use. Safe, evidence-based treatments of opioid dependence (e.g., MAT) exist and are preferred.”
The consensus among addiction experts is that the best and safest way to detox from alcohol or drugs (or both, in the case of polydrug use) is through medically supervised detoxification at a licensed professional drug and alcohol rehab treatment facility. There you will be constantly monitored throughout the detox process, and the treating professionals will be able to utilize evidence-based medications to help minimize withdrawal symptoms and cravings while they provide you a safe, reliable and comfortable detox.
FACTORS DETERMINING HOW LONG WITHDRAWAL LASTS
Still, with so many substances that can cause dependence or addiction, the question about what factors are involved in determining how long withdrawal to that particular substance (or combination of substances) lasts is legitimate. In truth, the determining factors are much the same as those involved in compiling an individual’s total assessment of substance abuse prior to drawing up a formalized drug rehab plan.
These include the person’s age, weight, sex, type of substance used, prior dosage, frequency of use, history of substance abuse, prior treatment for substance abuse, previous relapse, family history of substance abuse, dual diagnosis (co-occurring substance use and mental health disorders), and more.
With so many variable in the factors to be considered, the length of time involved in withdrawal is slightly different for each person – even if they’re seeking treatment for the same substance of abuse. It is also important to note that concurrent use of alcohol and other substances (such as opiates and benzodiazepines, for example) further complicates and extends the overall withdrawal process. Trying to self-detox from some of these substances can result in life-threatening consequences, even death.
HOW LONG CAN YOU EXPECT WITHDRAWAL TO LAST WITH VARIOUS SUBSTANCES?
Withdrawal symptoms, which are physical and psychological in nature, occur when a person stops using alcohol and drugs. Some symptoms begin shortly after discontinuing the substance. Other withdrawal symptoms may lag by several days, while still more may come weeks after quitting drug and alcohol use. There’s also symptom overlap, particularly if substance use includes a combination of alcohol and drugs. In addition, clinical depression, anxiety or other co-occurring mental disorder can affect withdrawal symptoms as to type, intensity and duration.
HOW LONG DOES ALCOHOL WITHDRAWAL LAST?
Symptoms of alcohol withdrawal begin within hours after the last consumed drink. Symptom duration depends on how severe the drinking problem is, yet in general can last from a few days to a week (longer in extreme cases).
The worst alcohol withdrawal symptoms (which not everyone who stops drinking experiences) include:
- Hallucinations – These start 6-24 hours after the last drink and can last a few days.
- Seizures – A seizure typically occurs in the first 1-2 days, generally only one time. If another seizure occurs, it’s generally within 6 hours of the first.
- Tremors – Mild to moderate tremors typically start 5 hours after last drink and resolve in several hours to days.
- Heart palpitations
- Delirium tremens (DTs) – This severe alcohol withdrawal symptom occurs in 5-20 percent of all alcohol detox cases. The confusion and hallucinations involved in DTs is severe. DTs begin 24-48 hours after last drink and generally last 3-4 days.
Data from the 2017 National Survey on Drug Use and Health (NSDUH) shows an estimated 140.6 million people currently used alcohol in 2017, including 66.6 million binge drinkers, and 16.7 million heavy drinkers, and 7.4 million underage drinkers. About 14.5 million people had alcohol use disorder (AUD) in 2017.
HOW LONG DOES BENZODIAZEPINE WITHDRAWAL LAST?
Benzodiazepine withdrawal generally lasts 10-14 days. Symptoms typically begin for short-acting benzos within 2 days of last use, while for longer-acting benzos, symptoms of withdrawal may start 2-3 days following last dose. Note that chronic benzodiazepine users may have withdrawal symptoms that remain for months or years after discontinuing use.
HOW LONG DOES MARIJUANA WITHDRAWAL LAST?
Marijuana withdrawal typically lasts around 20 days. First symptoms appear in week 1, while the worst symptoms generally occur by day 10, subsiding by the 20th day. There is a 40-60 percent relapse risk for marijuana use disorder – or higher, with multiple quit attempts. An estimated 4.1 million people had marijuana use disorder in 2017.
HOW LONG DOES OPIATE WITHDRAWAL LAST?
No matter what the opiate, opiate withdrawal, due to the many potential complications and both the complexity and overlap of polydrug use symptoms, or combination of substance use and co-occurring mental disorder, should always be medically supervised at a drug and alcohol rehab center. An estimated 2.1 million people had an opioid use disorder (OUD) in 2017.
The process of heroin detox and withdrawal, while rarely life-threatening, can result in uncomfortable physical symptoms. The physical aspects of withdrawal from heroin generally last about 1 week. Cravings for the illicit substance, however, can persist for months. The 2017 NSDUH reports that an estimated 494,000 people in 2017 currently used heroin, while 652,000 had heroin use disorder.
Anyone who uses fentanyl and then stops (or drastically cuts back) the drug goes through withdrawal. Fentanyl’s withdrawal lasts from around 2 weeks, in general, to months/years for those addicted to the substance who suffer from post-acute withdrawal syndrome (PAWS). MATS used in fentanyl detox helps minimize or prevent precipitated withdrawal, which is the rapid, potentially dangerous acceleration of withdrawal symptoms.
