Learn about protracted withdrawal, why you might experience unpleasant symptoms and what to do if your symptoms just won’t go away.

What do you do if your withdrawal symptoms don’t end when they’re supposed to?

Well, firstly, know that protracted withdrawal are normal and they will pass in time …you will get better eventually!

But when you’re unprepared and you get blindsided by symptoms that just won’t quit – or by symptoms that come back even months after you think you’re in the clear, it’s easy to get discouraged and relapse back to drinking or drug use.

So get prepared - read on to learn more about the second phase of the withdrawal process, something that can last for many months or even years after your quit date – and be ready to make it through to the other side.

Acute vs. Protracted Withdrawal

Acute Withdrawal

When you suddenly stop using a drug you’ve become addicted to you experience a brief period of generally unpleasant withdrawal symptoms.

The time frame can vary a bit, but in general, acute withdrawal will endure:

Acute withdrawal symptoms should largely disappear by the end of the predicted withdrawal duration.

Protracted Withdrawal (Post Acute Withdrawal Syndrome - PAWS)*

So withdrawal symptoms are supposed to end at the end of the acute withdrawal period – but sometimes they don’t!

When your withdrawal symptoms continue on for longer than they’re supposed to and/or when you also start experiencing more general (non-substance specific) withdrawal symptoms that persist for longer than the acute withdrawal period - you are in protracted withdrawal.

* Another common name for protracted withdrawal is post acute withdrawal syndrome (PAWS).

Does Everyone Get Protracted Withdrawal Symptoms?

No.

1. Some people experience no withdrawal symptoms after the end of the acute withdrawal phase
2. Some people find that acute withdrawal symptoms last for far longer than they’re ‘supposed’ to
3. Some people feel a lot better at the end of the acute withdrawal period and then a month or two later withdrawal symptoms come back, as if out of nowhere

Common Protracted Withdrawal Symptoms

Not everyone will go through protracted withdrawal and individual symptoms will vary depending on the drug(s) of abuse, your physical and mental health and other factors.

But that being said, some common protracted withdrawal symptoms include:

• Insomnia and other sleep problems
• Chronic fatigue
• Irritability
• Anxiety
• Anhedonia (an inability to feel pleasure, or as much pleasure as you used to)
• Short term memory problems
• Drug or alcohol cravings
• Concentration problems
• Depression
• Aches and pains
• A loss of libido

Why Do You Get Protracted Withdrawal Symptoms?

When you use drugs or alcohol for a long time your brain changes (an adaptation) and researchers can see these changes at the molecular and cellular levels and through changes to neurocircuitry (how the brain communicates).

These changes can affect your emotions, thinking capabilities and ability to resist impulses, and it can take a long time for your brain to revert back to a pre-addiction state of functioning.

Basically – through a long period of heavy use you induce some significant changes to your brain’s structure and functioning, so it’s not totally surprising that your brain needs a few months or longer to get back to normal!

Getting Through Protracted Withdrawal

Even if there is full recovery from the withdrawal symptoms, the actual devastation to a person's life during a long withdrawal, lasting for months, can be ruinous. 

What's more, protracted withdrawal increase your risk of relapse – so to keep your recovery on the right track, even when passing through the doldrums of post acute withdrawal symptoms, make sure to:³

Understand that things will get better – Though it may seem like you’ll never feel like your old self again, even protracted withdrawal will pass and in time. Understand that brain healing occurs slowly, but surely, and with patience and perseverance you will make it through.

Maintain good sleep habits – Since protracted withdrawal can lead to sleeping problems and sleep deficits can lead to relapse it’s important to make a good night’s sleep a priority. If protracted withdrawal has you tossing and turning, lean more about good sleep hygiene and habits and make a few simple but effective changes to improve your odds of a restful night’s sleep.

Stay involved with community support groups (like AA) – The support, encouragement and knowledge you find at community mutual self help groups can help you to stay on the right track and to identify dangerous habits before the pull you down to relapse. At community meetings, you’ll also get advice and encouragement from a group of people who understand exactly what you’re going through.

Stay active – Exercise relieves stress, increases positive emotions, promotes healthy sleeping and helps distract you from triggers and cravings…all in all, exercise is a must-do

Reduce stress – Getting through the initial recovery period is tough enough, so give yourself some room to breathe by minimizing your outside commitments and responsibilities for a while. This way you can take care of the most important thing…yourself.

Consider medications – Certain medications, like acamprosate for alcohol and methadone or Suboxone for opiates, can alleviate some or all of the protracted withdrawal symptoms you may experience. Talk to your doctor or therapist about the pros and cons of adding medications to your recovery program.

