Drug Withdrawal & Detox

Through deciding to stop taking addictive substances, you take the first step towards your recovery, and begin the process of your withdrawal and detoxification.

However, if you’re unfamiliar with what this entails, then this article will help you understand how the process of withdrawal and detoxification works so you can decide how best to approach it in your own life or in the lives of those you close to you.

Withdrawal: What Is It?

Not everyone knows what withdrawal is, but it isn’t complicated. Withdrawal is where you stop taking or take less of a substance you are addicted to, causing your body to react to this change in various ways.

This is because many of the substances of addiction interact with the brain and body in ways that create neurological and physiological dependencies, meaning functioning with the drug in your system has become your new ‘normal.’ Alongside this, you may have a psychological dependence on the drug, as you feel it helps you to unwind, relax or even feel happy.

As a result, withdrawal is an incredibly complex and challenging event in any addict’s life and can cause a great amount of suffering. However, it does play a key role in helping you to recover from addiction.

When Does Withdrawal Occur and Why?

You might be wondering when exactly withdrawn occurs. Does it happen when you stop taking any substances? Or does it happen when you start taking slightly less?

Simply put, Withdrawal starts to occur when less of your addictive substance is present in your system than your body considers ‘normal’. This is because substances like drugs and alcohol act in a way that suppresses the natural production of certain physical and mental functions. When there is less of these substances in your system, this suppression stops and your mind and body respond by providing a surge of functions (ie. adrenaline) that cause a wide range of painful withdrawal symptoms.

Each withdrawal from a substance is different, with some causing challenging physical symptoms (opiates, alcohol) and others causing largely entirely emotional symptoms (cocaine, ecstasy). On top of this difference is your physiological makeup and how that interacts with the substance. For example, some may have more aggressive and challenging symptoms that occur earlier than others.[3] What is the same throughout however is that withdrawal is always an extremely difficult period in any addict’s life.

Withdrawal Symptoms for different substances

Each type of substance causes different withdrawal symptoms, which can be understandably confusing. However, there are some patterns to each type of substance.

Opiates cause flu-like symptoms such as a runny nose and muscle aches that can develop into more extreme symptoms such as nausea, diarrhoea, and seizures.

Benzodiazepines (or ‘Benzos’) causes many psychological symptoms such as tension, panic attacks, and difficulty concentrating, and can cause an experience of anxiety which can last for several months.

Alcohol causes at least half of those who experience a use disorder to have symptoms. These can range from extremely serious symptoms such as delirium tremens, which can be fatal. Other symptoms can include headaches, nausea, vomiting, and loss of appetite. Many of these will usually be most intense during the first few days, but painful emotional effects and cravings can continue for much longer.[4]
Cocaine, due to its fast-action and stimulant nature, causes a particular manifestation of withdrawal symptoms. Taking place over three phases (crash period, acute withdrawal, and extinction period), withdrawal from cocaine causes a variety of psychological symptoms that are the opposite of its stimulant effect – ranging from depression and anxiety to suicidal thoughts.[5]

Each substance will present its own challenges in withdrawal for you, and it is likely that during this period your level of suffering will increase. However, it is important to understand that this does not last forever and you will soon recover.

Physical Symptoms of Withdrawal

During withdrawal, you will likely be faced with challenging psychical symptoms that can last from a few days up to a week.

Withdrawal symptoms in the head can be experiences of dizziness or headaches. Chest symptoms can be difficulty breathing or chest tightness. The heart can experience symptoms like palpitations, or heightened pulse rate. The stomach can be stricken with sensations of nausea, or cause you to vomit or suffer diarrhoea. The muscles can tighten, ache, and shake. And the skin can sweat profusely and feel like you have a tingling ‘pins and needles’ sensation.

Alongside these, there are the dangerous withdrawal symptoms which although begin in a certain area, can have a snowball effect over the entire body. These can be physical symptoms such as heart attacks, Grand Mal seizures, and strokes.

Psychological Symptoms of Withdrawal

Some of the most challenging aspects of withdrawal take the form of psychological symptoms. These can affect your cognitive function, your sleep, your level of depression, and your anxiety. As a result, these can greatly affect your happiness, relationships, and ability to operate at work.

