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Suppose you want to quit using alcohol or drugs, yet you’re afraid of going through withdrawal. When you know more about the symptoms of withdrawal, and how long withdrawal will last, you’ll be less fearful of the process. You can’t expect to stop drug or alcohol use without going through withdrawal, but medically-supervised detox and medication-assisted treatment (MAT) can ensure a safe and comfortable experience.
WITHDRAWAL SYMPTOMS – WHAT ARE THEY?
Withdrawal symptoms are the physical and psychological changes that occur in those who attempt to quit using drugs and alcohol. Every drug is different. Some drugs produce significant withdrawal symptoms, such as alcohol, opiates, and tranquilizers. Some, such as cocaine, marijuana, and ecstasy have little physical withdrawal symptoms, but more emotional withdrawal symptoms.
Physical Symptoms of Withdrawal
The list of physical symptoms of withdrawal include headache, dizziness, difficulty breathing, chest tightness, diarrhea, heart irregularities (racing heart, skipped beats, palpitations), muscle aches (including muscle tension, tremors, shakes, and twitches), nausea, stomach aches, sweating, tingling skin, and vomiting.
Emotional Symptoms of Withdrawal
The emotional symptoms of withdrawal are common to all drugs and may occur whether you experience physical symptoms of withdrawal or not. Emotional withdrawal symptoms include anxiety, irritability, panic attacks, restlessness, depression, fatigue, poor appetite, lack of enjoyment, social isolation, insomnia, poor concentration and memory.
Stages of Withdrawal
Withdrawal occurs in stages, acute and post-acute withdrawal syndrome (PAWS). During the acute stage, symptoms of withdrawal usually last no more than a few weeks. Yet, since each person is different, and each drug or substance is different, the type, duration, intensity of withdrawal symptoms varies. In acute withdrawal, physical withdrawal symptoms may be experienced.
The second stage of withdrawal, PAWS, involves fewer physical symptoms of withdrawal, but more symptoms of psychological and emotional withdrawal.
Symptoms of PAWS
While in PAWS, it feels like a roller-coaster of symptoms. These can sometimes change hourly. Some PAWS symptoms may subside after a few weeks or months only to return later. Each episode typically lasts a few days, so it’s time-limited, which should give you confidence that you can get through this. Important to remember is the fact that PAWS usually lasts for 2 years. So, even though PAWS episodes are not that long in duration, don’t get disappointed, as this could make relapse more likely.
Common PAWS withdrawal symptoms include anxiety, concentration that varies, variable energy, fatigue, low enthusiasm, irritability, mood swings, and sleep disturbances.
SYMPTOMS OF ALCOHOL WITHDRAWAL
Alcohol has some of the most dangerous physical symptoms of withdrawal (the other drug considered most dangerous for physical withdrawal symptoms is tranquilizers). That’s why medically-supervised alcohol detox, followed by treatment, is the best and safest route for anyone who stops drinking or wants to quit drinking. Medical detox helps minimize alcohol withdrawal symptoms and reduces risks of complications.
The most dangerous physical withdrawal symptoms with alcohol are grand mal seizures, heart attack, stroke, hallucinations and Delirium tremens (DTs). The changes the body goes through once chronic or heavy alcoholic 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.
Minor alcohol symptoms of withdrawal include headaches and slight tremors, beginning 6-12 hours after the last drink.
Moderate alcohol withdrawal symptoms include confusion, fever, sweating and vomiting, starting 12-24 hours after last consuming alcohol.
Severe alcoholic withdrawal symptoms include seizure and DTs. These occur 48-72 hours after stopping alcohol and are fatal in up to 15 percent of the cases. Symptoms of DTs include: agitation, breathing difficulties, confusion, disorientation, hallucinations (vivid), heart irregularities (rapid heart rate, palpitations, tachycardia), tremors (extreme).
DT risk may be greater:
- In middle-aged adults or seniors
- For those who’ve experienced seizures during previous alcohol withdrawal
- In those who have co-occurring mental illness (dual diagnosis with substance abuse)
- For those with abnormal liver functioning
- Among those experiencing intense cravings for alcohol
- In chronic, long-term alcohol abusers
- For anyone who had DTs before
SYMPTOMS OF BENZODIAZEPINE WITHDRAWAL
Benzodiazepines are in the tranquilizers class of drugs. Called “benzos” for short, these drugs, such as Valium and , are generally used in the treatment of anxiety and insomnia. They can also be abused, resulting in dependence or addiction, which can be treated in drug rehab.
Physical symptoms of withdrawal:
- Heart palpitations
- Heightened sensory sensitivity
- Muscle/joint pain/muscle twitching
- Pins and needles sensation
- Shaking and tremors
- Stomach discomfort
- Vision problems (blurred vision)
Psychological withdrawal symptoms:
- Cognitive difficulties
- Obsessive negative thoughts
- Panic attacks
- Rapid mood swings
- Suicidal thoughts
SYMPTOMS OF COCAINE WITHDRAWAL
According to MedLine Plus, a heavy cocaine user who cuts back or quits taking the drug goes into withdrawal. Symptoms of cocaine withdrawal can occur even if cocaine use is not completely stopped and some of the drug remains in the system. Some symptoms that occur with a crash – when stopping cocaine or a binge ends – include strong cravings, anxiety, fatigue, lethargy, irritability, sleepiness, and lack of pleasure. These are mostly psychological symptoms. Someone experiencing cocaine withdrawal may not have visible physical symptoms like those occurring with alcohol or heroin withdrawal, such as vomiting and shaking.
