Chapter 5


Distinguish Between Discomforting and Deadly

Written by Dr. Dina Macaluso, Psy.D, L.M.H.C., Alan Boyd, & Sharon Therien

withdrawal guide


You’ve decided to take the path to recovery from an addiction to alcohol or a drug, which is an admirable path to follow.

But this path can be difficult because of withdrawal symptoms that come when you stop using the drug, which is an important reason that recovery can be an uphill battle.

Nonetheless, withdrawal symptoms do end. It’s possible to overcome them in time and make that final climb over the mountain’s peak to the path of recovery on the other side. It has happened for many people, and it can happen for you too.

Acute Withdrawal

What Is Withdrawal and Why Does It Happen?

what is withdrawal

Your body gets used to having a drug or alcohol in your system when you use it continuously. So when you quickly take that substance away, your body experiences a number of symptoms in response for a period of time. This initial period is known as acute withdrawal

WebMD explains, “Drug withdrawal symptoms are caused by decreased amounts of alcohol or drugs in the blood or tissues of a person who has grown accustomed to prolonged heavy use and who then suddenly stops.”

The withdrawal process can happen with alcohol and a variety of street drugs and prescription drugs. It happens when you stop using the substance all of a sudden, or even if you cut back on your use to a large extent.

You are more likely to go through withdrawal if you are abusing substances or you’re addicted to the substance with a physical and/or psychological dependence to it, explains Mount Sinai Hospital. Also, abruptly stopping heightens the chances of having withdrawal symptoms.

General Acute Withdrawal Symptoms

The initial withdrawal experience varies from person to person, and it can differ based on:

withdrawal how much you useHow much of the drug you use

withdrawal type of drugThe type of drug

withdrawal-durationThe extent of time you’ve been using it

Nonetheless, you can expect some basic symptoms of withdrawal when you abruptly stop using just about any kind of substance. Withdrawal symptoms come at varying degrees of seriousness, and they can exhibit themselves in the form of emotional symptoms and physical symptoms.

It’s common to go through anxiety and depression at this stage. And according to the National Council on Alcoholism and Drug Dependence, you can have difficult physical symptoms that include:

  • Shaking
  • Headaches
  • Sweating
  • Irritability
  • Nausea, and more

What Is Withdrawal and Why Does It Happen?

You should also anticipate symptoms that are specific to the type of substance you have been using.

The U.S. Department of Health and Human Services explains that symptoms of withdrawal are often the reverse of what the substance’s symptoms are. “For example, pupils constrict during opioid intoxication and dilate during acute withdrawal.”

Mount Sinai Hospital describes typical withdrawal symptoms broken down by certain substances:

alcohol withdrawal
AlcoholBy going off alcohol, you could experience sweating, shaking, seizures and hallucinations as some of your symptoms.

marijuana withdrawal
MarijuanaMarijuana withdrawal can cause chills, irritability and nervousness. You could also lose weight, lose your appetite and have different sleep patterns than normal.

cocaine withdrawal
CocaineCocaine can make you feel tired, anxious and depressed.

prescription drug withdrawal
Prescription DrugsPrescription drugs also come with their own withdrawal effects.

  • Opioids: Stopping opioids can cause you to have pain, tremors, muscle aches, fever, cravings and various digestive issues, among other symptoms.
  • Barbiturates: Going off barbiturates can give you hallucinations, seizures and tremors, as well as take away your appetite and make you feel weak.
  • Benzodiazepine: Benzodiazepine withdrawal can create a quick heart rate, abdominal pain, vomiting, seizures and more.
  • Amphetamines: Withdrawal from amphetamines can make you irritable and depressed, in addition to changing your sleep patterns and causing aches in your muscles and pain in your abdomen.

Sometimes, withdrawal is very dangerous, requiring medical help. The Hazelden Betty Ford Foundation lists some dangerous symptoms that can occur in the process and potentially create a risk to your life.

