Alcohol and Drug Withdrawal
According to the Substance Abuse and Mental Health Services Administration, more than 40 million Americans 12 or older had some type of substance use disorder (SUD) in 2020, with an estimated 28.3 million of those people having an alcohol use disorder (AUD).1
Many individuals with AUD or SUD make the decision at some point to stop using drugs or alcohol. With certain types of substances, if a person stops suddenly, they may experience uncomfortable or even dangerous withdrawal symptoms, which is itself one of the criteria used when clinicians diagnose substance use disorders.1
Understanding withdrawal and how it can be managed safely is important if you or a loved one wants to stop using drugs or alcohol.
What is Withdrawal?
Withdrawal occurs when quitting alcohol and many other types of drugs. People may experience a withdrawal syndrome associated with the substance that was used, which may involve several unpleasant physical and emotional symptoms.2
Withdrawal symptoms are one of the diagnostic criteria for substance use disorders in the Diagnostic and Statistical Manual of Mental Disorders (5th edition), which is used by clinicians to help diagnose SUDs.6
Withdrawal symptoms vary according to the specific substance they are associated with but can often be very uncomfortable and even dangerous in some instances. Some of these withdrawal symptoms may be more safely managed with supervision and medication during a detox phase of treatment.
Alcohol Withdrawal Symptoms
The course and severity of alcohol withdrawal symptoms vary from person to person. The severity of symptoms may be increased by factors like age, co-occurring conditions, nutritional factors, and overall health.7
Alcohol withdrawal symptoms can range from mild to life-threatening with the potential for severe medical complications.8
Symptoms of alcohol withdrawal can include:6, 8
- Increased blood pressure.
- Elevated heart rate.
- Nausea and vomiting.
- Anxiety and agitation.
- Hypersensitivity to light, sound, and touch.
- Paranoid/persecutory delusions.
Drug Withdrawal Symptoms
The speed of onset, duration, character, and severity of various types of drug withdrawal symptoms depends on several factors including:
- The specific substance used.
- Average quantity or dose being used.
- Frequency of use.
- The total duration of such use.
Symptoms can range from mild to dangerous, such as is the case with benzodiazepine and other types of sedative withdrawal.5 In general, some potential withdrawal symptoms are seen in several types of withdrawal syndromes include:5
- Changes in mood.
- Gastrointestinal disturbances.
- Movement disturbances.
- Changes in heart rate and/or blood pressure.
Stimulant Withdrawal Symptoms
Symptoms of stimulant withdrawal can include:6
- Dysphoric mood.
- Increased appetite.
- Insomnia or hypersomnia.
- Unpleasant, vivid dreams.
- Psychomotor slowing.
- Psychomotor agitation.
Opioid Withdrawal Symptoms
Symptoms of opioid withdrawal can include:6
- Dysphoric mood.
- Excessively runny nose and eyes.
- Goosebumps, dilated pupils, or sweating.
- Muscle aches.
Heroin Withdrawal Symptoms
Symptoms of withdrawal from heroin can include:5, 8, 9
- Bone and muscle pain.
- Abdominal cramping.
- Goosebumps, cold flashes.
- Muscle spasms.
- Restlessness, uncontrollable leg movements.
- Runny nose.
- Tearing and yawning.
Benzodiazepine Withdrawal Symptoms
Symptoms of benzodiazepine withdrawal can include:5, 6
- Anxiety and panic.
- Poor concentration and recall.
- Racing pulse.
- Muscle aches, tension.
- Perceptual changes.
- Hand tremor.
Marijuana Withdrawal Symptoms
Symptoms of withdrawal from marijuana can include:5, 6, 8
- Depressed mood.
- Anxiety and nervousness.
- Sleep disturbances.
- Irritability, aggression, anger.
- Abdominal pain.
- Gastrointestinal upset.
- Appetite changes.
Drug Withdrawal Timelines
Withdrawal symptoms can start within hours to days and last from days to weeks, depending on individual factors, such as:4
- Duration of use.
- How often a substance is used.
- Quantity used.
- Substance used.
General timelines for specific substances are as follows:
- Stimulants: Symptoms begin within 24 hours of the last dose and may last 3 to 5 days.5
- Long-acting benzodiazepines: Symptoms begin within 2 to 7 days after the last dose and may last longer than 2 to 8 weeks.5
- Short-acting benzodiazepines: Symptoms begin within 1 to 2 days after the last dose and may last longer than 2 to 4 weeks.5
- Long-acting opioids (for example, methadone): Symptoms begin 12 to 48 hours after the last dose and may last 10 to 20 days.5
- Short-acting opioids: Symptoms begin 8 to 24 hours after the last dose and may last 4 to 10 days.5
- Heroin: Symptoms begin within 24 hours of the last dose and may last 4 to 7 days.8
- Marijuana: Symptoms may begin within days and may last several weeks.8
Risks of Withdrawal
Substance use disorders can have far-reaching consequences for both physical and mental health. People going through withdrawal may have co-occurring medical and/or psychological conditions that can influence the severity of withdrawal and potentially introduce additional withdrawal risks or complications.8
Throughout the range of different substance-specific withdrawal syndromes, some signs and symptoms that could indicate the need for urgent medical attention include:8
- Mental status changes.
- Increasing panic and anxiety.
- Fever greater than 100.4 may indicate concurrent infection.
- Significantly elevated blood pressure and heart rate.
- Abdominal pain.
- Gastrointestinal bleeding.
