The Withdrawal Handbook: Detoxing from Addictive Substances and Getting Your Life Back - AspenRidge

Did you know that fear of withdrawal is one of the biggest barriers that keeps some people from getting help for their substance abuse disorder?

When someone struggling with an active addiction admits there is a problem and asks for help, then they have taken the wonderful and all-important first step on the Road to Recovery. Having made this step, they are probably anxious to begin treatment.

But one more important task remains before recovery can move forward – detoxification.

What Is Alcohol and Drug Detox?

“If you don’t take care of this the most magnificent machine that you will ever be given…where are you going to live?”

~ Karyn Calabrese, Cleansing with Karyn: Secrets for Inner Healing and Outer Beauty

Detox is exactly what it sounds like: getting toxic substances out of your system – in this case, the alcohol and drugs you’ve been abusing. Even after you have stopped use, your body needs time to purge those substances.

But part of addiction is dependence – your body has grown accustomed to the substance, and when you stop taking it, you will begin experiencing withdrawal symptoms.

What Is Alcohol or Drug Withdrawal?

“If you have never been addicted, you can have no clear idea what it means to need junk with the addict’s special need. You don’t decide to be an addict. One morning you wake up sick and you’re an addict.”

~ William S. Burroughs, Junky

When you abuse any substance – alcohol, illicit drugs, prescription medications, or inhalants –your brain responds by triggering an artificially-massive surge in dopamine production.

Dopamine is a naturally-occurring neurotransmitter associated with:

  • Pleasure
  • Reward
  • Learning
  • Memory
  • Motivation

Because of these associations, dopamine plays a crucial role in both the development of an addiction and the subsequent recovery.

How does that work?

When you drink or use a drug of abuse, the dopamine spike makes you feel extreme PLEASURE and well-being – the “high”. From the very first use, your brain LEARNS to link the action—drinking/drugging—to a REWARD, and that link is stored in your MEMORY and you are continually MOTIVATED to repeat the action.

In the beginning, repeating the action is voluntary—you do it because you want to feel GOOD.

But over time and after chronic abuse, your stops producing dopamine naturally. This means that it is virtually impossible for you to experience pleasure, feel motivated, or even function normally unless you are under the influence of an intoxicant.

This is what causes cravings and drives addiction.

Now, repeating the action is compulsory – you do it because you don’t want to feel BAD

So, when you decide to give up drugs and alcohol and start recovery, your body respond by causing you to experience painfully-uncomfortable – but temporary – symptoms of withdrawal. In other words, your addicted brain will crave the substance that it can’t have until it gradually returns to normal.

Why is Drug and Alcohol Detox Needed?

“Don’t pick up a drink or drug, one day at a time. It sounds so simple; it actually is simple but it isn’t easy; it requires incredible support and fastidious structuring.”

~ Russell Brand

The most important thing to remember about alcohol or drug detox is that it is NOT recovery. The goal of detox isn’t to address the addiction itself or to teach you how to change your life to better manage your disease.

But detox DOES give you a firm foundation on which you can build your recovery.

When you are no longer mentally shackled by the physical effects of your addiction, you will be ready for the message of recovery and the concepts and lessons shared in treatment.

In addition, sometimes detox is medically necessary. This is definitely true when you have a long personal history of addiction to alcohol or benzodiazepine tranquilizers such as Xanax, Librium, or Ativan. Heavy or chronic abuse of either substance causes neurochemical changes within the brain so profound that unsupervised withdrawal can be fatal.

A medically-supervised detox takes place in a safe and monitored therapeutic environment where:

  • You overcome your physical dependence in private, away from other stresses or temptations.
  • Trained staff supports and encourages you, while making sure that you are as comfortable as possible.
  • When appropriate, anti-craving medications may be prescribed.

Some facilities can perform an “ultra-rapid detox”, where you are put under general anesthesia and given specific medications to accelerate the process. While reducing the amount of time needed to detox is an attractive option, there are a few caveats.

First, shorter detox time doesn’t result in higher rates of successful recovery.

Second, anytime you are put under general anesthesia, there are risks. There have been reports of deaths occurring during rapid detox procedures.

Lastly, an ultra-rapid detox costs considerably more than the established procedure, and many insurance plans do not cover the option.

Facts about Alcohol Detox and Withdrawal

“Every time I drank, I could feel pieces of me leaving. I continued to drink until there was nothing left. Just emptiness.”

~ Dina Kucera, Everything I Never Wanted to Be

Alcohol is the most-used intoxicant in the United States. 8 out of 10 Americans age 12 and older have tried alcohol. This is two-and-a-half times the amount of people who have experimented with marijuana.

