When individuals make the decision to pursue treatment for drug or alcohol dependence, they’ve likely explored the option to attend a treatment facility, at least for the first step: medical detox.
Medical detox, now referred to as “withdrawal management” by professionals involved in the treatment of substance use disorders, should be undertaken in conjunction with an appropriate facility where clients can be monitored appropriately by trained medical professionals. Certain withdrawal symptoms, particularly those that occur during moderate to severe withdrawal from alcohol or benzodiazepines, can be dangerous and even life-threatening.1,2
With inpatient withdrawal management, trained professionals monitor clients 24 hours a day to ensure safety, overseeing the administration of medication and ensuring abstinence from substances of abuse. Outpatient withdrawal management where an individual is regularly seen in a physician’s office or monitored by a home healthcare agency, may be appropriate depending on the substance(s) of abuse, the severity of withdrawal syndrome, and the individual’s pattern of use.2
If a person attempts to detox alone a home, they own’t have the benefit of this supervision. With supervision at a professional treatment facility, medications may be prescribed to help ease withdrawal symptoms. If individuals try to complete the detox process at home, the discomfort of withdrawal symptoms may prompt them to begin using again.
Alcohol withdrawal is well-studied and known to have a withdrawal syndrome with potentially serious—and deadly—consequences. In fact, approximately 10% of people who attempt to withdraw from alcohol will experience more severe side effects, such as seizures.3 Delirium tremens is a severe complication of alcohol withdrawal that can lead to death in 5-25% of those who experience it.3
Given the potentially fatal outcome of alcohol withdrawal, it’s imperative that a trained clinician or physician physically examine and obtain a thorough history of an individual’s alcohol use to establish the diagnosis and severity of alcohol withdrawal.4Individuals with mild to moderate withdrawal symptoms may safely be able to complete outpatient detoxification. Inpatient withdrawal management is indicated, however, for any individual with the following characteristics:4
- History of severe withdrawal symptoms.
- History of withdrawal seizures or delirium tremens.
- Multiple previous detoxifications.
- Concomitant psychiatric or medical illness.
- Recent high levels of alcohol consumption.
- Lack of a reliable support network.
Medications such as benzodiazepines and anticonvulsants may be prescribed for individuals undergoing either outpatient or inpatient alcohol withdrawal management.5 They help prevent progression of withdrawal symptoms if administrated early.5 Thiamine and folic acid may also be used because individuals experiencing alcohol withdrawal are often nutritionally depleted.5
If the medical detox process is completed in an inpatient treatment facility, medical staff will be able to give the client additional medication as needed to help with any symptoms that develop. This may include medications to treat depression, anxiety, nausea, body aches, and insomnia.4 In addition, mental health professionals are on hand to talk the person through any difficult feelings that arise and offer support during times of discomfort.
Alcohol detox should be followed by comprehensive treatment for alcohol dependence that addresses the underlying substance use disorder and arms an individual with coping skills that will help them avoid relapse. This includes individualized therapy, medication (as needed to minimize cravings or address psychiatric disorders such as depression), peer support groups, and family therapy.4
With abrupt cessation of stimulants such as cocaine or methamphetamine, individuals face not only physical withdrawal symptoms, but also strong psychological withdrawal symptoms. Although the physical symptoms are mild and typically aren’t life-threatening, they can be uncomfortable and difficult to process.1
Stimulant withdrawal can cause severe depression, anxiety, fatigue, difficulty concentrating, increased appetite, extreme sleepiness, and an inability to feel pleasure. Intense drug cravings will also be experienced. This can be an easy trigger for relapse.1
Abusing stimulants can change certain structures and processes in the brain, leading to symptoms lingering long after the detox process is complete. Continued treatment can help with these symptoms, especially coping skills to fight off drug cravings.6
Symptoms of withdrawal last 1 to 2 weeks, and medication may be initiated during this period in an effort to treat the addiction itself and assist in reducing cravings,7 which may last at least 5 weeks, during which an individual is at a higher risk of relapse.8
Stimulant detox can be an uncomfortable process and relapse is common. Entering a treatment center may help individuals to feel safe and comfortable during the detox process. This option also helps people by distancing them substances that could cause them to relapse easily.
