What Happens During Withdrawal?

When you enter addiction recovery, you may or may not go through withdrawal—and you can't always predict whether you'll have symptoms. Many people with alcohol use disorder or substance use disorder make the decision to stop using drugs or alcohol, but with certain substances, stopping suddenly can cause uncomfortable or even dangerous withdrawal symptoms. If you're ready to quit drugs or alcohol, it's a good idea to make a safety plan. And depending on your specific addiction, that plan might need to include medical detox.

Here, you'll find everything you need to know about withdrawal—from what causes it to how long it lasts to the treatment options that can help you navigate this phase safely.

What Is Withdrawal?

Withdrawal is your body's reaction to stopping a substance it's gotten used to having. When you suddenly quit drugs or alcohol, your body needs time to adjust—and that adjustment period can come with uncomfortable physical and emotional symptoms. The type of symptoms you experience depends on what substance you've been using and how your body has adapted to it.

What Causes Withdrawal?

Quitting any addiction can cause withdrawal.¹ That's true for drugs, alcohol, and even behavioral addictions like gambling. But your exact experience depends on your mental and physical health. Withdrawal doesn't affect everyone in recovery. That's because there are different ways you can come to rely on a substance.

Dependence

When you're physically dependent on a drug, your body's used to ingesting it on a regular basis. And you'll probably experience physical effects when you stop taking it. This is what most people think of when they picture withdrawal.

But you can be dependent on non-addictive drugs, too. If you stop taking your asthma medication, you'll probably feel immediate effects. The same is true for mental health meds, like antidepressants. Dependence doesn't equal addiction—it's a physical experience.² But the two often go hand in hand.

Addiction

Many addictions include physical dependence, but not all of them. Video game addiction, for example, is behavioral. Some experts even call drug addiction a mental health issue, rather than a physical one.³

People with untreated addiction keep engaging in unhealthy behavior in spite of its adverse effects. Those effects could be physical, mental, social, or even spiritual. And for some people, quitting causes physical symptoms—even if you weren't physically dependent on a drug.

What Are the Most Common Symptoms?

Everyone's recovery journey is a little different, but withdrawal symptoms can range from mild to life-threatening. The severity of symptoms may be increased by factors like age, co-occurring conditions, nutritional factors, and overall health.

Some common withdrawal symptoms include:⁴

• Changes in appetite
• Nausea and vomiting
• Diarrhea
• Sleep disturbances, like insomnia or excessive tiredness
• Mood changes or mood swings
• Tremors
• Anxiety
• Depression
• Increased blood pressure
• Elevated heart rate
• Restlessness
• Gastrointestinal disturbances
• Movement disturbances
• Changes in heart rate or blood pressure

These symptoms might be more or less severe depending on your overall health. If you have any chronic conditions, make sure to ask your doctor how to manage them while you're going through this transition. Whether or not you get formal treatment during detox, it's important to make a plan for support during withdrawal.

Alcohol Withdrawal Symptoms

The course and severity of alcohol withdrawal symptoms vary from person to person. The severity of symptoms may be increased by factors like age, co-occurring conditions, nutritional factors, and overall health. Alcohol withdrawal symptoms can range from mild to life-threatening with the potential for severe medical complications.

Symptoms of alcohol withdrawal can include:⁵

• Increased blood pressure
• Elevated heart rate
• Nausea and vomiting
• Insomnia
• Restlessness
• Anxiety and agitation
• Hypersensitivity to light, sound, and touch
• Hallucinations
• Paranoid or persecutory delusions
• Tremors
• Seizures

Stimulant Withdrawal Symptoms

Symptoms of stimulant withdrawal can include:⁶

• Dysphoric mood
• Fatigue
• Increased appetite
• Insomnia or hypersomnia
• Unpleasant, vivid dreams
• Psychomotor slowing
• Psychomotor agitation

Opioid Withdrawal Symptoms

Symptoms of opioid withdrawal can include:⁷

• Dysphoric mood
• Insomnia
• Yawning
• Excessively runny nose and eyes
• Fever
• Goosebumps
• Dilated pupils
• Sweating
• Muscle aches
• Nausea
• Vomiting
• Diarrhea

Heroin Withdrawal Symptoms

Symptoms of withdrawal from heroin can include:

• Anxiety
• Insomnia
• Bone and muscle pain
• Abdominal cramping
• Nausea
• Vomiting
• Diarrhea
• Goosebumps, cold flashes
• Muscle spasms
• Restlessness, uncontrollable leg movements
• Runny nose
• Sweating
• Tearing and yawning

Benzodiazepine Withdrawal Symptoms

Symptoms of benzodiazepine withdrawal can include:⁸

• Anxiety and panic
• Irritability
• Insomnia
• Restlessness
• Agitation
• Poor concentration and recall
• Sweating
• Racing pulse
• Muscle aches, tension
• Perceptual changes
• Hallucinations
• Hand tremor
• Seizures

Marijuana Withdrawal Symptoms

Symptoms of withdrawal from marijuana can include:⁹

• Depressed mood
• Anxiety and nervousness
• Sleep disturbances
• Irritability, aggression, anger
• Headache
• Abdominal pain
• Gastrointestinal upset
• Appetite changes
• Fever
• Sweating
• Chills

Can You Die From Withdrawal?