During withdrawal, you can experience negative effects on your cognitive function such as poor concentration and memory. You can experience an ability to sleep known as insomnia. You can suffer from heightened levels of depression, leading you to feel socially isolated, fatigued, and unable to enjoy life. You can also experience heightened levels of anxiety which make you nervous, suffer panic attacks, and feel restless.

Where physical symptoms are often a matter of willpower and endurance when it comes to recovery, psychological symptoms often effect that very willpower and endurance, causing a profound level of struggle and suffering in your life that can be extremely hard to overcome alone.

Causes for Withdrawal

You might be wondering what exactly causes the specific symptoms of withdrawal, but it’s actually a variety of factors . This is due to drugs and alcohol affecting many different areas of the mind and body.

When a substance is abused your mind and body learn to adjust to living with its presence in your system. This can cause a state where you are dependent on it, and suffer consequences when it is not in your system. In fact, humans are so adept at this, that people can ever suffer headaches when they no longer have some as simple as their typical morning coffee.

Substance abuse, however, causes a variety of complications beyond that which trigger and deepen withdrawal symptoms. All addictive substances, for instance, trigger your brains dopamine reward system, which is a huge contributor to why you become addicted to them in the first place. Simply put, your brain is designed to become addicted to them because it likes dopamine. When the substance is removed and that dopamine release is no longer being triggered, the brain will often adopt a low activity state, which can result in terrible feelings of depression, anger, and sadness.

Many substances, like alcohol, also carry a sedative effect which slows your brain function. When your brain becomes used to this slow state of functioning, removing alcohol can cause it to become shocked by the new levels of heightened, hyper-active activity. This can cause you to experience anxiety and even frightening hallucinations.[6] Such effects will likely compel to you seek out more alcohol to numb them away, one of the reasons why alcohol addition can be so challenging to overcome.

The Different Types of Withdrawal

If you have never experienced withdrawal then it can be hard to know what to expect. One way is to know how the different types of withdrawal are caused by the different types of substances.

Opiates, sedatives, and alcohol have strong withdrawal symptoms that can be life-threatening and affect you similar to having an illness and/or panic attack. Many of these are physical symptoms such as nausea, sweats and delirium tremens, but can also be psychological symptoms like depression and anxiety. [7]

Stimulant withdrawal is characterised by lethargy, low mood, and depression. In other words, the exact opposite of what a stimulant, such as cocaine, does. It is unlikely to be life-threatening but poses significant challenges psychologically and energetically, sometimes leaving you in a state where don’t really feel like you can do anything, which is extremely disheartening.

Withdrawal Timeline

Once you have decided to stop taking your substance of abuse, you may begin to start feeling your first withdrawal symptoms two hours after your last dose, or up to one day. These symptoms can then last for up to two days or a week. It is during this period that you will go through your withdrawal symptoms as your body detoxifies.

In the case of opiates, this stage is incredibly uncomfortable, with symptoms peaking at around the three-day mark. You may be faced with depression, anxiety, and vomiting, amongst other symptoms. In the case of alcohol, you can be faced with painful stomach aches, sweating, and insomnia. Due to this high level of discomfort across a variety of substances, this stage is where you may, understandably, consider relapsing.

The next stage, at roughly a week after taking your last dose, major and painful symptoms will begin to subside. You may experience similar symptoms, such as nausea, but they should be much less intense. However, you will likely still face cravings, so the challenge is far from over.

After this stage of withdrawal, it is much less likely you will be faced with any physical symptoms, however, for up to three months and beyond, you can be confronted with the psychological symptoms of withdrawal associated with your substance of addiction. Sometimes, substances like alcohol and opiates can trigger lasting, or recurring effects (such as post-acute withdrawal), but this is rare.[8] Generally, after a week or two of abstaining from substances and enduring withdrawal, the body will largely detoxified.

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Detoxification: What Does It Entail?

Detoxification is arguably the most important step you can take in your recovery from addiction. If you are unfamiliar, detox is a process by which you stop taking the substance of your addiction until all traces are removed from your system.

Undergoing detoxification is a challenging process, as it will trigger difficult withdrawal symptoms, however, it is essential if you are to combat your addiction and receive the help you may need.

The importance of detoxing

Understanding how your body is affected by substance abuse can help you to understand why detoxing is such an important factor in your recovery.

