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It’s just after 3 a.m., roughly a day and a half since John’s dad gave him the ultimatum: “Next time you’re high under my roof, you’re out.” John tosses and squirms under his nettle blanket, his mind foggy yet filled with an intense, unshakable craving. He reaches for a sip of water, but his uncontrollable shaking doesn’t allow him any relief as the water soaks into the already-damp bedding. He cries out as the invisible voices tell him he’s going to die. He wants to die. He wants more of what has already taken his job, his home, his relationships, and his self-worth –or he wants to die.
John’s predicament might sound like an over-exaggerated B-film about drug abuse, but sadly, situations similar to these play out on a daily basis in thousands of UK households. Over the last decade, our collective appetite for drugs has increased by about 23% (United Nations Office on Drugs and Crime), and while cannabis and alcohol remain the two most commonly consumed substances (along with nicotine), hard drugs such as cocaine, opioids, and amphetamines contribute more and more to individual and societal harm.
In addition to the direct damage that these drugs do to our persons, families, and communities, they also have one final trick to keep the abuser abusing – withdrawal symptoms. These refer to the physical and mental symptoms that someone who has developed even the slightest addiction to drugs will experience when they stop using, and very often, they’re so painful and uncomfortable that someone trying to get clean simply can’t take it anymore and turns back to the drug for relief.
If you yourself have fallen victim to the often-glamorised allure of drugs, or you love someone else who has, understanding the maelstrom of effects you’ll experience as the body rids itself of deadly toxins can help you physically and emotionally prepare, maximising your chances of quitting for good.
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Withdrawal symptoms encompass the full and largely-predictable range of physical and psychological symptoms associated with the abrupt absence of a substance that the body has become adapted to and come to rely on for maintaining normal function. It’s important to note that different substances can have very different withdrawal symptoms and intensities, but even drugs that ‘don’t have physical withdrawal symptoms’ in the public’s mind, such as cannabis, LSD, or psilocybin mushrooms, can cause irritability, sleeplessness, decreased appetites, and general irritability. While these symptoms are a far sight from the potentially fatal seizures of, for example, benzodiazepines or alcohol withdrawal, don’t make the mistake of thinking that using these drugs will be consequence-free when deciding to stop.
While a detailed description of the biological processes that cause withdrawal symptoms is best discussed in medical journals, in a nutshell, drugs cause withdrawal symptoms through two mechanisms:
For example, when someone takes an opioid, it (indirectly) causes the brain to flush itself with feel-good endorphins (A process). The body responds to this oversupply by reducing its own output (B process). With repeated use, the body develops a tolerance, reducing the pleasurable effects of the opioids at the same time that the body naturally produces fewer and fewer endorphins. This lack can cause withdrawal symptoms such as irritability, confusion, seizures, hallucinations, and many more.
Just as alcohol withdrawal symptoms (AWS) can vary between individuals based on a range of factors, drug withdrawal can also present different symptoms at different intensities, on different timelines. Even patients with similar physical health profiles could manifest different symptoms for the same drug based on individual factors such as genetic predisposition, metabolic rate, or liver function; and this doesn’t even begin to touch on factors such as co-occurring mental or psychological health factors.
All that being said, there are certain symptoms that one would typically associate with different types of drug withdrawal. While pretty much all drugs leave anxiety and irritability in their wake, severe withdrawal symptoms for antidepressants (SSRIs) are different from severe cocaine withdrawal symptoms, which are in turn different from some of the severe sedative-hypnotic (Zolpidem, Zopiclone, etc.) withdrawal symptoms.
You can consult the table below for a breakdown of some of the most common drug withdrawal symptoms. Again, this should only be used as a rough guide for a general understanding of drug withdrawal symptoms and their timelines. Gladstones Clinic cannot stress enough how important it is to seek medical guidance and counselling when attempting to stop using drugs, as a medically supervised detox can greatly decrease the associated pain and discomfort while simultaneously increasing the odds of a successful recovery.
| Drug and Rough Timeline | Common Symptoms | More Rare Symptoms | Presentation (mild, moderate, severe) |
|---|---|---|---|
|
Benzodiazepines1 Onset: 1-4 days depending on specific benzo Duration: Varies greatly (weeks to months) |
Anxiety, insomnia, tremors, sweating | Delirium, psychosis, seizures, panic attacks |
Mild: restlessness, insomnia Moderate: increased anxiety, tremors Severe: delirium, seizures, psychosis, panic attacks |
|
Opioids2 Onset: 8-24 hours after last use Duration: 4-10 days (Select symptoms may last weeks or months) |
Muscle aches, anxiety, insomnia | Opioid withdrawal syndrome: rapid heart rate, dehydration |
Mild: muscle aches, restlessness Moderate: abdominal cramps, nausea Severe: rapid heart rate, dehydration, seizures |
|
Cocaine3 Onset: 6-48 hours after last use Duration: Up to a few weeks |
Fatigue, depression, increased appetite | Paranoia, psychosis, suicidal ideation |
Mild: fatigue, depression Moderate: increased appetite, irritability Severe: paranoia, psychosis, suicidal thoughts |
|
Amphetamines4 Onset: 8-24 hours after last use Duration: Up to several weeks |
Fatigue, depression, increased appetite | Psychosis, hallucinations |
Mild: fatigue, depression Moderate: increased appetite, irritability Severe: psychosis, hallucinations |
|
Cannabis5 Onset: 1-3 days after last use Duration: 1-2 weeks (Select symptoms may last for months) |
Irritability, insomnia, decreased appetite | Increased anxiety, restlessness, vivid dreams, chills |
Mild: irritability, difficulty sleeping Moderate: increased anxiety, restlessness, sweating Severe: intense anxiety, vivid nightmares |
|
Antidepressants (SSRIs)6 Onset: 1-4 days depending on specific benzo Duration: Varies greatly (weeks to months) |
Dizziness, nausea, flu-like symptoms | "Brain zaps" (electric shock sensations in the head) |
Mild: dizziness, nausea, flu-like symptoms Moderate: increased anxiety, mood swings Severe: debilitating brain zaps, intense anxiety |
|
Sedative-Hypnotics7 Onset: 2-4 days after last use Duration: Varies greatly, typically up to 3 weeks. |
Rebound insomnia, increased anxiety | Delirium, hallucinations, seizures |
Mild: difficulty sleeping, increased anxiety Moderate: heightened restlessness, confusion Severe: delirium, seizures, hallucinations |
One of the biggest barriers to people quitting their drug habits for good is the withdrawal symptoms described in the table above. All of these symptoms (with the possible exception of an increased appetite) have a net negative effect on our physical and psychological well-being. These withdrawal symptoms are always uncomfortable and can become painful, driving one right back to the loving embrace of the drug – pain-free and content. By treating the withdrawal symptoms, one has a much better chance of recovery and avoiding relapse.
