Going Through Detox and Withdrawal

Desiring to stop using a substance can be a life-changing decision. However, the process of detoxification from substance use can be a difficult first step to recovery. This article will explore what detox is, why it happens, and what it may look like for different substances.

What Is Detox?

Detoxification from a drug is the process, with or without assistance, of allowing one’s body to fully cleanse itself from a drug.^{1(detoxification pg.4)} It refers to the process of clearing a drug from one’s body after acute intoxication or after chronic use with the development of physical dependence.^{1(detoxification pg.4)}While detox is often the first step in overcoming substance use disorder treatment, it is not designed to address the psychological aspects of addiction.^{1(detoxification, pg. 4)}Without further treatment, the brain changes involved in addiction remain.^{2(paragraph6)}

During detox, the levels of substances in a person’s body slowly diminish as they are cleared.^{1(detoxification pg. 4)} If a person has developed physical dependence upon the drug after chronic use, they may experience withdrawal symptoms during detox.^{2(paragraph6)} Furthermore, the experience of withdrawal symptoms during intentional or unintentional detox does not imply a person is addicted to the substance in question.^{2(paragraph5)} A person can have a physical dependence upon medications, such as opioids for chronic pain or some antidepressants, but after a successful detox, they do not engage with recurrent use or have ongoing signs of addiction.^{2(paragraph10)} Physical dependence can develop into addiction when a person continues to use the substance despite causing known harm and also shows other diagnostic signs of substance use disorder.^{2(paragraph11)}

Why Do Withdrawal Symptoms Occur?

Withdrawal symptoms may occur after a person has developed physical dependence upon a substance.^{2(paragraph5)} In plain terminology, a person’s body changes to accommodate the chronic presence of a substance.^3(etiology) When that substance is removed or quickly diminished, the body must quickly readapt to its absence.^3(etiology) Depending on the substance used, the process of readaptation may cause extremely uncomfortable or life-threatening withdrawal symptoms.^{3(history and physical)} Severe withdrawal symptoms can often be avoided or minimized by tapering the drug dose over time or with other medications administered for comfort or safety during detox.^{3(treatment/management)}

The amount and severity of withdrawal symptoms experienced depend on the duration of substance use, frequency of use, dose typically consumed, and personal factors.^{3(introduction)}

Alcohol Withdrawal

Physical dependence upon alcohol can lead to life-threatening symptoms during withdrawal from alcohol during detox. The first mild symptoms can arise as early as 6 hours after a person’s last drink.^{4(history and physical)} More severe symptoms may begin to show within 24-48 hours.^{4(history and physical)} Alcohol withdrawal symptoms can include:^1(pg.52)

• Feeling restless or agitated
• Irritation
• Anxiety
• Change or loss of appetite
• Nausea or vomiting
• Elevated heart rate or blood pressure
• Tremor
• Negative sleep changes (insomnia, vivid dreams, or nightmares)
• Difficulty concentrating
• Memory impairment
• Poor judgment
• Hypersensitivity to light, sound, and physical touch
• Hallucinations
• Delusions (such as paranoia)
• Seizures
• High fever
• Delirium

The seizures experienced in alcohol withdrawal can be life-threatening due to prolonged loss of consciousness, cessation of breathing and the possibility of bodily trauma from uncontrolled spasms.^{1(pg.50 bottom right)} Hallucinations, delusions, impaired cognition, and delirium can also put a person a state in which they are more likely to engage in dangerous or life-threatening activities.

Benzodiazepine Withdrawal

Benzodiazepines have a similar effect on the body as alcohol.^{1(pg. 74)} As a result, their withdrawal symptoms and dangers are similar as well.^1(pg.75) The timing of withdrawal from benzodiazepines depends heavily on the type of benzodiazepine used.^5(prognosis) Short-acting benzodiazepines can precipitate symptoms within hours of cessation of use, while longer-acting ones may take 1-2 days.^5(prognosis) Possible benzodiazepine withdrawal symptoms are:^{5(DSM-5 diagnostic criteria)}

• Hyperactive autonomic system (such as sweating, increased heart rate, and more)
• Tremor
• Difficulty sleeping
• Nausea or vomiting
• Hallucinations (visual, auditory, or tactile)
• Involuntary motor movements
• Feeling anxious
• Seizures
• Delirium

Without medical supervision and treatment, 20-30% of people undergoing withdrawal may undergo grand mal seizures.^{5(signs and symptoms)}

Marijuana (Cannabis) Withdrawal

Marijuana withdrawal is formally referred to as cannabis withdrawal by the Diagnostic and Statistical Manual of Mental Health Disorders (5^th edition) (DSM-5).^{6(pg. 517)} About one-third of people who have used cannabis regularly experience withdrawal symptoms, and 50-90% of people engaging in heavy use report withdrawal.^{6(pg. 518)} Symptoms may begin within 24-72 hours of cannabis cessation and commonly persist for 1-2 weeks.^6(pg.518) Cannabis withdrawal symptoms may include:^{6(pg.517-518)}