Your body functions in a way that it depends on a careful balance of chemicals for it to function properly. When you are abusing a substance, this chemical balance gets put into disarray, causing your body to function is far worse state than it ought to. Undergoing a detox helps your body return to a healthy, normal state, where you will feel much better.

Your brain helps to regulate the hormone production of your body, but how your brain does this when you abuse a substance is altered so that your hormone production is sub-optimal. This can have several effects on your quality of life. Undergoing a detox allows your brain to return to its normal state of hormone production, giving your system the right amount of hormones it needs to make you feel healthy on a day to day basis.

Many, if not all substances of addiction interact with the reward circuits of your brain, causing them to wrongly adapt, send faulty signals, and lead you to suffer cravings. Undergoing a detox gives your brain the time it needs to recover and for you to start feeling rewarded by the things in life you genuinely wish to pursue.

Whether you are looking to manage your addiction alone, with a therapist, or as part of a rehabilitation clinic, undergoing a detox puts you in a position where you are far more likely to succeed and free your life from the suffering of addiction.[9]

The detox process

Anytime you stop taking a substance that is toxic to your body, your body will naturally begin to detoxify. It does this with any substance from drugs to everyday alcohol, using various systems such as the liver to remove any trace of the toxic substances from your body. For example, the liver does this with alcohol by metabolising all the ethanol present in your system. This process takes time, sometimes lasting a few weeks, and it will cause withdrawal symptoms to occur.

There are generally two ways to go about a detox process. Cold turkey, which has you stop taking any drugs or alcohol all at once. Or gradually, which has your slowly taking fewer substances over a period of time.

Depending on which you choose, your withdrawal symptoms with vary in intensity. If you go cold turkey, for instance, then your withdrawal symptoms will hit very abruptly and with much stronger intensity.

What are the benefits of supervised detoxification?

If you’ve never undergone a supervised detox, you might not believe it will be of help to you, but the process itself has many useful benefits for you recovery. Because the detoxification process can be so dangerous, it helps to be under the supervision of someone who can not only take basic care of you but also is familiar with the detoxification process and how to help.

Two of the biggest risks that come from the detoxification process are delirium tremens and dehydration. Delirium tremens can escalate into conditions like respiratory failure which can be fatal. Likewise, dehydration can cause you to suffer seizures, which can also be lethal. These dangers at the very least can cause you to suffer a great deal, and even if they may not be fatal in your case, having someone to monitor your vitals, take care of your needs, and help to ease your pain can go a long way in helping your detoxification become a success.

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Detoxification timeline

You might be wondering how long a detox lasts. In truth, the timeline is deeply linked, and often identical to the timeline of withdrawal. After all, withdrawal symptoms are part of your bodies natural detoxification process.

Generally a detox lasts around 1 to 2 weeks, and usually comes with two phases of withdrawal symptoms. The early phase and the late phase. Although not all substance detoxifications are identical, they do follow a similar pattern. Take these two examples:

Oxycodone detoxification sees physical withdrawal symptoms lasting around 2 weeks, after which the body is clear of the drug and its influences. In the first 1-2 days, symptoms such as agitation, insomnia, and sweating are common. Beyond that, intense withdrawal symptoms like vomiting and diarrhoea begin to show up. [10]

Alcohol has three defined phases (or stages) of detoxification. Stage 1 sees mild withdrawal symptoms begin to occur within 6-8 hours of your last drink. These can range from anxiety to headaches. Stage 2 sees moderate withdrawal symptoms arrive between 12-48 hours after your last drink. These range from elevated blood pressure to confusion. Stage 3, the final stage, begins between 48-72 hours in your detox process and can cause you to have delirium tremens, seizures, alongside the previous symptoms. After 7 days without drinking, withdrawal symptoms generally disappear and you level of suffering will greatly decrease.[11]

Treatment methods and options

If you’re considering going through a detox, then it’s important to understand that there are a variety of different treatment options that can help. You can go through the treatment at home, at an inpatient centre, an outpatient centre, and you can receive medically assisted care. Alongside this, there are certain treatments that go well with certain substances.

Opioid detoxification benefits from having effective medication assistance as a treatment method. Medications such as opioid agonists like buprenorphine can help you to manage some of the symptoms like cravings, anxiety, and distress.

Likewise, those suffering from alcohol addiction can benefit from the use of naltrexone as it helps to prevent heavy drinking.[12][13] Going through a treatment in an inpatient centre may provide this.