For instance:

  • Withdrawal from alcohol can cause tremors, seizures, strokes and heart attacks.
  • You can have seizures during a withdrawal from benzodiazepines.
  • Withdrawal from cocaine or crack can lead to seizures, strokes, convulsions and respiratory failure; they can risk your life from these problems or from another symptom of their withdrawal, suicide.
  • Methamphetamines have withdrawal symptoms that are like cocaine.
  • Barbiturate withdrawal can be a risk to your life as well.

How Long Does Acute Withdrawal Last?

You can expect symptoms of acute withdrawal to start pretty quickly after you stop or greatly cut back on a substance – it usually starts within hours or sometimes days.

Then, you can expect the length of time acute symptoms lasts to vary based on the type of substance you use.

The U.S. Department of Health and Human Services says:

withdrawal timelines
  • Alcohol withdrawal tends to take five to seven days
  • Marijuana withdrawal takes five days
  • Opioid withdrawal takes four to 10 days
  • Benzodiazepine withdrawal takes one to four weeks (or three to five weeks if you cut back slowly)
  • Stimulant withdrawal takes one to two weeks
  • Nicotine withdrawal takes two to four weeks

Medical Detox


If you’re somewhere on the spectrum from hesitant to completely afraid of quitting your substance because of how acute symptoms may affect you, that’s normal. These symptoms make it very difficult to stop using the substance and easy to go back to it just to make the withdrawal period stop.

But know that there is a solution that can help: medical detoxification. Since it helps the withdrawal period, it’s also called withdrawal therapy. This process can make withdrawal easier, and in some cases, is necessary when the type of drug or amount makes the withdrawal process a threat to your life.

The detoxification process will vary based on your needs, so an addiction professional could help you figure out what you would require based on your situation.

“The goal of detoxification…is to enable you to stop taking the addicting drug as
quickly and safely as possible,” says

Some people can go through detoxification through an outpatient program, while you might instead require an inpatient center or a hospital. Depending on the variety of drug you’re taking, your detoxification might be focused on slowly cutting back how much you’re taking.

Or you might need to take a medication in place of the original drug for a certain period of time. For example, you could take methadone instead of heroin. Medications can help cut your cravings or reduce your symptoms of withdrawal.

In addition, physicians might need to closely monitor your body during the detox process.

After or along with the detoxification phase, you should also engage in other treatments to overcome your addiction on other levels.

Just taking care of the symptoms won’t help you:

withdrawal causes
  • Understand why you have turned to drugs
  • Come up with coping strategies to deal with stressful situations
  • Learn how to avoid triggers
  • Discover other ways that could help you recover from addiction

treatment for withdrawals

That’s why it’s important to gain additional treatment at a specialized substance use treatment center, whether an inpatient or outpatient program works best for you. You can gain help through behavioral therapy, support groups and other methods.

It might even be necessary for you to enter a residential program, or therapeutic community, for an extended period of time. The stay can last from six months up to a year, guiding you to really get your life back and learn how to live in a new way.

But what works best is the treatment method that works for you. We’ll discuss treatments more as we continue with this guide.

Post-Acute Withdrawal Syndrome (PAWS)

What Is PAWS and When Does It Happen?

After the initial withdrawal period, which is acute, you can experience another stage, known as post-acute withdrawal syndrome, or PAWS.

Some professionals instead call this stage post-withdrawal syndrome, prolonged withdrawal syndrome, protracted withdrawal syndrome or a host of other names that don’t always follow the acronym PAWS, such as chronic withdrawal or extended withdrawal.

PAWS tends to happen specifically with the recovery from certain substances, including:

  • Opiates
  • Barbiturates
  • Benzodiazepines
  • Ethanol
  • Antidepressants

Nonetheless, you could experience lasting effects of other drugs, such as alcohol, when the drug changes the brain and the central nervous system during the addiction process. When these changes take place because of using the substance, it will take time for the brain and body to adjust themselves to life without the substance.

At the same time, not everyone has to go through the PAWS stage. Some people have recovered from the substance once they are through the acute withdrawal syndrome phase, so the experience varies.