In short: Yes, you can die from withdrawal. Certain addictions are strongly associated with physical dependence. And when you quit these drugs, you might have very serious symptoms. Talk to your doctor about medical detox if you're quitting any of the following:

• Opioids
• Benzodiazepines
• Alcohol

Without proper care, withdrawal from these 3 substances can be life-threatening.¹⁰ And even if your physical symptoms are minimal, detoxing off any drug can reveal other health concerns.

Risks of Withdrawal

If you have other health conditions—whether physical or mental health related—they can make withdrawal more severe or complicated. It's important to be honest with your care team about your complete health history so they can help you stay safe.

Get emergency medical help right away if you experience any of these symptoms during withdrawal:

• Seizures
• Confusion or changes in consciousness
• Severe panic or anxiety that's getting worse
• Seeing or hearing things that aren't there
• Fever over 100.⁴°F (which could signal an infection)
• Very high blood pressure or rapid heart rate
• Severe stomach pain
• Blood in vomit or stool
• Eyes that don't respond normally to light
• Extreme sleeplessness

If you or a loved one experiences a medical emergency related to withdrawal, overdose, or other medical condition, call 9-1-1 immediately. Drugs with the greatest risk of severe or complicated withdrawal include opioids, alcohol, benzodiazepines, and other central nervous system depressants.

How Long Does Withdrawal Last?

It depends on what drugs you've been taking, and in what quantities. And your other health issues can play a role here. For example, nicotine is an antipsychotic.¹¹ So if you have schizophrenia and you smoke cigarettes, they can interact with your prescribed meds. For people with co-occurring disorders, withdrawal and detox are often complex.

If addiction is your only concern, it may be easier to estimate how long you'll spend in withdrawal. Withdrawal symptoms can start within hours to days and last from days to weeks, depending on individual factors, such as:

• Duration of use
• How often a substance is used
• Quantity used
• Substance used

Drug Withdrawal Timelines

General timelines for specific substances are as follows:

Alcohol

Withdrawal lasts 5–7 days.

Benzodiazepines

• Long-acting benzodiazepines: Symptoms begin within 2–7 days after the last dose and may last longer than 2 to 8 weeks.¹²
• Short-acting benzodiazepines: Symptoms begin within 1–2 days after the last dose and may last longer than 2–4 weeks.

Opioids

• Long-acting opioids (for example, methadone): Symptoms begin 12–48 hours after the last dose and may last 10–20 days. Methadone withdrawal can last up to 3 weeks.¹³
• Short-acting opioids: Symptoms begin 8–24 hours after the last dose and may last 4–10 days.

Heroin

Symptoms begin within 24 hours of the last dose and may last 4–7 days.

Stimulants

Symptoms begin within 24 hours of the last dose and may last 1–2 weeks (approximately 3–5 days in some cases).

Marijuana

Withdrawal lasts approximately 5 days. Symptoms may begin within days and may last several weeks.

Nicotine

Withdrawal lasts between 2–4 weeks.

These are just general guidelines—your symptoms may subside faster. And for some people, they go on much longer.

If you're still feeling the effects of withdrawal long after these estimated timelines, talk to your care team about your options. At that point, you might need an evaluation for post-acute withdrawal syndrome (PAWS).¹⁴ This condition is serious, but treatable. And with your provider's support, you can continue to move forward.

Treatment for Withdrawal

Withdrawal from drugs and alcohol can affect each person differently, so it's important to find a treatment that suits your needs and the substance being used. Because of the potential risks and discomfort of withdrawal, it's best for you to receive medical supervision throughout the detox and withdrawal process. Relapse after withdrawal management is common, so entering other forms of treatment after detox is key to successful recovery.

To be effective, treatment needs to be easily personalized, accessible, and adaptable to meet changing needs during treatment and recovery, starting with the withdrawal process. Medically assisted detox is a good first step in the recovery process.

Detoxification and Withdrawal Management

Medical detox is designed to help you get through withdrawal as safely and comfortably as possible. Healthcare providers use medications and monitoring to reduce your symptoms and prevent dangerous complications. Detox can happen in different settings—from outpatient clinics to residential facilities—depending on what substance you're quitting and how severe your symptoms might be.

