Withdrawal is one of the first steps to overcoming a drug problem, but it can be a very distressing and uncomfortable experience. To safely go through drug withdrawal, you need careful medical supervision and extensive follow-up treatment.
The withdrawal process will differ, depending on the substance of abuse, the length of abuse, and personal factors.
Alcohol withdrawal occurs when a person who has been regularly drinking a lot of alcohol and suddenly discontinues their consumption.
The chemical changes that occur are because alcohol is a central nervous system (CNS) depressant. When it is present, it slows down the responses and operations of the brain and its myriad connected systems. The more you expose your CNS to this depressant, the more work the brain has to do to overcome the dulled responses and muted nerve functions.
When the alcohol intake is abruptly stopped, the brain does not revert to pre-drinking levels. It has to overcome its depressed state, and this uncomfortable process is what is behind alcohol withdrawal.
The initial effects of alcohol withdrawal are not dissimilar to those of a hangover. There may be nausea, headache, malaise, and general fatigue.
People who are ending alcohol consumption will go through the tougher parts of withdrawal, after building a physical and/or psychological dependence on drinking. These include periods of depression and anxiety and a desperate craving for more alcohol.
For those who drank to the point of developing mental health imbalances, the psychological effects of withdrawal can come as early as 12 hours after the last drink of alcohol has been metabolized. Hallucinations, uncontrollable trembling, and even seizures may occur.
While all forms of drug withdrawal carry some risk with them, alcohol withdrawal is one of the few processes that can actually be fatal. The seizures that come with withdrawal can make people vomit up food from their stomach and inhale it through their trachea, possibly leading to a choking death.
How To Safely Withdraw From Alcohol
As the body adjusts to the toxicity of the alcohol, suddenly removing it from the equation upsets a very precarious balance. Someone addicted to alcohol, which quickly deprives the body of the substance will risk dysfunctions of multiple organs and systems, including the heart, kidneys, or liver. Any additional weaknesses in these areas can prove deadly.
The best way to treat an alcohol problem is to get professional help. This can mean going to a treatment facility, where you will receive the medication and care you need to control the worst parts of the withdrawal process.
Psychology Today writes that clients in medical detox are given benzodiazepines to calm their central nervous systems, and fluids to ensure that nutrients lost through vomiting and diarrhea are quickly replaced. Doing so reduces the risk of seizures and hallucinations.
Detox & Therapy
When undergoing withdrawal in a controlled, secure way, with appropriate medical and emotional support, the process is known as medical detox. This is the only recommended way for people who have chronic alcohol dependence disorders to break free of their compulsion to drink. Doing it alone is fraught with risk, from the possibility of relapse to the real danger of death.
Following this time of medical detox, clients receive therapy to heal from the psychological damage of alcohol addiction. They also address any underlying issues behind the dependence on alcohol.
People who receive ongoing support, usually in the form of 12-step or alumni programs, stand the best chance of enjoying a long-term recovery from alcohol addiction.
Opioids & Withdrawal
Opioid drugs come in many different forms: medicinal ones like oxycodone, hydrocodone, and codeine; and illegal ones, like heroin. Regardless of the presentation or legitimacy of the use, they are all chemically similar, which accounts for the shared effects, potency, and forms of treatment.
Their potency means that opioids can induce withdrawal symptoms only hours after the last dose.
Unlike alcohol, opioid withdrawal is rarely life-threatening. However, the stress it puts on the body can be such that it leads to health conditions that themselves are life-threatening.
There is always the danger of relapse if you are not adequately monitored during the withdrawal process.
Basic withdrawal symptoms of opioid use include:
- Pain in the muscles, joints, and bones
- Nausea and diarrhea
- Wild mood swings
- Episodes of depression and anxiety
- Flu-like symptoms
- Cravings for more opioids
Brain Changes & Half-Life
As with most forms of substance abuse, chronic use of a chemical substance will change the way your brain functions, rewiring and rewriting key neural pathways. This is what leads to the physical and psychological dependence that is characteristic of addiction.
It also makes quitting a drug of abuse very difficult and painful. Being on an opioid becomes the new normal, so much so that withdrawal symptoms can start between doses.
In terms of timeline, the Anesthesiology journal writes that every opioid has its own half-life, which is how long it takes for half the amount of the drug to be removed from the body.
Withdrawal symptoms can start at different times, based on the opioid itself and how it was taken. As the fastest-acting opioid, heroin also has the shortest half-life of the drugs in the opioid family starting anywhere in a few minutes to a few hours.
Prescription opioids, like oxycodone and hydrocodone, are engineered to be short-acting (so people get quick relief from their pain). As a result, they tend to have half-lives that last around six hours. Methadone, a slow-acting opioid, has a half-life of 30 hours.
This is vital information for a doctor to have when a person needs to be detoxed from an opioid, as it will influence what kind of medication the person is given to ease the process.
Opioid Withdrawal Timeline
The extent of the opioid withdrawal symptoms can also depend on how long the particular opioid was taken, how much was taken, and if there are other drugs present in the system. Underlying mental health and physical health issues, and biological or environmental factors, such as stress and a family history of addiction or lack thereof, are also considered.
The first withdrawal symptoms start to present themselves within 12 hours of the last dose for short-acting opioids and within 30 hours for the longer-acting ones.