- Changing responsiveness to light shined in pupils.
- Hyperactive deep tendon reflexes (indicating neurological irritability and potentially pending seizure activity).
If you or a loved one experiences a medical emergency related to withdrawal, overdose, or other medical condition, call 9-1-1 immediately.
Drugs with the greatest risk of severe and/or complicated withdrawal include opioids, alcohol, benzodiazepines, and other CNS depressants.8
Treatment for Withdrawal
Withdrawal from drugs and alcohol can affect each person differently, so it’s important to find a treatment that suits a person’s needs and the substance being used. Due to the potential risks and discomfort of withdrawal, it’s best for a person to receive medical supervision throughout the detox and withdrawal process.
Relapse after withdrawal management is common so entering other forms of treatment after detox and withdrawal is key to successful recovery. To be effective, treatment needs to be easily personalized, accessible, and adaptable to meet the changing needs during treatment and recovery, starting with the withdrawal process.11 Medically assisted detoxification is a good first step in the recovery process.11
Detoxification and Withdrawal Management
Detoxification is a specific set of medical interventions to safely guide someone through the withdrawal phase while minimizing harm from the substance being misused.8 It can be provided in a variety of settings and levels of care depending on the person’s needs.
Detoxification is an important part of the recovery process. Supervision during detox can help reduce the intensity of withdrawal symptoms and prevent complications, some of which may be life-threatening.8 For some people, detoxification is their first interaction with available treatment systems.8
Detoxification generally has three components: evaluation, stabilization, and guiding the patient into ongoing treatment.8 After detoxification, other forms of treatment can provide ongoing support to help foster long-term recovery.
Medications Used for Withdrawal
The detoxification process is an important phase in recovery to help reduce or eliminate medical complications associated with some withdrawal syndromes, uncomfortable withdrawal symptoms, and cravings associated with stopping the use of substances.7
Detoxification is meant to address the physiologic effects of stopping the use of a substance. It is not intended to address the psychological, social, and behavioral problems associated with addiction.7
Medications are primarily used during withdrawal to:7
- Suppress withdrawal using cross-tolerant medications.
- Reduce withdrawal symptoms.
During detox, medications can also be used to manage co-occurring medical and mental health conditions. These conditions can include those like hypertension, diabetes, schizophrenia, severe depression, and anxiety, or other nutritional deficiencies.7, 8
Medications for Alcohol Withdrawal
Benzodiazepines are often used to treat alcohol withdrawal. They can help reduce the severity of withdrawal and risks of potentially life-threatening seizures.7, 8
The medications diazepam (Valium) and chlordiazepoxide (Librium) are often given by injection or by mouth.7, 8 Diazepam and chlordiazepoxide are longer-acting benzos and are particularly effective at reducing seizures associated with alcohol withdrawal.7, 8
Shorter-acting benzodiazepines include Lorazepam (Ativan) or oxazepam (Serax). They can also be effective at reducing alcohol withdrawal symptoms. They can also be used if a person is more at risk of too much sedation from longer-acting benzodiazepines. Elderly people, those with significant liver disease, or long-term respiratory depression may benefit from shorter-acting benzodiazepines.7, 8
Anticonvulsants can also be useful during alcohol withdrawal. The medication carbamazepine (Tegretol) has been shown to be as effective as benzodiazepines to help manage mild to moderate alcohol withdrawal.7
Carbamazepine doesn’t have the potential for abuse that benzodiazepines have.7 Long-term administration of carbamazepine has been associated with side effects like nausea, vomiting, and dermatitis, which may limit how long it can be used.13
The medication sodium valproate may be used in a similar way to carbamazepine.7
Other medications that may be useful for alcohol withdrawal include gabapentin, baclofen, clonidine, atenolol, and propranolol.7, 8, 13
Medications for Opioid Withdrawal
Choosing the medication used for opioid withdrawal is based on several factors including:7, 8
- Assessment of the severity of a person’s addiction.
- Co-occurring medical and/or mental health conditions.
- Other substances that are being misused.
- Type of treatment setting preferred.
The following medications may be used during opioid withdrawal:14, 15
- Methadone. A long-acting opioid agonist, it can help alleviate the uncomfortable withdrawal symptoms and reduce cravings. Due to its potential for misuse, it should be given under supervision in a hospital or treatment facility.
- Buprenorphine. A partial opioid agonist, buprenorphine helps to limit euphoric feelings that may cause a person to want to use opioids again. It can be effective at reducing cravings and the severity of withdrawal symptoms. Buprenorphine doesn’t require supervised administration. Some programs and/or providers have waivers from the federal government, so people can self-administer medication at home.
Inpatient and Outpatient Treatment
Following detox, people may continue their recovery in outpatient or inpatient/residential treatment at varying levels of intensity depending on the person’s needs.
Inpatient care involves a person living at the facility for the duration of treatment. Outpatient treatment allows a person to visit a facility to receive treatment services while still living at home.11
Inpatient and outpatient treatment can include various services, including:
- Individual and/or group therapy.
- Drug counseling.
- Medication management.
- Aftercare or continuing care planning.
- 12-step facilitation and support groups.
Detoxification and withdrawal from substances can be a difficult process that carries the risk of medical complications–but you don’t have to do it alone. If you or someone you love are struggling with substance misuse or addiction, help is available. Call American Addiction Centers at to learn about treatment options and check your insurance coverage so you or your loved one can begin recovery and lay a good foundation for a bright future.