Consider therapy – certain therapies, like cognitive behavioral therapy, teach skills that help you to compensate for the diminished cognitive functioning and poor impulse control that are typical to many recovery efforts.

Warnings and precautions about protracted withdrawal must be part of any pharmacological treatment plan. Don't go through protracted withdrawal without medical support.

Image Copyright: Sherman Geronimo-Tan

Learn what to expect from a Xanax detox, and how to deal with Xanax withdrawal symptoms.

Most people don't realize that the two most dangerous substances to withdraw from are benzodiazepines and alcohol. Detoxing from drugs like Xanax must never be attempted without medical supervision. We offer the facts below not as medical advice but rather as guidance and support.

Xanax is a potent benzodiazepine, prescribed most frequently to sufferers of anxiety or panic disorders. Xanax works fast and has a relatively short half-life, and this means that after quitting – withdrawal symptoms begin quickly and severely.

Xanax Withdrawal Symptoms

Usually, symptoms will be noticeable within 12 hours, and symptoms will peak within 3-4 days. Residual and lingering symptoms of withdrawal can last for months.

Some common Xanax withdrawal symptoms:

• Anxiety
• Panic
• Hallucination
• Insomnia
• Tremors
• Convulsion
• Nightmares
• Nausea
• Vomiting

CAUTION: A drastic detox from Xanax or other benzodiazepine should never be attempted without medical supervision!

The most serious (but more rare) side effect is convulsion – and these can be life threatening. More common side effects are psychological in nature, and are very unpleasant. Problematically, many people take Xanax to manage symptoms of a metal health disorder, and when in withdrawal from Xanax, these mental health symptoms are greatly worsened.

How Does Xanax Work?

Xanax causes a decrease in anxiety through an increase in GABA (a neurotransmitter) in the brain. This increase in GABA calms and soothes an excited mind, and can be very pleasant.

Because the medication feels good, especially when used in excess, the drug is classified as a schedule 4 medication – a drug with some probability for abuse.

Xanax can work very well, but when used for too long, or when used in excess, it can create a physical and psychological dependence, and withdrawal symptoms upon cessation.

Xanax Changes Your Mind

Xanax increases the activity of GABA in the brain, and this increase in GABA calms an otherwise excited and anxious mind.

Over time, the brain responds to this increased GABA activity by lowering the amount of available GABA.

At this point, the patient will need to take a larger dose of Xanax to feel the same effects – and at this point, if the user tries to stop taking Xanax completely, they will experience withdrawal pains.

Once the brain has adjusted to prolonged Xanax usage, GABA levels are reduced. GABA keeps anxiety and other negative feelings in check, and so with less GABA, and no medication increasing the activity of existing GABA, the user will go into very uncomfortable withdrawal.

Quitting Xanax: Tapering Down

The best way to break an addiction to Xanax is through a medically monitored period of tapering down the dosage. This can take many months, but is safer and far less unpleasant than a "cold turkey" detox.

The pace at which the dosage is reduced will depend on the length of the dependency, with longer dependencies requiring a slower reduction. One suggestion is to reduce the dosage by 0.25mg each every two weeks, but individual recommendations must come from a doctor familiar with your case and your medical history.

The advantage of a very long and slow tapering down is that it allows your brain time to adjust to the decreasing dosages of medication, and to begin producing more GABA to compensate. The symptoms of withdrawal are caused by this GABA insufficiency, so allowing the brain to "keep up" with the tapering, alleviates the severity of the symptoms.

Just as the brain compensated for increased levels of Xanax by lowering endogenous levels, it will compensate for reduced quantities of the ingested drug by increasing endogenous levels – but it takes time!

By tapering very slowly, you avoid severe symptoms of withdrawal, and most users report minimal discomfort. An additional advantage is that by controlling for withdrawal symptoms, you are better able to gauge your need for the medication. If you were initially prescribed Xanax for panic – and you detox quickly – you will feel panic, but you won’t know if you are feeling panic as a symptom of withdrawal, or as a symptom of a still active panic disorder.

By tapering slowly, you can better judge your need for the continuing use of the medication.

Quit Xanax Cold Turkey?

It is possible to detox safely off of Xanax quickly while under medical supervision, but even with the prescription of symptoms controlling medications, a quick detox is very tough and uncomfortable.

A drastic detox should never be attempted without medical supervision! In extreme cases, a Xanax withdrawal can induce potentially fatal convulsions.