Three days after the first onset, withdrawal symptoms hit their peak. People experience the most physically exacting effects, such as loss of nutrients through vomiting and diarrhea, and endure periods of clinical depression and an overwhelming desire to go back to opioids.
How To Safely Withdraw From Opioids
On its own, going through opioid withdrawal is rarely life-threatening, although the distress can be so severe that people can feel like they are dying or even like they want to die. The real danger is when the stress placed on the body itself is not treated.
Dehydration is a real threat, for example, because of all the vomiting, sweating, and diarrhea. If fluids are not replenished with an IV drip, there is a danger of experiencing multiple organ failure, which is a medical emergency that will result in death if not immediately treated.
Similarly, opioid withdrawal can push the heart to such extremes that it cannot pump blood as regularly and as effectively as it should. This is a condition known as cardiac arrhythmia. The European Society of Cardiology explains that cardiac arrhythmias can lead to death, and this is a real danger if an opioid user attempts to discontinue their use without proper precautions.
Precautions include withdrawing from opioids in a hospital or treatment center, where there are trained medical staff on hand to ensure safety and comfort. They will administer drugs and supplements to keep vitals in check and ensure that seizures are kept to a minimum and controlled. Specific medications, such as buprenorphine, can be given to strategically wean off chemical dependence on opioids.
Critically, staff can administer the medications in the proper doses and formulations, making sure that introducing more chemicals to a precariously unbalanced system does not cause further problems.
Therapy & Social Support
In many cases, the psychological symptoms of opioid detox will outlast the physical symptoms. Even after the body has stabilized, and supplied with adequate nutrition and rest, therapy and psychological support are needed to address the mental damage done by the withdrawal process. It will also bring to light any mental health problems that might have prompted the initial opioid abuse.
The outcome of this is that you will have the necessary coping skills and strategies when the temptation to relapse appears. In addition, ongoing social support (in the form of Narcotics Anonymous or another kind of aftercare program) will ensure that you have the best possible outcome from opioid detox.
Stimulants are another class of drugs for which people often seek medical detox due to unpleasant withdrawal experiences. Stimulants cause significant excitation in the central nervous system, giving users a boost of euphoria and strong feelings of alertness, physical strength, hyperactivity, and general energy.
In some ways, this can be beneficial. Prescription stimulants like Ritalin and Adderall are effective at moderating the symptoms of attention deficit hyperactivity disorder. Caffeine, as a stimulant, is widely used by millions of people to get a start on their day.
However, pharmaceutical stimulants are also abused recreationally for their effects. Illegal drugs like methamphetamine and cocaine are also stimulants, and they are infamous for their trafficking and use.
Changes & Withdrawal
When a stimulant is taken at a dangerous level, general effects include an increased heart rate and blood pressure, as well as increased respiration and body temperature.
As with many other drugs, abruptly discontinuing stimulant intake can be very dangerous and bring about destabilizing withdrawal symptoms.
How long these symptoms take to begin, and how long they last, can vary greatly based on many factors. These include the nature of the drug, how much was being taken, and if there were other drugs present in the user’s system. Also taken into consideration are if the user has other mental health or physical issues, if there is a family history of substance abuse, and other environmental or lifestyle factors.
Prescription stimulants, for example, are designed to be extended-release, so that users are not overwhelmed by their chemical effects. For that reason, withdrawal tends to be longer, but less distressing than with illicit stimulants, which are designed to go into effect immediately upon consumption.
Cocaine, for instance, is a fast-acting and quickly metabolized stimulant. Its withdrawal period might be shorter than that of Ritalin, but it will be much more intense.
Regardless, unsupervised withdrawal is always risky, as the cascade of symptoms can easily cause other health problems that could be permanent or even fatal. Many stimulant users will experience rapid psychological changes as they withdraw, covering everything from deep depression to hallucinations to paranoia. If left unchecked, these conditions can make users act dangerously toward themselves and others.
Symptoms & Safe Withdrawal
Other effects of stimulant withdrawal include insomnia, fatigue, and an unshakeable craving for more stimulants. Without medical support, the risk of relapsing on drugs during this critical time is very high, and actually indulging in that desire could deepen the addiction to deadly levels.
If you go through withdrawal with proper medical care in a treatment facility, doctors and staff will be available to ensure that the cravings are dealt with in safer ways.
Benzodiazepines are another group of drugs that necessitate medical detox when physical dependence is present. If you suddenly stop taking these drugs cold turkey, seizures are possible, and they could be deadly.
Even if you’ve been taking benzodiazepines for a while, according to a doctor’s prescription, you shouldn’t stop taking them suddenly. Your doctor will advise you to gradually reduce your dosage over a period of days or weeks. This tapering process prevents withdrawal symptoms that can be dangerous.
Benzodiazepines are sometimes used during alcohol withdrawal to prevent seizures that can occur due to delirium tremens (DTs). Long-acting benzo is generally used, and this dose is reduced in the same tapering fashion to prevent withdrawal symptoms.
Drug abuse can do serious damage to your mental health. Getting through withdrawal without help will not protect against the psychological fallout of the addiction process. Much therapy and work need to be done after withdrawal, and this will likely not happen if you attempt to go through withdrawal on your own.
Medical detox ensures that the physical stresses of withdrawal are monitored and managed. It will also make sure that you are connected to a therapist as soon as possible.
This will give you the best chance of long-term recovery from drug abuse, as you will rapidly understand the mechanics and psychology of your addiction, and how you can defend yourself against relapse in the future.