holding a wine bottle

Withdrawal is a common problem for people who develop a physical dependence on alcohol, illegal drugs or legal, mind-altering medications. It occurs when the brain, which has grown accustomed to the regular presence of a given substance, reacts badly when the use of that substance falls sharply or comes to an end. While unpleasant, withdrawal is a necessary first step in overcoming physical dependence and establishing a substance-free lifestyle.

Facts About Alcohol Withdrawal

Alcohol withdrawal can produce mild, moderate or severe — even fatal — symptoms. But this doesn’t mean every alcoholic requires medical detox. Only about 10% to 20% of alcoholics will experience alcohol withdrawal that’s serious enough to require monitoring and medication. The trouble is it’s difficult to know if you fall into that group without medical input and making a guess can be risky. Even if it’s not a medical necessity, many people still choose medical alcohol detox to ensure their comfort, safety and progress to the next stage of treatment. In addition, it’s important to seek medical help even for mild symptoms because alcohol withdrawal symptoms can get worse quickly. Others who shouldn’t stop drinking abruptly without supervision include people with other health conditions or who have gone through alcohol withdrawal before.

If your fear of alcohol detox is keeping you from getting help, ask questions. You may not require medical detox, but if you do, there are many ways to make your symptoms more manageable.

Most people dependent on alcohol experience mild symptoms, which can include things such as:

  • A depressed or “down” mental state
  • Irritability, nervousness or anxiousness
  • Unusual jumpiness or jitteriness
  • Pupil dilation
  • Nausea
  • Vomiting
  • An unusually rapid heartbeat
  • Loss of sleep
  • Unstable or shifting moods
  • Headaches
  • Trembling hands
  • Nightmares

These symptoms usually appear about eight hours after alcohol consumption falls off or ends. They reach their worst in roughly one to three days before tapering off for several more days.

Symptoms associated with moderate or second-stage alcohol withdrawal include:

  • High blood pressure
  • A hallucinatory state called alcoholic hallucinosis
  • Full-body seizure known as a grand mal seizure
  • Delirium tremens

Second-stage symptoms are less common than mild symptoms. They usually appear 12 hours to four days after drinking stops or drops off. Delirium tremens (known informally as the DTs) is a potentially life-threatening condition. In addition to grand mal seizures, a person going through the DTs can develop serious or lethal changes in heart rhythm, as well as a range of other symptoms. It can develop after a period of heavy drinking, particularly among those who drink heavily every day for several months. DTs can also be caused by illness in someone with a history of alcohol abuse, and is more common in people with a history of alcohol withdrawal or a long history (10-plus years) of drinking alcohol. The condition usually develops within 48 to 96 hours after the last drink, but it’s possible to experience DTs up to 10 days after drinking.

Delirium tremens is a medical emergency that needs to be treated in a hospital intensive care unit, where medical staff can track vital signs and other critical functions, treat symptoms, and administer medication to keep the person calm until they stabilize. In addition, the person may have other alcohol-related illnesses that require treatment, such as alcoholic liver disease or alcoholic cardiomyopathy. For example, when someone drinks a lot but doesn’t eat much, they take in a lot of calories but little nutrition and their B vitamin levels drop. Because the brain doesn’t work well when vitamin B1 is depleted, such life-threatening issues as Wernicke-Korsakoff syndrome can develop, which can progress to a type of psychosis.

Treatment for alcohol-related withdrawal often includes the use of IV fluids to offset the loss of fluids through vomiting and high sweat output. Alcohol withdrawal medication options center on the use of benzodiazepine sedatives such as Xanax, Ativan and Valium. Doctors may use these medications on a set schedule, or only when called for by the specific symptoms affecting their patients. A classic tool for alcohol detox is the Clinical Institute Withdrawal Assessment for Alcohol, or CIWA. This 10-item scale is used by medical professionals to gauge the severity of alcohol withdrawal. It also helps guide the process for managing symptoms, including whether to prescribe benzodiazepines. These objective, validated tools have been studied and proven to reduce treatment duration and minimize the risk of over- or under-treatment.

Facts About Drug Withdrawal

Many types of drugs and medications can trigger dependence and addiction, including stimulants (e.g., cocaine, amphetamine and methamphetamine), opioids (e.g., heroin, oxycodone and hydrocodone), marijuana/cannabis and benzodiazepines. In turn, each type of drug or medication produces its own withdrawal symptoms. For example, opioid withdrawal commonly leads to symptoms such as:

  • Excessive tear and mucus output
  • Achy or cramping muscles
  • Abdominal pain
  • Body chills

The symptoms of withdrawal from benzodiazepines, which are typically used to treat anxiety and insomnia, can be similar to alcohol, and may require medical detox. Some of the most common symptoms of benzo withdrawal mirror the issues the person was trying to address with the medication, such as insomnia and panic attacks. Other symptoms include muscle tremors, sweating, nausea, dizziness, rapid heart rate, headaches and irritability. But it can get worse, especially for those who take high doses or take the drug for a long period of time. Seizures and hallucinations can occur, in some cases reaching levels of severity most commonly associated with drugs like alcohol.