Symptoms of PAWS

With PAWS, you can have many hard-to-handle symptoms that are mainly emotional. These could include:

post acute withdrawal symptomsAnxiety

depression and withdrawalDepression

panic attacks and withdrawalPanic attacks

mood swings withdrawalMood swings

withdrawal anhedoniaAnhedonia*

*when the drug is the only thing that gives you pleasure

In addition, PAWS can make sleeping and brain processes difficult, create intense cravings for the substance and even lead to suicidal ideation or suicide.

The U.S. Department of Health and Human Services says that PAWS can both include extended symptoms from acute withdrawal and new symptoms that pop up once you’re past acute withdrawal.

Certain responses, including cravings, impulsivity, anxiety and cue-induced stress, can get worse during the PAWS stage. Just like with acute, your PAWS symptoms can vary depending on the type of substance you have stopped using.

Why Is This Phase of Recovery So Difficult?


This phase can make it feel like withdrawal will never end and you’ll never recover. But it does end and you can recover. Many people do.

“Understanding the lingering effects of substance abuse can go a long way toward educating addicts about relapse prevention and maybe most importantly, giving them hope that this, too, shall pass,” says Jeanene Swanson for The Fix.

PAWS leads many people to relapse because the period is long and difficult. Instead of feeling better from being off the drug, you’re actually feeling worse, so it can be all too easy to feel as though life is better with the drug.

Instead of letting PAWS keep you away from recovery, hopefully you can know that this difficult recovery period is common, it has a name and it’s possible to get past it.

Remember the problems the addiction is causing in your life, and realize that your mind and body will start to feel better once you make it through this PAWS stage.

A professional treatment program can help you recognize when you’re in this phase and provide tools and support to help you get through it.

How Long Does PAWS Last?


The U.S. Department of Health and Human Services says, “In a pattern unique to each client, symptoms related to substance abuse may be felt for weeks, months, and sometimes years.”

This can definitely make recovery, or even the thought of recovery, feel hopeless, but the department continues, “SUD [substance use disorder] treatment providers can help clients avoid this cycle [of relapse] by helping them recognize and manage symptoms.”

It’s important to keep in mind that if you do relapse, you will probably want to try to stop your addiction again, so it’s better to try to get past this hump of PAWS after you have already made it partially there, instead of starting over again and again.

Also, many of your intense symptoms will end earlier on, and then you can learn to manage many of the ongoing symptoms.

Getting Through PAWS

Unfortunately, “While there are specific treatments for acute detox, most PAWS treatments are still in the experimental phase,” explains Jeanene Swanson.

This mostly refers to medications that could potentially help with PAWS symptoms, but have not been agreed upon by medical professionals for their use during this time. Nonetheless, some medications are used, varying based on the substance you’re recovering from.

Additional treatments can help with various symptoms, such as anxiety; these include exercise, meditation, yoga, therapy and more.

And it’s important to check for signs of a co-occurring disorder, such as depression, instead of assuming that depression-like symptoms are only coming from PAWS.

Swanson quotes a person who has gone through this phase, saying, “The advice I would give is to be patient with the time it takes to heal and feel better. These tough issues weren’t created overnight, and they won’t disappear overnight.”

A quality treatment program can help you get through the post-acute withdrawal stage. According to the U.S. Department of Health and Human Services, some factors that can improve your chances for success include:

addiction withdrawalBeing aware of this stage

monitoring withdrawalBeing monitored for signs of this phase

addiction help for withdrawalsGetting support from addiction specialists

withdrawal helpGetting preventative help to try to keep you from relapse

You can also watch for signs of this stage in yourself, and try to understand that you’re going through a common phase that does have an ending. Try to be patient at this time.

Lean on support from addiction specialists and others going through similar experiences. It’s also possible that your addiction professionals could offer medication that could help you with some of your symptoms.

Now you know more about the different phases of the withdrawal process and why it can be so difficult to stop using substances once you are addicted. But you also know there is help in the form of detox and other treatments that can help you climb over that mountain and make it to the other side.

Continue reading this guide to learn more about treatment options available to you.

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