Withdrawal from drugs and alcohol is a difficult, painful and even life threatening process. It is imperative that an individual with a significant substance use disorder seek proper medically monitored or medically managed detoxification services before holistic and psychological interventions can take root to establish long-term recovery experiences. This is a comprehensive overview of the withdrawal symptoms and timelines associated with common drugs of abuse.
Note: the severity and duration of detoxification is affected by several factors, including:
– Level of dependency
– Length of abuse
– Substance type
– Method of use
– Amount(s) taken
– Family history
– Medical factors
Alcohol
Withdrawing from alcohol occurs over three distinct phases, beginning from 6 to 24 hours after an individual’s last drink.
Alcohol Withdrawal
Stage 1
Insomnia, anxiety, abdominal pain, loss of appetite, nausea, fatigue, tremors, clouded mental functioning, mood swings, tremors & heart palpitations.
- Stage 1 occurs between 6 and 8 hours after the last drink of alcohol is consumed.
- This is early in the withdrawal process, and alcoholics who are not yet fully detoxing will often go get another drink to “calm their nerves”.
Stage 2
High blood pressure, increased body temperature, irregular heart rate, sweating, irritability, mood disturbances
- Stage 2 occurs between 1 and 3 days after the last drink
- Increased blood pressure and heart rate bring about significant disturbance. A sudden separation from alcohol may send the body into a state of shock, and may cause abused organs to begin to fail.
Stage 3
Hallucinations, seizures, confusion, agitation, fever
- Stage 3 usually lasts from 3 days to a week but may endure for several weeks if left untreated.
- This is the phase of detoxification wherein alcoholics develop delirium tremens, including potentially permanent psychological symptoms.
Opioids
Early opioid withdrawal often starts within 6 to 12 hours following the last use of short-acting opioids, and around 30 hours for longer-acting drugs.
Opioid Withdrawal
Early Symptoms
- Aching Muscles
- Agitation
- Irritability
- Insomnia
- Yawning
- Anxiety
- Runny Nose
- Sweating
- Increased Heart Rate
- High Blood Pressure
- Fever
Late Symptoms
These symptoms peak within 72 hours and usually last a week or more:
- Nausea and vomiting
- Diarrhea
- Goosebumps
- Stomach cramps
- Depression
- Drug cravings
Heroin
Heroin addiction is well and accurately described as a condition of the mind and body. Withdrawal includes a multitude of both physiological and psychological symptoms, and is one of the most difficult phases in overcoming heroin addiction, but it can be done. It’s essential to understand what to expect to best prepare for what is commonly a life-altering experience. Withdrawal timelines may vary from person to person, depending on many factors. However, heroin withdrawal often operates along a fairly common trajectory.
Symptoms & Timeline
Physical
- A runny nose
- Nausea
- Abdominal pain
- Tremors or shaking
- Yawning
- Muscle cramping
- Rapid heart rate
- Hypertension
- Drug cravings
- Excessive sweating
- Overproduction of tears
- Aches and chills
- Vomiting
- Diarrhea
- Goosebumps
Psychological
- Agitation or irritability
- Difficulty concentrating
- Mood disorders
- Difficulty feeling pleasure
- Insomnia
- Fatigue
- Mood swings
- Restlessness
- Personality changes
Phase 1: Days 1-3
Most withdrawal symptoms start within the first 24 hours after a person stops using heroin. Withdrawal symptoms can be uncomfortable, or even painful. As a result, relapse is very likely to occur during the first two or three days of withdrawal. Early symptoms include:
- Aggression
- Headaches
- Irritation
- Muscle pain
- Sweating
- Stomach problems
- Insomnia
- Anxiety
- Loss of appetite
- Panic attacks
Phase 2: Days 3-5
Following the initial phase of heroin withdrawal, an individual is likely to feel:
- Stomach cramping
- Minor muscle aches
- Shivers
- Fatigue
Remember, each person experiences withdrawal differently. For many people, symptoms may persist beyond five days, or even 7.
Benzodiazepines
Withdrawing from benzodiazepines is difficult and can be life threatening. Many people experience seizures, hallucinations, anxiety, and trouble falling and staying asleep. The withdrawal timeline may last anywhere from days to weeks.
Benzodiazepine Withdrawal
Acute Symptoms
According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), an individual who experiences 2 or more of the following symptoms within several hours to a few days after quitting or slowing their benzodiazepine use may be experiencing benzodiazepine withdrawal:
- Anxiety
- Insomnia
- Hallucinations
- Nausea or vomiting
- Psychomotor agitation
- Increased heart rate
- Seizures
- Sweating
- Tremors
Post-Acute Symptoms
After detox many people may experience post-acute withdrawal symptoms (PAWS), or protracted withdrawal. Signs of PAWS include:
- Anxiety
- Insomnia
- Aches and pains
- Difficulty performing tasks
- Poor concentration
- Decreased libido
- Depression
PAWS mimics mental health issues like anxiety and depression, and may be difficult to distinguish from a mood disorder.
Detox Timeline
Withdrawal timelines differ from individual to individual and are influenced by factors like length of use, and whether the individual abused any other substances concurrent with benxodiazepines. The timeline will also vary depending on which type of benzodiazepine the person used.
- Short-acting benzodiazepines (Ativan, Xanax, Restoril): Withdrawal effects begin within 6-8 hours, peak around the second day, and begin to improve on the fourth or fifth day.
- Long-acting benzodiazepines (Valium, Librium): Withdrawal effects may not develop for more than a week, peak during the second week, and improve during the fourth or fifth week.
Cocaine & Crack Cocaine
It may take weeks for acute cocaine withdrawal to resolve. Cocaine manifests detox symptoms that can start just hours after an individual’s last use, and extend for days, weeks and even months after cessation. However, the general timeline is around a month and can be understood and approached in standard time periods, or phases:
Withdrawal Timeline
24-72 Hours After Last Dose
- Confusion
- Depression
- Disorientation
- Cravings
- Fatigue
- Hunger
- Irritability
- Restlessness
- Remorse
- Sleep deprivation
4-7 Days After Last Dose
- Anxiety
- Apathy
- Decreased cravings
- Depression
- Dysphoria
- Irritability
- Paranoia
Week 1
- Agitation
- Decreased cravings
- Increased appetite
- Feeling better
- Unpleasant dreams
Week 2
- Anger
- Cravings return
- Depression
- Vivid dreams
Weeks 3-4
- Depression
- Mood swings
- Problem sleeping
- Stress
Long Term
Individuals who have abused cocaine for extended periods may additionally experience Post Acute Withdrawal Symptoms (PAWS), including:
- Anxiety
- Agitation
- Cravings
- Depression
- Mood swings
Unique Detoxification Programs
Bradford Recovery Center’s PA drug rehab centers employ a unique approach to individualized detoxification and treatment designed to address the complex needs arising out of substance withdrawal. There is no one-size-fits-all approach to separation from drugs of abuse, and patients at BRC may participate in various holistic, experiential and evidence based programs aimed at establishing lasting health and wellness. Call today for a free substance abuse assessment.