About HALF of alcoholics will suffer withdrawal symptoms when they stop drinking. Here is a typical alcohol withdrawal timeline:

6-12 Hours

  • Anxiety
  • Restlessness
  • Nausea/Vomiting/Dry Retching/Diarrhea
  • Dehydration
  • Tremors/Shakes
  • Accelerated Pulse
  • Loss of Appetite
  • Headaches
  • Insomnia

12-24 Hours

  • Worsening Tremors, Especially in the Hands
  • Muscle Aches and Pains
  • Disorientation/Confusion
  • Seizures

48 Hours

  • High Blood Pressure
  • Extremely High Fever
  • Profuse Sweating
  • Dry Mouth
  • Severe Insomnia
  • Terrifying Auditory and Visual Hallucinations
  • Loss of Reality
  • Unconsciousness
  • Seizures – Possibly Fatal
  • Delirium Tremens – the DT’sPossibly Fatal

It bears repeating – NEVER attempt to abruptly quit alcohol on your own. Because of the seriousness of some alcohol withdrawal symptoms, ALWAYS detox from alcohol under close medical supervision.

What You Need to Know About Delirium Tremens

About one 1 of every 5 alcoholics in withdrawal will experience delirium tremens. It typically manifests within 2 days into the process, and can last up to 5 days.

The DTs are characterized by a rapid onset of global confusion, extreme delirium, and severe hallucinations. Over a third of delirium tremens patients die if they don’t receive medical treatment.

Sadly, 15% die even WITH treatment.

The known risk factors for delirium tremens include:

  • A long personal history of chronic alcoholism – more than 10 years.
  • A previous medical history of alcohol withdrawal, especially among heavy drinkers.
  • Age

How Long Does It Take to Detox from Alcohol?

Alcohol withdrawal symptoms can start manifesting within 6 hours following the last drink. Alcohol detox typically last between 3 and 4 days, but heavy drinkers and those who have a long history of alcoholism may require up to a week.

Here’s the good news – 70% of people who check into an alcohol detox facility successfully complete the process. Even better, HALF subsequently enter an alcohol rehab program.

Post-Acute Withdrawal Syndrome (PAWS)

After those initial withdrawal symptoms experienced during alcohol detox, some alcoholics may still experience prolonged side-effects well into recovery. PAWS can persist from several weeks up to a year. Symptoms include:

  • Persistent Anxiety
  • Irritability
  • Mood Swings and Emotional Outbursts
  • Sleeping Difficulties – insomnia, wakefulness, poor quality sleep
  • Memory Impairment
  • Dizziness/Balance Problems
  • Delayed Acute Withdrawal Symptoms

What Are the Best Medicines for Alcohol Withdrawal?

Most medical and addiction recovery professionals are in agreement that severe alcohol withdrawal responds well to treatment with certain prescription medications. This has two main goals – easing immediate acute withdrawal symptoms and preventing future complications.

Typical alcohol withdrawal medications used during detox include:

  • BenzodiazepinesTranquilizers lessen anxiety, help with confusion, reduce tremors, and decrease the risk of seizures and delirium tremens.
    • Librium/Chlordiazepoxide
    • Valium/Diazepam
    • Serax/Oxazepam
    • Ativan/Lorazepam
  • Naltrexone Cuts the frequency of heavy drinking, the total number of drinking days, and the quantity of alcohol consumed.
  • Topiramate – To reduce cravings.
  • Antabuse/Disulfiram – To enforce abstinence by making the person physically unable to tolerate alcohol.
  • Tegretol/CarbamazepineAn anticonvulsant benzodiazepine alternative that is non-sedating and has a low abuse potential.
  • Dilantin An anticonvulsant
  • AntipsychoticsFor hallucinations, psychosis, and agitation.
    • Haloperidol
    • Chlorpromazine
    • Olanzapine
    • Risperidone
    • Quetiapine
    • Paliperidone
    • Aripiprazole
    • Ziprasidone
  • Beta blockersFor hypertension and tachycardia.
  • ClonidineFor hypertension.

Facts about Opioid Detox and Withdrawal

“Junk sickness is the reverse side of junk kick. The kick of junk is that you have to have it. Junkies run on junktime and junkmetabolism. They are subject to junk climate. They are warmed and chilled by junk. The kick of junk is living under junk conditions. You cannot escape from junk sickness any more than you can escape from junk kick after a shot.”

~William S. Burroughs, Junky

Opioids are derived from the opium poppy and include prescription painkillers such as Vicodin (hydrocodone), OxyContin (oxycodone), fentanyl, morphine, and many cough medicines (codeine), as well as the illicit Street drug heroin.

How bad is the opioid epidemic in America?

  • Although the United States has only 5% of the world’s population, we consume 75% of the world’s prescription drugs. Even more telling – Americans use 99% of the world’s hydrocodone supply.
  • It is estimated that up to 65,000 people died because of prescription drug overdoses in 2016 – 70% of Them because of prescription opioids. That equates to over 45,000 unnecessary deaths.
  • 2002-2015, heroin deaths increase more than SIXFOLD.
  • Synthetic opioids like fentanyl caused over 20,000 opioid deaths in 2016.

