What are the two types of withdrawal?

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), there are two types of withdrawal: acute withdrawal and protracted withdrawal.

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Acute withdrawal is the initial emergence of symptoms after suddenly discontinuing the use of a substance. These symptoms tend to be opposite of the effects of the substance, making them different between substances.

Alcohol : 5-7 days

5-7 days Benzodiazepines : 1-4 weeks, or 3-5 weeks if reducing dosage gradually 1-4 weeks, or 3-5 weeks if reducing dosage gradually Cannabis : 5 days

5 days Nicotine : 2-4 weeks

2-4 weeks Opioids : 4-10 days; methadone may be 14-21 days

4-10 days; methadone may be 14-21 days Stimulants: 1-2 weeks

Symptoms that last beyond this period, or reappear after this period, are then labeled as protracted withdrawal (commonly known as post-acute withdrawal, chronic withdrawal, or extended withdrawal). Protracted withdrawal is the lesser studied of the two types of withdrawal, but it can often be a major factor in the incidence of relapse.

Symptoms of Acute Withdrawal for Various Substances

Though symptoms of acute withdrawal will differ between substances, it is generally known that these symptoms will be opposite the effect of the substance. Withdrawal symptoms are often dangerous for individuals, and they are best managed by medical professionals. The symptoms of acute withdrawal for various substances are as follows:

Alcohol Hyperactivity

Anxiety and tremors

Sweating

Nausea

Increased heart rate

Increased blood pressure

Fever

Hallucinations

Delirium tremens (in less than 5 percent of individuals) Benzos Double or blurry vision

Headache

Body pains

Restlessness

Sweating

Nausea and diarrhea

Disorientation and dizziness

Dry mouth

Fever or chills

Decreased muscular control

Shortness of breath

Hallucinations Cannabis Insomnia

Loss of appetite

Anxiety and tension

Depression

Nausea

Fatigue

Night sweats

Nightmares or strange dreams

Headache Nicotine Cravings

Irritability and irrational rage

Anxiety

Depression

Weight gain

Dizziness

Headaches Opioids Irritability

Anxiety

Fatigue

Insomnia

Muscle aches

Nausea, vomiting, and diarrhea

Fever or chills

Sweating

Runny nose

Teary eyes Stimulants Depression

Hypersomnia

Increased appetite

Anxiety

Slow thoughts

Slow, or lack of, movement

During the acute withdrawal phase, medication may be prescribed to assist with withdrawal symptoms, though this is not always the case. It is recommended that this phase be overseen by a medical professional, especially in cases of severe addiction, or these symptoms can become dangerous. In cases of alcohol, benzo, or opiate detox, medical detox is always required.

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Symptoms of Protracted Withdrawal

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The majority of the symptoms of protracted withdrawal are psychological in nature, due to the fact that long-term substance abuse can alter the brain in various ways. According to the National Institute on Drug Abuse, addictive substances stimulate the reward circuit in the brain, causing a flow of feel-good chemicals, like dopamine, to users. In the early stages of addiction, using a substance causes overstimulation of the system or an overproduction of dopamine, which results in euphoria or feeling “high”. However, over time, the brain can lose its ability to produce such chemicals on its own, resulting in a shortage. Individuals who struggle with addiction will find that they require more of a substance to achieve the same feeling, or to experience pleasure at all, due to the reliance of the brain on the substance. It is these alterations in the brain that produce protracted withdrawal, or post-acute withdrawal syndrome (PAWS). Long-term aftereffects of substance abuse, according to SAMHSA, can include any of the following:

Anxiety and irritability

Difficulty focusing on tasks, concentrating, and making decisions

Reduced enjoyment of previously pleasurable activities (anhedonia)

Depression

Problems with sleep and increased fatigue

Reduced libido

Substance cravings

Impaired executive control

Physical symptoms that are otherwise unexplainable

These symptoms make individuals particularly vulnerable to relapse due to their increased duration. Some of these symptoms can several months, some a year, and some several years. Often, when transitioning from inpatient recovery to outpatient recovery, it can be helpful to create a plan for the first few days following discharge, in the event that such symptoms occur. Individuals should not attempt to overburden or overstress themselves immediately, as this can exacerbate PAWS symptoms and increase the desire for relapse. Other ways to combat PAWS symptoms include developing a new system of positive coping mechanisms, exercising regularly, and joining recovery groups.

Ongoing Recovery

There are many resources for those in recovery, especially those suffering from post-acute withdrawal syndrome. Though the process of withdrawal can be difficult, symptoms do eventually subside, and there is plenty of support offered for individuals going through recovery. While chances of relapse can increase during withdrawal phases, there are healthy mechanisms that can assist with symptoms and foster overall wellbeing.

americanaddictioncenters.org - What Are The Dangers of Withdrawal & Detox?

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