Xanax Addiction Treatment

If you have been taking the medication as prescribed for a legitimate disorder, then once you have tapered down off of the drug you will have no need for any addiction treatment. You were dependent physically, but not addicted psychologically – and the risk of relapse is very low.

If you abused the medication to get high, you will likely need addiction therapies to help you stay drug free.

Image Copyright: tao lin

Learn what to expect from cocaine withdrawal and learn how long your cravings will last – and what you can do to tame your urges.

Something unappeased, unappeasable, is within me.” Friedrich Nietzsche¹

Nietzsche wasn’t talking about cocaine when he wrote this, but he might as well have been, because in the early days of cocaine withdrawal, the only thing you want in life (more cocaine) is the one thing you can’t have.

But how long do the cravings and withdrawal symptoms persist? Read on for:

• A timeline for common cocaine withdrawal symptoms.
• A timeline for cocaine cravings, plus – what worsens cravings and what you can do to manage your urges.
• A brief explanation of your detox options - should you do it alone or do you need outpatient or residential detox care?

Cocaine Withdrawal Timeline

• Primary cocaine withdrawal symptoms last 1 to 2 weeks, peaking in severity early and then progressively easing after that.

Studies show that symptoms peak within a day or two after abstinence and then gradually ease-up. If you’ve made it past the first couple of days, you can expect to feel a little better with each additional day of abstinence.  By a week or two, most symptoms should dissipate, though you may still experience thinking difficulties and you’ll almost certainly experience continuing strong cravings.²

Psychological Symptoms Include:³

• Depression.
• Strong cocaine cravings.
• Concentration problems.
• Anxiety.
• An inability to find pleasure in anything (anhedonia).
• Fatigue and lethargy.
• Increased appetite.
• An increased need for sleep.
• Increased REM sleep and also increased dreaming.
• Suicidal thoughts (less common).

In most cases, symptoms will dissipate significantly by 1 to 2 weeks.

Physical Symptoms Include:

• Muscle aches and pains.
• Chills.
• Tremors.
• Involuntary jerks and twitches.

Physical symptoms are rarely serious or dangerous and generally don’t require treatment.

Cocaine Cravings Timeline

• Cravings don’t peak in severity until 2 months post abstinence. They start to dissipate after 6 months of abstinence.

Though early withdrawal symptoms like irritability and fatigue aren’t any fun, most people say that long-lasting cravings are the largest obstacle to sustained abstinence.

Though general withdrawal symptoms ease up after a day or two and largely disappear by a week or more, cocaine withdrawal symptoms actually get progressively worse for the first 2 months! Research shows that:⁴

1. Cocaine cravings continue to worsen to a peak in intensity at 2 – 3 months.
2. Cravings start to decrease after 6 months of continuous abstinence. 

Six months is a long time to battle intense cocaine cravings. So what to do about it?

Since one slip-up in a moment of weakness can lead to full-blown relapse, to stay quit for good you have to learn effective cravings-management strategies, for example:⁵

• Urge surfing techniques – learning to ride your cravings like a wave.
• Learning to accept cravings as a normal and non-harmful experience that will pass in time.
• Learning to recognize and identify your cravings in the very early stages so you can stop them before they intensify.
• Learning distraction and relaxation techniques to employ against cravings. 

You can learn to manage cravings on your own, but since most addiction treatment programs focus extensively on teaching relapse prevention skills and cravings management techniques, getting cocaine addiction treatment can be a quick and easy way to enhance your odds of maintaining abstinence. You don’t necessarily need to start with costly rehab either, according to the National Institute of Health, for most people addicted to cocaine, outpatient treatment proves as effective as more disruptive residential care.

Stress Worsens Cravings

Going through withdrawal and dealing with cravings can be stressful. Unfortunately, high stress levels are associated with a decreased ability to resist cravings and greater amounts (larger binges) of cocaine used with relapse.⁶ Talk about a catch 22!

• To compensate, it’s important to reduce your daily stress exposure, especially during your first 6 months of abstinence, and to learn effective stress management techniques.

Depression Worsens Cravings

Research shows that having co-occurring depression along with cocaine addiction results in worsened drug cravings with abstinence. Given this, if you have depression, you should strongly consider learning cravings management strategies (getting addiction treatment) and treating your depression.⁷

Do You Need Inpatient Detox?

Most people can detox safely without needing professional assistance. In some more serious cases, heavy cocaine users will benefit from a short period of residential or hospital supervision during the first period of withdrawal. According to the Australian Department of Health, situations indicating a possible need for residential or hospital detox treatment include.

• You have failed to complete detox at home on multiple previous attempts.
  
