Withdrawal is the period of time when substances leave a person’s body. When someone is physically dependent on drugs or alcohol, withdrawal symptoms often occur as the substance exits the person’s system. These physical and psychological symptoms are often uncomfortable and distressing.

The specific symptoms differ between substances, but they generally include feelings of disease and discomfort, mood changes, and cravings for the substance in question. Physical symptoms typically subside after a few days. Psychological symptoms, like depression or dysphoria, can last much longer. Withdrawal is only the first step in recovering from addiction and substance abuse; additional treatment, including comprehensive therapy, is needed in order to achieve lasting sobriety.

CNS Depressants

Central nervous system depressants (CNS depressants) are drugs that decrease brain activity. These substances are sometimes called sedatives and tranquilizers. These types of drugs are typically available by prescription and often used to treat anxiety or sleep disorders. The most common types of drugs in this class are benzodiazepines, non-benzodiazepine sleep medications, and barbiturates.

Withdrawal from central nervous system depressants like barbiturates and benzodiazepines can cause symptoms that are more serious than some other types of drugs. Some CNS depressants have a withdrawal syndrome that can be life-threatening. Because of this, NIDA recommends that anyone seeking to withdraw from this class of substances should receive medical supervision and care throughout the process. Dosages of CNS depressants are typically tapered gradually over time in order to avoid the more dangerous symptoms that can occur when stopping use.

Symptoms associated with barbiturate withdrawal include the following:

  • Anxiety
  • Restlessness
  • Insomnia
  • Tremors
  • Dizziness
  • Seizures
  • Psychosis

Without medical intervention, withdrawal from barbiturates can lead to hyperthermia, circulatory failure, and death.

Benzodiazepine withdrawal syndrome can also lead to serious symptoms, although risk of death is lower than with barbiturate withdrawal. The journal Addiction lists the following symptoms of benzodiazepine withdrawal:

  • Difficulty sleeping
  • Irritability
  • Anxiety
  • Panic attacks
  • Tremors
  • Sweating
  • Difficulty concentrating
  • Nausea and dry retching
  • Weight loss
  • Heart palpitations
  • Headaches
  • Muscle pain and stiffness
  • Changes in perception, such as vision and hearing changes

Most people withdrawing from benzodiazepines experience a relatively short withdrawal syndrome that begins 1-4 days after stopping use, with anxiety and insomnia being the primary symptoms. More severe withdrawal from these drugs can last 10-14 days. Medical detox is always required for benzodiazepine withdrawal.

CNS Stimulants

Central nervous system stimulants are prescription medications typically used to treat attention deficit hyperactivity disorder (ADHD), narcolepsy, and occasionally depression. Stimulants work by increasing levels of certain neurotransmitters within the brain. These drugs stimulate receptors in the central nervous system, causing alertness, increased attention, and energy.

Doctors believe that people with ADHD have lower levels of dopamine within their brains. Stimulants can correct this imbalance and improve concentration and focus. Because stimulants correct an imbalance within the brains of people who have been prescribed these medications for legitimate use, people with ADHD and similar disorders do not usually become addicted to stimulants. However, these drugs can be highly addictive among people who do not have a chemical imbalance and use stimulants illicitly.

In addition, cocaine is a stimulant. This illegal drug is often abused in both its powder and rock forms. Cocaine is often used in a binge cycle, and it is highly addictive.

NIDA lists the following symptoms of CNS stimulant withdrawal:

  • Depression
  • Fatigue
  • Insomnia
  • Loss of appetite
  • Cravings

Hallucinogens

Hallucinogens are drugs that primarily cause altered perceptions, such as visual or auditory hallucinations. Hallucinogenic substances can be found in some plants and mushrooms and can also be synthetically created in a lab. Common hallucinogens include ayahuasca, DMT, LSD, peyote, psilocybin, and salvia.

Withdrawal symptoms resulting from the use of hallucinogens are not typically seen. Some people who chronically abuse large doses of hallucinogens may experience a mild withdrawal syndrome when stopping use. It is unclear whether these symptoms result from true physical dependence or whether psychological factors cause the physical symptoms. Psychological withdrawal symptoms may include:

  • Cravings
  • Fatigue
  • Irritability
  • Anhedonia, or the inability to experience pleasure

Dissociative Anesthetics

Dissociative drugs are substances that produce a sense of detachment from reality. People who use these drugs feel detached from their environment and from themselves, and experience distortions in perception, such as changes in sight and hearing. PCP and ketamine are common dissociative anesthetics of abuse.

Physical dependence on these substances is rare, but some long-term users may experience a mild withdrawal syndrome when stopping use. Withdrawal symptoms may include:

  • Depression
  • Cravings
  • Increased appetite
  • Increased need for sleep

Opiates

Both heroin and prescription painkillers fall under the opiate class of drugs. Also called opiates, narcotic analgesics are painkillers derived from the seed pod of the poppy plant. Opiate drugs include oxycodone, morphine, hydrocodone, and codeine. In addition, heroin is an opiate drug, also derived from the poppy plant.

This class of substances is highly addictive. With prescription opioids, using higher doses than prescribed or using the drugs in ways other than their intended uses increases the risk of physical dependence. Common symptoms of opioid withdrawal include:

  • Abdominal cramps
  • Anxiety
  • Sweating
  • Diarrhea
  • Dilated pupils
  • Goosebumps
  • Hypertension
  • Insomnia
  • Muscle twitching
  • Runny nose and eyes
  • Irregular heartbeat

Withdrawal syndrome typically begins within a day of last use. Physical symptoms may last several days, while psychological symptoms, such as changes in mood and anxiety, may last much longer.

Medications are frequently used to help ease withdrawal symptoms when in detox from narcotic drugs and heroin. NIDA lists methadone, buprenorphine, and naltrexone as being the most common medications used for this purpose. Methadone and buprenorphine mimic the effects of opioids and are used to minimize withdrawal and prevent cravings. Naltrexone blocks the effects of opioids, which can help the individual remain sober and prevent relapse.

Inhalants

Inhalants are common household substances that are inhaled in order to produce psychoactive effects. Younger teens abuse inhalants more than any other age group. Spray paints, markers, glues, and cleaning fluids are often “huffed” for their mind-altering effects.

Physical dependence is uncommon but may occur if large doses are used frequently. A mild withdrawal syndrome may occur when use is stopped. Symptoms of inhalant withdrawal may include:

  • Headaches
  • Nausea or vomiting
  • Hallucinations
  • Runny eyes or nose
  • Cravings
  • Rapid heartbeat
  • Depression
  • Anxiety

Cannabis

Cannabis, or marijuana, is an illicit substance commonly abused by smoking or eating it. Many people who regularly abuse large doses of marijuana develop physical dependence on the substance.

Dependence on marijuana is linked to a mild withdrawal syndrome. Symptoms of marijuana withdrawal include:

  • Irritability
  • Mood swings
  • Difficulty sleeping
  • Decreased appetite
  • Cravings
  • Restlessness

Marijuana withdrawal syndrome typically appears within the first week after stopping use of the drug, and it may last as long as two weeks.

Managing Withdrawal

While certain substances bring on an intense withdrawal symptom, virtually all substances of abuse involve some degree of withdrawal, even if only psychological withdrawal symptoms are in play. As a result, most people who are addicted to substances can benefit from medical detox where withdrawal symptoms can be managed and relapse is less likely. Certain substances of abuse, such as alcohol, benzodiazepines, and opiates, always require medical detox due to the potential for life-threatening withdrawal symptoms and high risk of relapse during detox.