In contrast to quitting alcohol and benzodiazepines, opioid withdrawal is not dangerous. However, the withdrawal symptoms ARE painfully uncomfortable and can manifest in as little as 12 hours:

Acute Opioid Withdrawal: 12 Hours-5 Days

  • Extreme Anxiety
  • Confusion/Inability to Concentrate
  • Agitation/Restlessness
  • Listlessness/Lack of Motivation
  • Nausea/Vomiting/Dry Retching
  • Abdominal Cramps/Diarrhea
  • Excessive Sweating
  • Tearing
  • Runny Nose/Sneezing
  • Dehydration
  • Sexual Dysfunction
  • Constant Fatigue
  • Uncontrollable Yawning
  • A sensation that the skin is “crawling” or that there are insects on or under the skin.

Up to 10 Days

The most-frequently-heard complaint from people in opioid withdrawal is of feeling unwell. The feeling has been likened to a severe cold or the flu, explaining why opioid addicts in withdrawal say they are “sick”.

Post-Acute Opioid Withdrawal: 6 Days-Two Weeks

  • Hot/Cold Flashes
  • Dilated Pupils
  • Muscle Pain/Cramps
  • Goosebumps – this is where the term “cold turkey” originates.

Extended Opioid Withdrawal: Up to a Year

  • Recurring Anxiety
  • Persistent Insomnia
  • Feelings of Restlessness

How Long Does It Take to Detox from Opioids?

The disease of addiction manifests differently each person. Likewise, opioid withdrawal symptoms will also vary from person to person, depending upon the severity of their addiction and the level of treatment and support they receive during recovery.

For most people who are NOT in an opioid replacement program utilizing methadone or buprenorphine, opioid detox usually takes about 5 days, with most withdrawal symptoms subsiding after two months.

 

What Are the Best Medications for Opioid Withdrawal?

Treatment specialists very often recommend ORT – Opioid Replacement Therapy. This involves substituting a less-euphoric opioid for the abused drug.

The World Health Organization endorses ORT as a “harm reduction” strategy, because it curtails crime rates, limits the spread of communicable diseases such as HIV/AIDS and hepatitis, and significantly reduces the number of overdose deaths.

Furthermore, ORT patients can lead more stable, productive lives when their drug cravings and withdrawal symptoms are at manageable levels.

With ORT medications and structured rehab services, two-thirds of patients can completely abstain from illicit use, while 95% significantly reduce their opioid use.

  • Methadone MMT – Methadone Maintenance Therapy – is a the most-frequently-prescribed treatment for those opioid addicts who are currently unable to maintain their sobriety.

The goal is to slowly reduce the dosage over time, until the addict can discontinue MMT without illicit relapse.

  • Buprenorphine“Bupe” is increasingly acknowledged as a safer alternative to methadone, because it limits the possible high, thus reducing its potential for misuse.
  • NaltrexoneBecause it is administered via once-a-month injections, naltrexone completely eliminates the possibility of abuse.

Facts About Benzodiazepine Detox and Withdrawal

“With opiate addiction, you can tell people they’re through the worst of it after two or three weeks. That’s not true with benzo withdrawal. With benzos, the brain has more difficulty reregulating, and withdrawal is especially agonizing. We see a lot of people trying to get off Xanax and Ambien with acute emotional and physical discomfort that lasts many months.”

~ Reverend Jack Abel

Benzodiazepines are minor tranquilizers typically given for such conditions as anxiety, insomnia, depression, alcohol withdrawal syndrome, or seizures. The list of “benzos” is extensive, but includes:  

  • Xanax/Alprazolam
  • Librium/Chlordiazepoxide
  • Ativan/Lorazepam
  • Klonopin/Clonazepam
  • Valium/Diazepam
  • Restoril/Temazepam
  • Serax/Oxazepam

One-third of all overdose fatalities in the US are due to benzo medications. In 2016, that meant an estimated 19,500 tragically unnecessary deaths.

Benzodiazepine withdrawal symptoms typically manifest within 24-48 hours of the last dose. Here is benzodiazepine withdrawal timeline:

Initial Benzodiazepine Withdrawal: 1-4 Days:

  • Anxiety
  • Insomnia

Acute Benzodiazepine Withdrawal: 5 Days-2 Weeks

  • Worsened Anxiety to the Point of Panic and Terror
  • Persistent Insomnia and Poor Sleep
  • Nausea/Vomiting/Dry Retching/Diarrhea
  • Blurred or Double Vision
  • Muscle Spasms
  • Extreme Agitation
  • Unpredictable Mood Swings
  • Consuming Paranoia
  • Impaired Memory
  • Trouble Concentrating
  • Nightmares
  • Sleep Paralysis
  • Hallucinations
  • Psychosis
  • Delusions
  • Heightened Sensitivity to Light, Sounds, Smells, and Touch
  • Aggression
  • Violence
  • Homicidal and Suicidal Ideation
  • Disconnection from Reality
  • Catatonia – Possibly Fatal
  • Convulsions – Possibly Fatal

Extended Benzodiazepine Withdrawal: Up to One Year or Longer

  • Persistent or Recurring Anxiety
  • Cognitive Difficulties
  • Depression
  • Increased Risk of Suicide

Most of the worst symptoms manifest when people who have used benzos long-term at high doses abruptly stop taking the drug.