Other cocaine withdrawal symptoms that sometimes occur include agitation, extreme paranoia, or suspicion. Low-end symptoms include lethargy and fatigue, while as symptoms persist, feelings of anxiousness and anxiety will likely continue for a few days or weeks as the toxins gradually are eliminated from the body. Strong cocaine cravings, however, may continue longer, or even suddenly appear after years of sobriety.
SYMPTOMS OF OPIATE WITHDRAWAL
A user of opiate narcotic drugs who stops or cuts back on use after using heavily for a few weeks or longer will experience a number of symptoms of withdrawal. Opiate drugs include fentanyl, heroin and narcotic pain relievers, including codeine, heroin, hydrocodone (Vicodin), hydromorphone (Dilaudid), methadone, meperidine (Demerol), morphine, and Oxycodone (Oxycontin, Percocet).
Heroin Withdrawal Symptoms
Someone experiencing withdrawal symptoms of heroin will find they start setting in within 6-12 hours after last use and typically lasts about a week. Chronic heroin users, however, can have withdrawal symptoms that last 3-4 weeks.
Heroin withdrawal symptoms happen in phases. During the first phase, starting in days 1-3, heroin withdrawal symptoms first experienced are generally temporary, peaking between 2-3 days. These withdrawal symptoms include agitation, aggression, anxiety, digestive problems, headaches, insomnia, irritability, loss of appetite, muscle aches/pains, nausea, panic attacks and sweating. Most of heroin’s most intense symptoms of withdrawal subside by days 3-5, with remaining symptoms that may include chills, fatigue, minor muscle aches, stomach cramps, and tremors. By days 6-7, most withdrawal symptoms have dissipated, with only mild discomfort remaining.
Chronic heroin users or those diagnosed with heroin use disorder will likely experience longer-lasting withdrawal symptoms. And, as a 2018 study in Drug and Alcohol Dependence found that, 65 percent of heroin injectors experience infections of the skin and soft tissue. Researchers said treatment is often delayed due to fear of withdrawal symptoms and inadequate pain management.
Prescription Painkiller (Vicodin) Withdrawal Symptoms
Vicodin (hydrocodone bitartrate and acetaminophen) withdrawal starts shortly after cessation of drug use. How long Vicodin 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.
Vicodin withdrawal symptoms include:
- Abdominal cramps
- Appetite loss
- Cold/flu-like symptoms
- Fatigue (severe)
- Intense psychological cravings
- Mood swings
SYMPTOMS OF METHAMPHETAMINE WITHDRAWAL
Anyone stopping methamphetamine (meth) use will likely experience painful and even dangerous symptoms of withdrawal. In general, symptoms cluster and vary in frequency, intensity and duration, depending on whether the user is in early or later stage of meth withdrawal.
Meth withdrawal symptoms include:
- Increased appetite
- Lack of motivation
- Mood swings
- Red, itchy eyes
- Suicidal thoughts
SYMPTOMS OF MARIJUANA WITHDRAWAL
Although not life-threatening and usually without physical symptoms, marijuana withdrawal symptoms are typically psychological. As a 2018 study in CNS Drugs reported, some 30 percent of regular marijuana (cannabis) users report withdrawal symptoms when they quit. Regular users can see symptoms start to reverse within 2 days of quitting, with a return to normal within 4 weeks of abstinence from marijuana. Severity of cannabis withdrawal syndrome varies and depends on the amount of cannabis used before quitting, gender, heritable and several environmental factors. For chronic dependent marijuana users or those diagnosed with cannabis use disorder (CUD), the incidence of withdrawal symptoms can range from 50-95 percent.
Common symptoms of marijuana withdrawal include:
- Intense Craving — The most common symptom of marijuana withdrawal, intense craving has been reported by more than 75 percent of marijuana smokers.
- Mood Swings — Reported by slightly more than 50 percent of those trying to quit, mood swings can range from euphoria to anger to depression, along with reported irritability, anxiety, aggression, loss of concentration, nervousness and restlessness.
- Sleep Problems – About 47 percent of marijuana smokers report insomnia and sleep problems when trying to quit. These can last a few days or a couple of weeks, although some former users have occasional sleeplessness months after quitting. A 2014 study in The American Journal on Addictions showed that sleep problems/vivid dreams actually increased over time among chronic cannabis smokers.
- Headaches – Headaches usually start 1-3 days after quitting. A 2012 study published in Clinical Neurology and Neurosurgery found that 18 percent of psychoactive substance abusers reported headache after using the substance or during withdrawal. Cannabis was the most commonly-used substance (80.5 percent).
SYMPTOMS OF PRECIPITATED WITHDRAWAL
Another type of withdrawal is precipitated withdrawal. A rapid and intense onset of opiate withdrawal symptoms, precipitated withdrawal is triggered by starting MAT too soon after last dose of opiates. Medications used for MAT to overcome opiate dependence and addiction include Suboxone (which combines buprenorphine and naloxone) and naltrexone. Symptoms of precipitated withdrawal may be severe, and may, in some cases, require hospitalization.
Common symptoms of precipitated withdrawal include:
- Abdominal cramps
- Altered consciousness levels
- Severe agitation
- Anxiety, agitation
- Body aches
- Severe diarrhea
- Dilated pupils
- Increased heart rate
- Low blood pressure
- Muscle cramps
- Excessive vomiting
For more about withdrawal symptoms for various drugs and alcohol, addiction and recovery, check out these articles:
How Long Will 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
- MedLine Plus. “Cocaine withdrawal.” Retrieved from https://medlineplus.gov/ency/article/000947.htm
- MedLine Plus. “Opiate and opioid withdrawal.” Retrieved from https://medlineplus.gov/ency/article/000949.htm
- 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
- Substance Abuse and Rehabilitation. “The cannabis withdrawal syndrome: current insights.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28490916
- 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