• Increased irritability, anger, or aggression
• Feeling nervous or anxious
• Difficulty with sleep
• Loss of weight or decrease in appetite
• Feeling restless
• Depression
• Abdominal pain
• Tremor
• Sweating
• Fever or chills
• Headache

Methamphetamine (Meth) Withdrawal

Withdrawal from methamphetamine is typically characterized by symptoms opposite to those experienced while taking meth.^6(pg.569) Symptoms may set in as early as a few hours after the last dose or take up to several days after prolonged usage.^6(pg.569) Meth withdrawal symptoms may include:^6(pg.569)

• Extreme tiredness
• Vivid, unpleasant dreams
• Difficulty sleeping (insomnia)
• Excessive sleeping (hypersomnia)
• Increase in appetite
• Slowed movements
• Agitation
• Slowed heart rate
• A feeling of general unwellness or lack of purpose
• Cravings

Cocaine Withdrawal

As a drug in the stimulant category, cocaine withdrawal symptoms are nearly the same as methamphetamine withdrawal.^6(pg.569) Within DSM-5, the two syndromes have identical diagnostic criteria as “stimulant withdrawal”.^6(pg.569) Thus, cocaine withdrawal may include:^6(pg.569)

• Extreme tiredness
• Vivid, unpleasant dreams
• Difficulty sleeping (insomnia)
• Excessive sleeping (hypersomnia)
• Increase in appetite
• Slowed movements
• Agitation
• Slowed heart rate
• A feeling of general unwellness or lack of purpose
• Cravings

Opioid Withdrawal

Opioid withdrawal is not life-threatening but does produce extremely uncomfortable symptoms that can be difficult to manage on your own.^6(pg.548)Depending on the type of opioid your body is used to taking, withdrawal symptoms may set in as early as 6 hours (for short-acting agents) or as late as four days (for longer-acting agents) from your last dose.^6(pg.548)Symptoms usually subside by seven days, but sub-acute withdrawal symptoms may persist for months.^6(pg.548) The severity of symptoms depend on the type and amount of opioid used but may include:^6(pg.548)

• Muscle aches
• Feeling extreme discontentment, depression, or indifference
• Nausea or vomiting
• Teary eyes
• Runny nose
• Dilated pupils
• Goosebumps
• Sweating
• Diarrhea
• Spontaneous daytime ejaculation (in males)^{6(pg.549 associated features)}
• Yawning
• Fever
• Insomnia

Post-Acute or Protracted Withdrawal Syndromes

After the period of acute withdrawal (described above), many people also experience post-acute or protracted withdrawal symptoms.⁷ Research indicates that post-acute withdrawal symptoms have occurred with alcohol, opioids, meth, cocaine, benzodiazepines, and marijuana.^7(pg.3) Each substance causes a different protracted withdrawal, but there are many common symptoms.^{7(are protracted withdrawal symptoms the same)} Common symptoms found in many long-term withdrawal syndromes include:^{7(are protracted withdrawal symptoms the same)}

• Feeling anxious
• Increased hostility or irritation
• Depression
• Mood swings
• Fatigue
• Difficulty sleeping
• Cognitive difficulties
• Decreased libido
• Otherwise, inexplicable physical complaints (particularly of pain)

Protracted withdrawal may last for weeks, months, or even years after the last time a substance is used.^7(pg.3)

Medically Assisted Detox

If you or a loved one are thinking about quitting alcohol or drug use, medically assisted detox is available to help you get through withdrawal safely and provide the tools you need to keep going. Depending on which substance(s) you are trying to stop using, there may be several ways professionals can assist you. Virtue Recovery Center has accredited treatment centers in Arizona, Oregon, and Texas that offer detox assistance and ongoing recovery. Call today to find out how Virtue Recovery Center can help you become substance-free.

Looking for more detox content? Check out our article on mastering Ozempic detox.

Resources:

1. Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.
2. Szalavitz, M., Rigg, K. K., & Wakeman S. (2021). Drug dependence is not addiction—and it matters. Annals of Medicine. 53(1), 1989-1992.
3. Gupta, M., Gokarakonda, S. B., & Attia, F. N. (2022). Withdrawal syndromes. StatPearls Publishing.
4. Newman, R.K., Sobart Gallagher, M.A., & Gomez, A.E. (2022). Alcohol withdrawal. StatPearls Publishing.
5. PsychDB.com (2021). Sedative, hypnotic, or anxiolytic (benzodiazepine) withdrawal.
6. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5^th edition)
7. SAMHSA. (2010). Substance abuse treatment advisory: protracted withdrawal.