Alternatively, a home detox may be suited for people with low levels of addiction or perhaps those who feel like they are on the cusp of an addiction. This kind of detox, however, has you going through the detoxification entirely on your own and unsupervised, which has its risks.

How safe is home detox?

A home detox can be successful if done carefully, but a supervised detox is generally recommended, as they can be unsafe. Withdrawal symptoms can be extremely challenging, causing you to suffer a great deal over several days, in ways which can cause you to struggle to live a normal life. Some withdrawal symptoms can be so strong they interfere with your ability to look after yourself in basic ways such as preparing meals and drinking enough water. This is always something to consider before choosing to detox at home.

Choosing a Withdrawal and Detox Centre

Choosing the right withdrawal and detox centre can make an enormous difference in whether or not your detox is a success. Understanding the differences between residential and outpatient services, how inpatient detoxification work, the role of confidentiality, and whether to attend a clinic near home all help you to make the right decision and move closer to the recovery from addiction you want.

Residential centres vs. outpatient services

Residential centres and outpatient services offer different types of detoxification. There are merits to both and which one is right for you will depend on your own circumstances and level of addiction.

Inpatient detoxification

Residential centres offer something called inpatient detoxification. This is a live-in programme of detoxification that is supervised by professional staff experienced in helping you handle your withdrawal process. As you will be living in the centre, you will receive constant monitoring and care, as well as potentially receiving key medications that help to smooth the process of your detoxification and minimise your suffering.

Residential centres allow for supervised detoxification where you live in a residential facility and receive care from professionals. This can help with extremely difficult drugs to go through withdrawal, like, for instance, PCP.

Outpatient supervised detox

Outpatient supervised detox takes place outside of your treatment centre. You will live at home, but receive treatment and monitoring when you travel into the centre, usually daily. Sessions may last around 2 hours, during which you may relieve a physical exam and begin our treatment. These check-ups help you to minimise the challenges of your treatment and manage your addiction when you are at home. If you have a manageable level of addiction, then this can be an option that allows you to balance your home life with your recovery.

Private rehabs and confidentiality

It is important to understand that private rehab clinics take your confidentiality extremely seriously.

Private rehab centres are regulated by UK law, and will inform you of what data they are taking from you, how and when they will share it, and who with. This helps to protect your right to privacy, and let you know that your information will be used – giving you the peace of mind that allows you to get on with your treatment.

Treatment near home vs. away, and even abroad

Finding the right treatment centre can be challenging, and deciding whether to get treatment near your home or at a far away location depends on a few factors.

The most important amongst them is what kind of treatment you need, and which centre is best suited to provide it. If your nearest treatment centre doesn’t offer the kind of service you need, then it may be necessary for you to travel away from home, possibly even abroad.

Another thing to consider is affordability. Your nearest treatment centre may be too expensive. You should also consider how important local knowledge is to helping your detox. If, for instance, you live in a neighbourhood with easy access to substances of abuse, working with people who understand this hurdle may be a great help.

Questions to ask treatment centres

Before you attend any treatment centre, make sure you ask them the right questions so you understand how they manage withdrawal and detoxification. For example:

  • Do they have experience with your substance of addiction?
  • What is their inpatient process for handling detox?
  • What is their outpatient process for handling detox?
  • Do they provide a medically assisted detox?
  • What is the cost of the treatment centre?

What Follows Detox?

You may be wondering what comes after detox. Although many withdrawn symptoms will go away after the first 1-2 weeks of withdrawal, some psychological symptoms can persist for longer and will need care. As the risk of relapse will still be present in your life, much of this care will be based around helping you avoid it.

Detoxifying your system of drugs is an incredible first step, but following it up with therapy is crucial. Many factors lead to a life of addiction, and working with a therapist helps you to gain control of these and start taking steps to have the life you want. This helps you to gain a better understanding of your addiction, and learn what triggers you towards relapse so that you can remain sober in the future. You may also receive medically assisted treatments to help you manage your addiction and cravings.

You can choose to attend peer support groups where you can meet like-minded people suffering from similar (or identical) addictions. In these groups you will be encouraged to share, help others, and receive help. All of these methods can be an enormous support in helping you feel connected, reminding you that you aren’t alone, and helping you to remain sober.