People coming off of Xanax have reported confusion, elevated temperature, distressing sensations like insects on the skin and hallucinations (often snakes or spiders), which are very similar to symptoms of alcohol DTs. Because benzo withdrawal can be lethal, people who are dependent on these drugs may require supervised medical detox.

The symptoms of cannabis/marijuana withdrawal also partially resemble those of alcohol withdrawal, and may include:

  • A depressed mental state
  • Headaches
  • Trembling muscles
  • A restless, anxious or irritable mental state
  • Sleep disruptions
  • Loss of appetite
  • High sweat output
  • Stomach pain
  • Fever

Stimulant withdrawal can lead to symptoms such as:

  • Loss of appetite
  • Periods of insomnia and excessive sleepiness
  • Pointless or aimless body movement
  • A depressed mental state that may meet the terms for an official depression diagnosis
  • An anxious or irritable mental state
  • Realistic dreams/nightmares
  • Jitteriness or paranoia
  • Memory problems

In addition, all forms of drug withdrawal can include a strong craving for an active return to the substance in question. People typically think of withdrawal as a three- to five-day process. And it is. But that’s the first stage of a two-part process. After “acute withdrawal,” there’s a second phase of withdrawal called post-acute withdrawal syndrome (PAWS), which can last a year or more. During this time, people often feel tired and irritable and unable to sleep or think properly. It’s a phase marked by intense emotional ups and downs as the brain chemistry gradually returns to normal.

PAWS is less feared and less understood than acute withdrawal, but it’s far more likely to cause relapse. By week three into recovery, most people start to feel a little better and their energy starts to improve. By the third or fourth month, they’re 80% of the way there. But it’s a slow go so it’s important to have realistic expectations.

Recovery is also different depending on the drug used. The drugs that do the least harm while you’re using them — for example, benzodiazepines — tend to be more challenging to recover from. On the other hand, alcohol, which does the most harm when you’re actively addicted, has a fairly quick recovery period.

Withdrawal Doesn’t Necessarily Mean You’re Addicted

Not everyone who experiences withdrawal symptoms is addicted. People who take prescription medication in accordance with their doctor’s orders, following surgery or to treat chronic pain, for example, may become physically dependent on the drug. This means their brain has grown accustomed to it. They may experience withdrawal symptoms if they abruptly stop using it. But this doesn’t mean they’re addicted. Certain blood pressure medications, antidepressants and other non-addictive medications can also lead to withdrawal if suddenly stopped. Conversely, some highly addictive drugs like crack cocaine don’t cause withdrawal symptoms.

Has Your Use Become Addictive?  Ask Yourself These Questions:

Are you using the medication in accordance with your doctor’s orders?

Do you crave the medication when you aren’t using it?

Do you continue to use the medication in spite of negative consequences?

Talk with an addiction specialist if you feel yourself losing control or others have begun to express concerns about your medication use.

Get Unstuck

There is a great deal of fear around drug detox and alcohol withdrawal. While the fear is understandable — withdrawal can be painful and lead to quick relapse if it isn’t handled properly — knowing what to expect can mean the difference between letting fear keep you stuck in addiction and taking the first bold step toward recovery.

Seek Expert Help

Whether you or your loved has a problem with alcohol, an illegal drug or a prescription medication, seek advice and help from a qualified addiction expert. Only professionals who understand how dependence and addiction affect your mind and body can properly safeguard your health through the withdrawal process. In addition, only experts in the field can assess your progress through withdrawal, help you follow up with appropriate enrollment in a substance treatment program, and thereby help you establish a lasting, substance-free lifestyle.

Resources

U.S. National Library of Medicine – MedlinePlus: Alcohol Withdrawal https://medlineplus.gov/ency/article/000764.htm

American Family Physician: Alcohol Withdrawal Syndrome http://www.aafp.org/afp/2004/0315/p1443.html

World Health Organization: Management of Substance Abuse – Withdrawal State http://www.who.int/substance_abuse/terminology/withdrawal/en/

National Institute on Drug Abuse for Teens: Marijuana Withdrawal Is Real https://teens.drugabuse.gov/blog/post/marijuana-withdrawal-real

Substance Abuse and Mental Health Services Administration: Quick Guide for Clinicians – Treatment for Stimulant Use Disorders https://store.samhsa.gov/shin/content/QGCT33/QGCT33.pdf