How Long Does It Take to Detox from Benzodiazepines?

Because benzodiazepine withdrawal can be fatal, dosages should ALWAYS be gradually reduced under the strict medical supervision. This may take several months or even over a year.

The biggest determining factor is the history of benzo use – length, dosage, cross-use with other substances, etc.

It is important to note that over time, chronic benzodiazepine abuse can considerably worsen any existing emotional disorders that may have been the reason for the initial prescription.

What Are the Best Medications for Benzodiazepine Withdrawal?

Unfortunately, there are no medications currently approved for benzo withdrawal.

On the other hand, there are several substances that MUST be avoided during withdrawal:

  • Antipsychotic Medications – increase the likelihood of seizures
  • Barbiturate Medications – cross-tolerant with benzos
  • Caffeine – intensifies withdrawal symptoms
  • Alcohol – can trigger a relapse, even in small amounts

Facts About Methamphetamine Detox and Withdrawal

“All I did was get high and look for drugs, so I could have cared less there was no power or water. Meth takes away your appetite, so I didn’t need the refrigerator to work anyway. My kids needed it though, and I was too lost in meth to see that.”

~ Joanna, former meh addict

Methamphetamine – also called “ice” or “crystal” – is a stimulant drug used recreationally as a euphoriant and aphrodisiac.

At higher doses, meth abuse results in muscle loss, bleeding in the brain, psychosis, paranoia, seizures. Over time, meth can cause a decrease in brain volume.

Methamphetamine is one of the most-addictive substances on the planet – nearly 88% of heavy meth users experience symptoms of withdrawal within 24 hours following the last use.

Methamphetamine Withdrawal Timeline:

Initial Methamphetamine Withdrawal: 1-3 Days

  • Fatigue to the Point of Exhaustion
  • Excessive Sleep
  • Depression

Acute Methamphetamine Withdrawal: 3-10 days

  • Overwhelming Cravings
  • Uncontrollable Mood Swings
  • Extreme Irritability
  • Emotional Distress
  • Worsening Depression
  • Debilitating Lack of Motivation
  • Sleep Disturbances
  • Confusion
  • Memory Problems
  • Paranoia
  • Increased Risk of Suicide
  • Nightmares
  • Hallucinations
  • Weight Gain

After the acute phase, withdrawal symptoms will persist for quite a while, but a person is typically stable enough to move forward to drug treatment.

Post-Acute Methamphetamine Withdrawal: 1 Week-1 Month

Many symptoms gradually disappear by this point, but some difficulties may remain:

  • Sleeping Problems – Insomnia OR Excessive Sleeping
  • Mood Swings
  • Dysphoria
  • Confusion/Cognitive Difficulty
  • Drug Cravings

Prolonged Methamphetamine Withdrawal: 1-3 Months

At this point, while most withdrawal symptoms will have eased, EXCEPT for drug cravings which may intensify and peak at the three-month mark.

At about 6 months, however, cravings subside substantially.

How Long Does It Take to Detox from Methamphetamines?

Even more than other drugs, methamphetamine Withdrawal is a PROCESS. While the stabilizing detox portion is over in about a week, the meth-damaged brain takes much longer to heal. It is not unheard of for withdrawal symptoms to last over a year.

What Are the Best Medications for Methamphetamine Withdrawal?

There are no medications approved to help with methamphetamine withdrawal. Because of this, and because of the months-long persistence of symptoms, professional addiction treatment, and ongoing support becomes even more crucial for successful recovery.

Why Can’t I Just Self-Detox on My Own?

Most addicts abuse more than one substance. This means that polydrug detox may be necessary, and that is too difficult a task for most still-fragile people new to recovery.

Many substance abusers also struggle with co-occurring emotional disorders, such as anxiety, depression, bipolar disorder, PTSD, or ADHD. It takes specialized care and support to safely address such a dual diagnosis. Unsupervised withdrawal negates the possibility of support.

Here’s the bottom line – there is no need to endure painful symptoms of withdrawal without relief. Even more important, however, is the fact that in some cases, withdrawal can be dangerous. You owe it to yourself and your future to avail yourself of the comfort, care, and support that can only be found in a medically-monitored detox facility.

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