Once you have undergone detox and therapy, there are after-care programmes that are typically offered. These usually less frequent versions of the same types of support (therapy, peer support groups) that you receive after detox, but none the less help you to remain anchored to your goal of sobriety, and free from the suffering of addiction.

Helping an addict into rehab

It might not be you who is suffering from addiction, but instead or family member.

Helping an addict into rehab can be challenging, and ultimately it is always the individual’s choice whether they attend rehab or not. Addiction is a condition that will be causing them to suffer, but also one that is difficult for them to shake. It is important that you approach them with love, empathy, and understanding. Listen to them and find out what they want, and support them on their way towards rehabilitation.

Sometimes, an intervention may be required – in this case, the same approach is recommended, but instead of just you, it will be you and the individual’s loved ones.

In either case, being an understanding, empathetic support who lets them know that there are options of help and rehab available to them can be crucial, as addiction can be incredibly lonely and isolating to those suffering from it.

Staying clean and sober

Staying clean and sober is incredibly important for your well-being. If you have gone through detoxification and rehabilitation, then returning to drug or alcohol use can be distressing and disheartening.

Staying away from sources of your substance of abuse will help you to stay clean. You might have friends or places you frequent that provide easy access or even encouragement to use. Avoiding or managing your relationships with these people and places will help you to remain sober. You may also have trigger emotions that motivate you to pursue the substance you were addicted to. Continuing to work through your emotions and habits with a therapist will help you with this.

Ultimately, staying clean and sober is about living in a new way that honours who you are, but also accounts for the necessary changes and structure that will help you stay clean and remove the suffering of addiction from your life.

The role of counselling in addiction withdrawal and detox

During withdrawal and detox, a counsellor can be used to help you manage some of the challenging psychological symptoms such as depression, anxiety, and even suicidal thoughts. This can help to reduce your level of suffering during this challenging period.

In most cases, counselling typically occurs after you have gone through your detoxification period. This is because therapy is much more difficult when your substance of addiction is in your system. Once the detoxification period is finished, counsellors can work with you in a number of ways to help you manage your addiction and learn to gain control over it. They do this by working with you and using a variety of therapeutic techniques such as cognitive behavioural therapy.

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Sources

1) https://www.naabt.org/faq_answers.cfm?ID=16

2) https://adf.org.au/alcohol-drug-use/supporting-a-loved-one/withdrawal/

3) https://www.addictionsandrecovery.org/withdrawal.htm

4) https://www.nejm.org/doi/full/10.1056/NEJMra1407298

5) https://americanaddictioncenters.org/withdrawal-timelines-treatments

6) http://www.brainfacts.org/Ask-an-Expert/What-causes-drug-withdrawal

7) https://www.ncbi.nlm.nih.gov/books/NBK526012/

8) https://firststepbh.com/addiction-treatment/drug-withdrawal/

9) https://novarecoverycenter.com/detox/importance-detox-in-recovery/

10) https://www.mentalhelp.net/articles/oxycodone-detox/

11) https://www.aafp.org/afp/2013/1101/p589.html

12) https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction

13) https://www.uptodate.com/contents/medically-supervised-opioid-withdrawal-during-treatment-for-addiction

FAQs

Here are some of the frequently asked questions about withdrawal and detoxification.

When is detoxification necessary?
If you are suffering from addiction to any substance and wish to make a recovery, then detoxification is necessary. It is the first, and crucial step needed to cleanse your system of your addictive substance so that you can begin to receive treatment. The same is also true of behavioural addictions, such as an addiction to gambling. Abstinence from the addictive behaviour would be a necessary part of treatment.
How Important is medically supervised detox?
Medically supervised detox is incredibly important because some of the symptoms of withdrawal faced during detox can be life-threatening and debilitating. You will also face extremely high levels of craving. Medical assistance will help to ease you through this period and reduce your suffering.
Do symptoms and their duration vary from person to person?
Yes, every person is different and will respond to withdrawal in different ways. Some will have mild symptoms that go away within a few days, others will have intense symptoms that last up to two weeks. This is due to their individual biology and psychology, as well as the intensity of their addiction.
Are withdrawal symptoms deadly?
Yes, some withdrawal symptoms such as delirium tremens and dehydration can be fatal, but the vast majority are not.

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