• You have a poly-drug addiction and your dependence on at least one other substance is severe enough to warrant hospitalization (alcohol and benzodiazepines withdrawal are especially dangerous.)
• You have a severe cocaine dependence and complicated withdrawals are expected.
• You have a medical condition that could complicate withdrawals.
• You have co-occurring psychiatric condition, particularly concurrent psychosis or concurrent severe depression.
• You are having suicidal thoughts (more common during cocaine withdrawal).
• You are homeless or have no safe and stable place to detox.

So, unless any of the criteria listed above apply to your situation, you can probably detox at home

If you decide to detox at home, you have to choose between:

1. Doing it on your own, with no professional help.
2. Getting into an ambulatory detox program – where you detox at home, but still get the support and expertise of professionals.

While many can make it through the detox period without professional assistance (after all – quitting is easy, it’s staying quit that’s hard – ambulatory detox programs offer some compelling advantages, for example:

• They offer education about what symptoms to expect – what’s normal and what’s not – and advice on how to cope with the discomfort.
• Through interactions with detox staff you get a daily symptoms and mood check-up. This allows for early intervention if required (for example, transition to a residential facility in cases of severe psychosis or suicidal thinking.)
• Staff support and encouragement can help you stay motivated to keep at it.

When entering a treatment stream at the detox phase, whether in an ambulatory or residential detox – you also receive a needs assessment, an individualized treatment plan and a streamlined entry into an appropriate next stage of treatment. Therefore, if you plan on getting some form of cocaine addiction treatment at some point, it makes some sense to enter treatment at this first stage of care.

Read this before you start your meth detox and find out: what to expect, whether you need an outpatient or residential detox (or whether you can do it on your own), how to stay safe and how to make it through protracted withdrawals.

Ready to quit meth?

Well if so, get informed and prepared before you start and maximize your chances of a successful outcome.

Read on to learn more about:

• What to expect over the first and second phases of the withdrawal period
• The possible dangers and what factors increase the severity of withdrawal symptoms
• Your detox options and how to know if you need residential or outpatient detox
• How to stay clean through the longer term protracted withdrawal period

Typical Methamphetamine Withdrawal Symptoms

So what does methamphetamine withdrawal feel like, and how long does it last for?

Methamphetamine withdrawal symptoms occur over 2 phases:

1. The Acute Phase (the first week to 10 days)
2. The Protracted Phase (for many weeks or months after the completion of the acute phase)

Common symptoms during the Acute Phase include:

• Irritability
• Intense drug cravings
• Mood swings
• Depression (an inability to feel pleasure, sadness etc.)
• Sleeping problems
• Agitation
• Anxiety
• Paranoia
• Hallucinations
• Fatigue
• An inability to concentrate
• Aches and pains

Common symptoms of the Protracted Phase include:

• Cravings
• Problems with thinking and memory
• Sleeping problems
• Depression¹

Why Do You Get Meth Withdrawal Symptoms?

Researchers think that most meth withdrawal symptoms occur for 3 primary reasons:

1. Chronic meth use depletes the levels of certain neurotransmitters, like dopamine
2. Chronic meth use causes a reduction of receptors for neurotransmitters like dopamine (so you have insufficient levels of dopamine and you also have too few receptors for what little you do have left!)
3. Chronic meth use causes neurotoxicity (brain damage). This brain damage can take a long time to heal and this is one reason why some meth withdrawal symptoms like thinking problems, depression and cravings, can persist for a long time after you quit²
   

Is Methamphetamine Withdrawal Dangerous?

Although the withdrawal from some drugs can be life threatening (like alcohol or benzodiazepines) methamphetamine withdrawal, by itself, is rarely dangerous.

However, in some extreme cases, the way methamphetamine withdrawal makes you think or feel can lead you to hurt yourself or others.

Methamphetamine withdrawal is dangerous if:

• You experience strong psychosis and are a danger to yourself or to others
• You become very depressed and have suicidal thoughts

What Influences the Severity of Withdrawals?

You are more likely to have severe withdrawal symptoms if you:

• Inject
• Use high doses/at high frequency
• Use other drugs alongside methamphetamine
• Are in poor health
• Except severe withdrawal symptoms (be careful about looking for the worst…you sometimes find what you’re looking for!)
• Go through the withdrawal period in an uncomfortable environment or without psychosocial support³

Crystal Meth Detox Options

OK, so you’re getting ready to quit meth and go through the withdrawal phase…now what – what are your options?