When individuals become dependent on opioids, such as heroin or prescription painkillers such as oxycodone, hydrocodone or morphine, they will experience mild to severe physical withdrawal symptoms if they simply stop taking them. Symptoms include agitation, anxiety, tremors, muscle aches, nausea and vomiting and more. For that reason, many recovery programs use medication-assisted treatment to help reduce both cravings and withdrawal symptoms.
The symptoms of opioid withdrawal may appear within 8-12 hours after the last dose and reach their maximum intensity after 48-72 hours.9 Symptoms may last up to 10 days.9
Opioid addiction sometimes requires the use of medications like buprenorphine or methadone during the withdrawal management process. These medications may be administered in an inpatient or outpatient environment. The medications are used to reduce the likelihood of withdrawal symptoms and prevent individuals from experiencing a high if they use an illegal drug while on the replacement medication.9
Therapy is a critical component when recovering from opioid dependence.9 In therapy, clients learn coping skills that will help them to abstain from heroin or prescription painkiller use. A good support system is also crucial.9
Benzodiazepines can also produce a very dangerous withdrawal syndrome in those who have been using or abusing the drugs. In fact, many users of benzodiazepines, like Xanax, don’t even realize they are addicted to the drugs. Some users may simply begin upping their dosages or taking it outside of the parameters of their prescriptions in order to experience more of pleasant, relaxing effects of the drugs.
Generally, medical professionals will slowly taper users off benzodiazepines in a slow manner, gradually reducing the dosage over time in a structured manner. Quitting benzodiazepines cold turkey, in an abrupt manner, can send users into severe withdrawal. Withdrawal symptoms that are potentially life-threatening include seizures and psychosis.1
Benzodiazepines are often abused with other substances as well, complicating the effects of withdrawal. Inpatient settings can help an individual be safely detoxed from polysubstance abuse, ensuring comfort and safety throughout the process.
Stopping the long-term, regular use of marijuana does not tend to produce life-threatening withdrawal symptoms, however it may induce a withdrawal syndrome characterized by unpleasant mood and behavioral symptoms. This can usually be treated in an outpatient setting.10
Co-occurring Mental Disorders
If a person undergoing withdrawal management has any co-occurring mental health issue—such as depression or anxiety—or an unsafe home environment where the potential to relapse is high, then inpatient withdrawal management and managed care and treatment is typically necessary.11
- Herron, A. & Brennan, T.K. (2019). The ASAM Essentials of Addiction Medicine, 3rd Edition. Philadelphia: Wolters Kluwer.
- Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
- Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998). Complications of alcohol withdrawal: Pathophysiological insights. Alcohol Health and Research World, 22(1), 61–66.
- Bayard, M., Mcintyre, J., Hill, K.R., Woodside, J. (2004). Alcohol Withdrawal Syndrome. American Family Physician, 69(6): 1443–1450.
- Muncie, H.L., Jr., Yasinian, Y., & Oge’, L. (2013). Outpatient Management of Alcohol Withdrawal Syndrome. American Family Physician, 88(9), 589–595.
- Center for Substance Abuse Treatment. Substance Abuse and Mental Health Services Administration. (1999). Treatment for Stimulant Use Disorders. Chapter 2—How Stimulants Affect the Brain and Behavior.
- Forray, A., & Sofuoglu, M. (2014). Future pharmacological treatments for substance use disorders. British Journal of Clinical Pharmacology, 77(2), 382–400.
- Zorick, T., Nestor, L., Miotto, K., Sugar, C., Hellemann, G., Scanlon, G., … London, E. D. (2010). Withdrawal symptoms in abstinent methamphetamine-dependent subjects. Addiction (Abingdon, England), 105(10), 1809–1818.
- American Society of Addiction Medicine. (2015). The ASAM National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use.
- Bonnet, U., & Preuss, U. W. (2017). The cannabis withdrawal syndrome: Current insights. Substance Abuse and Rehabilitation, 8, 9–37.
- Substance Abuse and Mental Health Services Administration. (2016). Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.