Whether one decides to go at it alone or seek medical assistance in ending drug abuse, for all the drugs mentioned above (and ones not mentioned), you can reasonably expect a detox or detoxification period to start within a few hours to a few days of the last use. During the detox period, the symptoms will reach their highest level of intensity, and depending on the drug, individual, and circumstances, one might need medical or pharmaceutical intervention to alleviate pain or discomfort. Although severe withdrawal symptoms from substances like opioids and amphetamines can be brutal, for lack of a better word, withdrawal-symptom-related fatalities are extremely rare. Unfortunately, the same cannot be said for alcohol withdrawal where severe instances of delirium tremens (DT) can and do cause fatal seizures.
Typical drug withdrawal treatment again varies between classes of drugs but could include tapering down drug use to minimise withdrawal symptoms, treating symptoms such as insomnia or nausea directly, as well as pharmaceutical intervention. Not all classes of drugs have widely approved medications available to treat the symptoms of withdrawal; however, opioid abusers could receive Methadone, Buprenorphine, Naltrexone, or Clonidine to alleviate cravings and symptoms, while long-acting Benzodiazepines could be prescribed to help someone avoid the worst of Benzo-related symptoms. Pharmaceutical intervention for the treatment of drug withdrawal symptoms must take place under medical supervision. A lot of the medicines used in the treatment of drug abuse have abuse potential themselves, making them unsuitable for over-the-counter prescriptions.
Once one is over the hump of the withdrawal symptoms, all the literature on drug rehab points to continued therapy for the best chance at a complete recovery. This could take the form of one-on-one sessions with a counsellor or therapist, or joining a support network or group. Full recovery from drug abuse doesn’t tend to stick to a predetermined timeline and could range anywhere from a couple of weeks to a lifetime.
For more than two decades, Gladstones Clinic has been helping people from all walks of life reclaim their lives from the grip of drug abuse. Our highly trained and experienced addiction specialists have years of first-hand experience in dealing with addiction and withdrawal of all types and employ modern, evidence-backed approaches to dealing with detox and primary care.
Gladstones Clinic looks forward to being your partner in recovery If you or a loved one are serious about ending drug abuse. Our fully-integrated and holistic non-12-step program has proven time and time again that even those who feel completely lost and hopeless can make a full and permanent recovery with dedicated and understanding support and care.
For more information about specific drugs or addiction treatments, you can visit the following pages on our site:
Please feel free to contact us with any of your questions about us, our processes, or to learn more about addiction-beating resources.
Connor, JP, et al. “Clinical management of cannabis withdrawal.” Addiction, vol. 117, no. 7, 2022, pp. 2075-2095. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9110555/#:~:text=The%20early%20phase%20of%20withdrawal,over%207%20days%20of%20abstinence. Accessed 17 17 2023.
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Petursson, H. “The benzodiazepine withdrawal syndrome.” Addiction, vol. 89, no. 11, 1994, pp. 1455-1459. Wiley Online Library, https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1994.tb03743.x?sid=nlm%3Apubmed. Accessed 17 07 2023.
Radke, Anna, et al. “Articles, Behavioral/Systems/Cognitive An Anatomical Basis for Opponent Process Mechanisms of Opiate Withdrawal.” The Journal of Neuroscience, vol. 31, no. 20, 2011, pp. 7533-7539. JNeorosci, https://www.jneurosci.org/content/31/20/7533. Accessed 14 07 2023.
Shoptaw, SJ, et al. “Treatment for amphetamine withdrawal.” The Cochrane database of systematic reviews, vol. 2009, no. 2, 2009. Cochrane Library, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138250/. Accessed 17 07 2023.
United Nations Office on Drugs and Crime. “2023 World Drug Report.” United Nations Publications, 2023, pp. 12-20. United Nations Office on Drugs and Crime, https://www.unodc.org/res/WDR-2023/WDR23_Exsum_fin_SP.pdf. Accessed 14 07 2023.
Weaver, Michael F. “Prescription Sedative Misuse and Abuse.” The Yale journal of biology and medicine, vol. 88, no. 3, 2015, pp. 247-257. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553644/. Accessed 17 17 2023.