For many people, detox is their first experience with formal treatment. And it's an important step. With medical supervision, you're much less likely to experience life-threatening complications or relapse during those difficult first days.

Detox typically includes 3 phases:

1. First, your care team evaluates your health and substance use history.
2. Then, they help stabilize you through the withdrawal process.
3. Finally, they connect you with ongoing treatment—because detox alone isn't enough for lasting recovery.

Medications Used for Withdrawal

Medications play a key role in detox. They help ease your symptoms, reduce cravings, and prevent serious medical complications that can come with withdrawal. But it's important to understand what medications can and can't do.

Detox medications address the physical side of quitting. They help your body adjust to functioning without the substance. However, they don't address the reasons you started using in the first place—the psychological, social, or behavioral patterns that contributed to your addiction. That's why therapy and ongoing treatment after detox are so important.

During detox, medications are used to:

• Ease withdrawal symptoms by replacing the substance with a safer, similar medication
• Reduce the severity of specific symptoms like nausea, anxiety, or muscle aches

Your care team may also prescribe medications to manage other health conditions you have, like high blood pressure, diabetes, depression, anxiety, or nutritional deficiencies. Managing these conditions during detox helps keep you safe and more comfortable.

Medications for Alcohol Withdrawal

Benzodiazepines are the most common medications used for alcohol withdrawal. They help reduce symptoms and—most importantly—prevent seizures, which can be life-threatening. Your doctor might prescribe diazepam (Valium) or chlordiazepoxide (Librium), either as a pill or through an IV. These longer-acting medications are especially good at preventing seizures.

If you're older, have liver problems, or have breathing issues, your doctor might choose shorter-acting benzodiazepines instead, like lorazepam (Ativan) or oxazepam (Serax). These work just as well for withdrawal symptoms but are less likely to cause excessive drowsiness in people with these conditions.

Anticonvulsants are another option. Carbamazepine (Tegretol) works as well as benzodiazepines for mild to moderate alcohol withdrawal, and it doesn't carry the same risk of misuse. However, it can cause side effects like nausea, vomiting, and skin irritation if used long-term, so it's not ideal for extended use. Sodium valproate is a similar medication that may be used in the same way.

Other medications your doctor might use include gabapentin, baclofen, clonidine, atenolol, and propranolol. Your care team will choose the right combination based on your specific symptoms and health needs.

Medications for Opioid Withdrawal

Your doctor will choose medications for opioid withdrawal based on your unique situation, including:

• How severe your addiction is
• Whether you have other mental health or medical conditions
• If you're using other substances
• What type of treatment setting works best for you

The 2 main medications used for opioid withdrawal are:

Methadone

Methadone is a long-acting medication that eases withdrawal symptoms and reduces cravings. Because it's an opioid itself and carries some risk of misuse, you'll need to take it under supervision at a clinic or treatment facility. You'll visit regularly to receive your dose from healthcare providers.

Buprenorphine

Buprenorphine also reduces cravings and withdrawal symptoms, but it works differently than methadone. It blocks the euphoric high that opioids create, which helps reduce the urge to use again. The benefit of buprenorphine is that many providers can prescribe it for you to take at home, giving you more flexibility in your treatment. You won't necessarily need to visit a clinic every day.

Your care team will help you decide which medication is the better fit for your lifestyle, health needs, and recovery goals.

Inpatient and Outpatient Treatment

Following detox, you may continue your recovery in outpatient or inpatient (residential) treatment at varying levels of intensity depending on your needs. Inpatient care involves living at the facility for the duration of treatment. The program may be 28–30 days, 60 days, or 90 days long. Outpatient treatment allows you to visit a facility to receive treatment services while still living at home.

Both inpatient and outpatient treatment can include various services, including:

• Individual or group therapy
• Drug counseling
• Medication management
• Aftercare or continuing care planning
• 12-Step facilitation and support groups

What Happens After Withdrawal?

Quitting is just one step in your journey. After you go through withdrawal, you'll have several options. You might start therapy or join a support group. If you attend medical detox, you might be required to go straight into residential rehab. Some facilities even combine these programs, so you won't need to move in the middle of treatment.

The important thing is choosing a path that meets your specific needs. Detoxification is an important part of the recovery process, but it’s not intended to address the psychological, social, and behavioral problems associated with addiction. Following detox, inpatient or outpatient treatment can provide ongoing support to help foster long-term recovery.

There are countless ways to map out the recovery process. Talking with a professional treatment team is a great way to lean about your options and start planning your recovery.

Help Is Available

Detox and withdrawal from substances can be a difficult process that carries the risk of medical complications—but you don't have to do it alone. If you or someone you love are struggling with substance misuse or addiction, help is available. Find a detox program that matches your needs today.