The National Institute on Drug Abuse (NIDA) provides guidance to the public on every facet of substance abuse, including the withdrawal experience.

Withdrawal is a natural process and can be thought of as the varied bundle of symptoms that emerge after regular, typically long-term, use of an addiction-forming drug. In some instances, withdrawal can occur when a person takes a significantly lower amount of a drug of abuse.

Withdrawal is part of a larger biological process known as physical dependence. As NIDA explains, physical dependence is a physiological state that a person goes into as a result of the body adapting to regular use of an addiction-forming drug. A person may be physically dependent on a drug without becoming psychologically addicted to it. For example, a person with an injury who takes prescription opioids as part of a pain management plan may become physically dependent on this drug without ever manifesting symptoms or signs of a psychological addiction (e.g., stockpiling the drug out of fear of running out of it).  However, anyone who is addicted to a drug is generally, as a matter of course, also physically dependent on it.

The severity of withdrawal symptoms depends on a host of factors. Some of the most impactful factors include:

  • The time period of use: In general, the longer a person abuses a drug, the more severe the withdrawal symptoms will be when use ends. Depending on the drug, a taper may be recommended so the body does not go into a severe withdrawal mode (more on this topic later).
  • The regular dosage: Tolerance to a drug is a hallmark of physical dependence. The longer a person abuses a drug, an increasingly greater amount of the drug will be needed for the person to achieve the familiar high. This means that individuals who have been abusing a drug on a long-term basis will likely have recently consumed a relatively high dose compared to someone who is newer to abuse of the same drug. The greater the regular dosage, the more likely it is that withdrawal symptoms will be severe if use stops.
  • Individual physiological and environmental factors: Some individuals are more sensitive to withdrawal and/or experience more severe withdrawal symptoms compared to others. It is not possible to gauge how severe a withdrawal process will be until it is already underway. A person’s environment also plays a key role. For example, if the person is not living in a supportive environment with family or friends who provide encouragement, the overall withdrawal experience may feel worse.
  • Opting for a taper versus going cold turkey: As noted, in some instances, a taper is recommended to prevent the body from a sort of shock that occurs when a familiar drug of abuse is no longer being absorbed into the blood. Going cold turkey can precipitate severe withdrawal symptoms in some instances. In fact, going cold turkey has been associated with causing a person to experience post-acute withdrawal symptoms (PAWS), which can last for months after last intake of the drug of abuse.

Withdrawal symptoms vary in type. As Psychology Today discusses, drugs that are considered to have the worst possible withdrawal symptoms are opioids, benzodiazepines, and alcohol. Psychology Today recommends that a person never quit any of these drug types cold turkey; medical detoxification is always advisable.

The following is a partial list of the withdrawal symptoms associated with each of the three noted drug types:

Opioids, early symptoms
  • Sweating
  • Yawning
  • Runny nose
  • Aching muscles
  • Insomnia
  • Agitation
  • Anxiety

Opioids, later symptoms

  • Nausea
  • Vomiting
  • Diarrhea
  • Dilated pupils
  • Goosebumps
  • Abdominal cramping
Abruptly discontinuing benzodiazepine use can cause the following severe benzodiazepine withdrawal symptoms to emerge (partial list):

  • Coma (can lead to death)
  • Convulsions (can lead to death)
  • Catatonia (can lead to death
  • Suicidal thoughts and attempts (can lead to death)
  • Violent behavior, such as urges to break things or harm someone
  • Homicidal thoughts (can lead to death of another)
  • Self-harm
  • Delusions
  • Psychosis
  • Confusion
  • Mania
  • Delirium tremens
Alcohol withdrawal symptoms include but are not limited to:

  • Anxiety
  • Agitation
  • Irritability
  • Seizures
  • Severe confusion
  • Fever
  • Irregular heartbeat
  • Hallucinations
  • Delirium tremens (can lead to death in 1-5 percent of cases)

The above discussion sets a spotlight on three drug categories but is not intended to suggest that withdrawal from other drugs is safe. Most, if not all, drugs of abuse can present a more complicated withdrawal process and set of symptoms than anticipated. For instance, marijuana has a much debated status in the US, but many Americans who use this drug may feel that it is benign. This perception, however, may alter if such a person stops using this drug and goes into withdrawal. Research confirms that marijuana withdrawal occurs in some heavy users.

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    According to NIDA for Teens, one study of teens in treatment for marijuana abuse found that 40 percent had experienced withdrawal symptoms when they stopped using the drug. The main withdrawal symptoms associated with marijuana include but are not limited to:

    • Restlessness
    • Trouble sleeping
    • Appetite changes
    • Weight loss
    • Sweating
    • Shakiness
    • Chills
    • Fever
    • Stomach pain
    • Headache

    There is a general side effect of withdrawal that presents a serious danger: relapse. As the National Institute on Drug Abuse notes, there is a 40-60 percent drug abuse relapse rate. Withdrawal symptoms often include drug cravings. When a person tries to withdraw cold turkey, there may be little to no safeguards in place to prevent relapse.

    In addition to direct treatment services, medical detox services provide a buffer against relapse. Whether in an outpatient or inpatient medical detox program, a client will receive care and support from all attending staff members. Programs also generally provide clients with therapy during the withdrawal process.

  • In this way, a medical detox program not only manages the physical and mental symptoms of withdrawal, but also adds an important layer of safety to the process.