Prescription Pain Reliever Withdrawal
Pain reliever prescription drugs were misused by an estimated 11.1 million people in 2017, while 1.7 million had prescription pain reliever use disorder. These are opiate narcotic drugs and include hydrocodone (Vicodin), oxycodone (Oxycontin), hydromorphone (Dilaudid), tramadol products, codeine, morphine, fentanyl, oxymorphone, buprenorphine products, Demerol, and methadone. Here’s how long withdrawal lasts for a few of these prescription pain reliever drugs:
- Dilaudid – Withdrawal from hydromorphone pain relievers (Dilaudid, in this case) begins in the first 3-6 hours after last use of the drug. Within 36-72 hours, symptoms generally worsen and peak, although they start to subside after about 1 week. Intense cravings, however, can occur throughout the withdrawal process, and PAWS may persist for months/years.
- Methadone – Withdrawal symptoms typically appear about 30 hours after last use, and most are mild to moderate in nature. The acute stage lasts 2-3 days (or up to 3 weeks in severe cases). Look for most of the symptoms to improve by day 10. Methadone withdrawal necessitates professional medical management, including ongoing psychiatric evaluation.
- Oxycontin – Particularly addicting and subject to much misuse, Oxycontin (the brand name of the oxycodone pain reliever) users will start to experience oxycodone withdrawal symptoms as early as 4 hours after last use. More moderate symptoms appear in 12-24 hours. The worst symptoms peak at about 3-4 days, and it takes 1-2 weeks for symptoms to subside. Be aware that long-term effects from chronic oxycodone use can remain for months, even years.
- Vicodin – Hydrocodone generally disappears in about 8 hours from the body, yet Vicodin withdrawal may take 7-10 days. How long withdrawal lasts depends on how long the user was addicted, their tolerance for the drug, cravings, and detox method used. Cold turkey withdrawal is shorter, but more painful than professional Vicodin detox using MAT for symptom relief.
HOW LONG DOES STIMULANT WITHDRAWAL LAST?
Stimulant withdrawal from drugs such as cocaine, methamphetamines (including crystal meth) and amphetamines (such as Adderall) begins, in general, with symptom onset in the first 24 hours after last use. The first withdrawal stage may last 3-10 days. The length of second and subsequent stage (depending on the type of drug, among other factors), can range from 1-10 weeks, and 11 weeks to 6 months or longer, respectively.
For more about alcohol and drug detox and withdrawal, check out these articles:
AccessDataFDA.gov. “Dilaudid.” Retrieved from https://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019034s018lbl.pdf
American Society of Addiction Medicine. “Public Policy Statements.” “Rapid and Ultra Rapid Opioid Detoxification.” Retrieved from https://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/rapid-and-ultra-rapid-opioid-detoxification
Drugs.com. “Dilaudid.” Retrieved from https://www.drugs.com/dilaudid.html
Centers for Disease Control and Prevention. “Deaths and Severe Adverse Events Associated with Anesthesia-Assisted Rapid Opioid Detoxification – New York City, 2012.” Retrieved from http://www.naabt.org/urod.cfm
Centers for Disease Control and Prevention. “Deaths Involving Fentanyl, Fentanyl Analogs, and U47700 – 10 States, July-December 2016.” Retrieved from https://www.cdc.gov/mmwr/volumes/66/wr/mm6643e1.htm
Drugs.com. “Benzodiazepines.” Retrieved from https://www.drugs.com/drug-class/benzodiazepines.html
JAMA Network. “Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction A Randomized Trial.” Retrieved from https://jamanetwork.com/journals/jama/fullarticle/201451
Journal of Addiction Medicine. “Transferring Patients from Methadone to Buprenorphine: The Feasibility and Evaluation of Practice Guidelines.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/?term=Journal+of+Addiction+Medicine.+Transferring+Patients+from+Methadone+to+Buprenorphine+%3A+The+Feasibility+and+Evaluation+of+Practice+Guidelines.+May%2C+2018.
National Alliance of Advocates for Buprenorphine Treatment. “Evidenced-Based Addiction Treatment vs. Ultra-Rapid Detox.” Retrieved from http://www.naabt.org/urod.cfm
National Institute on Alcohol Abuse and Alcoholism. “Alcohol Withdrawal.” Retrieved from https://pubs.niaaa.nih.gov/publications/arh22-1/toc22-1.htm
National Institute on Drug Abuse. “Cocaine.” “What are the long-term effects of cocaine use?” Retrieved from https://www.drugabuse.gov/publications/research-reports/cocaine/what-are-long-term-effects-cocaine-use
Substance Abuse and Mental Health Services Administration. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.” Retrieved from https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report
U.S. Food and Drug Administration. “FDA Approves the First Non-Opioid Treatment for Management of Opioid Withdrawal Symptoms in Adults.” Retrieved from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm607884.htm