1. Tough it out on your own
2. Stay at home, but get support though an outpatient detox program
3. Go to a residential detox facility for the duration of the primary withdrawal symptoms

So, should you go it alone, or should you get into an outpatient or residential detox program for some support?

Though meth detox is rarely dangerous it is tough and unpleasant, and getting support and assistance during the withdrawal phase increases your odds of success.

If you want to try it on your own, find a safe place to hole up for a few days, away from temptation, and lean heavily on your sober social support network to help you through this first stage.

• If you’ve tried it on your own before one or more times without success, you should consider an outpatient or residential program
• If you’re worried about what’s going to happen when you try to quit, you should contact an addiction treatment provider (they can help you decide whether or not you need outpatient or residential care)
• If you start off on your own, and find it too tough or scary, then contact an addiction treatment provider
• If you start off on your own and start having thoughts of suicide or hurting yourself, call 911 or go right away to an ER

Read on below to find out whether an outpatient or residential program best fits your needs.

How to Know if You Need Residential Detox

Whether you need residential treatment or not is something you’ll need to consider carefully, and ideally, it’s not a decision you make on your own.

In an ideal world, whether or not you think you want continuing addiction treatment, you should talk to your doctor or a local addiction treatment provider to get an assessment and to make a plan for the detox period prior to attempting your withdrawal.  

By getting expert advice you’ll gain a better sense about what type of detox and continuing addiction treatment you’ll need, and even if you decide to do detox at home, you’ll have a better idea of what to expect and know when to call for help (if needed).

Most people can detox safely at home, but some methamphetamine users will need residential or even hospital care to stay safe and abstinent through the first tough period.

You can likely detox on an outpatient basis (at home) if:

• Your doctor does not expect withdrawal complications
• You have no co-occurring medical conditions that would require close observation during this stressful period
• You have no psychiatric illnesses and methamphetamine associated psychiatric problems, like psychosis and depression, are mild (for example, mild paranoia, sadness, anhedonia)
• You have a sober social support network in place that is ready and willing to help you through this period
• You have a safe and stable drug-free home environment
• You have never previously tried and failed with a home detox
• You are motivated to succeed

You will probably need residential detox if you meet some or all of the following characteristics:

• You are also dependent on alcohol or other drugs
• You lack a supportive home environment or a sober social support network (if you are homeless, for example)
• You are experiencing strong psychotic symptoms or you are at risk to harm yourself or others
• You are having suicidal thoughts or you have a history of severe depression or severe psychosis
• Your doctor anticipates potential problems or you have co-occurring medical health problems that require monitoring during this period
• You have a very serious dependence and so extreme withdrawal symptoms are expected
• You have tried and failed on previous occasions with outpatient detox⁴

The Use of Medications for Meth Detox

There are no FDA approved medications available to treat methamphetamine addiction, but in some cases, medications are used to minimize distressing symptoms during the detox period.⁵

Medications sometimes used include:

1. Anxiolytics and Sedative Hypnotics – Medications like valium may be prescribed for short term use to help alleviate anxiety during the initial withdrawal phase.
2. Antipsychotics – Medications like haloperidol or phenothiazine may be used in the first week or two to manage symptoms of psychosis.
3. Antidepressants – Medications like SSRIs may be prescribed to help ease symptoms of depression that typically plague the early recovery period.
4. OTC Pain Medications – Medications like acetaminophen can be used to relieve aches and pains⁶

Avoiding Relapse during Protracted Withdrawal

Protracted withdrawal is the fancy name for the longer lasting second stage of withdrawal symptoms.

Most people can make it through the acute stage within a week or two, and after a week or two there’s no doubt you’ll be feeling a lot better and thinking a lot clearer.

But unfortunately, you may still need to progress through a long period of protracted withdrawal symptoms before you really feel like your old self again.

1. During protracted withdrawal you’ll still experience a lot of cravings, you may feel down and find it hard to get much enjoyment or pleasure from life (anhedonia) and your thinking may remain a little fuzzy.
2. These symptoms will go away in time, but until they do, you’ll always feel temptation and you’ll always know that a little meth will make you feel so much better.
3. And unfortunately, when you combine anhedonia and cravings with thinking problems like reduced impulse control and concentration and memory deficits, what you have, too often, is a recipe for relapse.

You accomplish something great by making it through the first couple of weeks, but you’ve won a battle not the whole war, and you need to continue with your hard work to make sure you continue on the right path.

The straight truth is that getting into an addiction treatment program (outpatient or residential) and staying involved for up to a year, greatly increases your odds of making it through the protracted withdrawal phase.

In a good methamphetamine addiction treatment program you will:

• Learn strategies to minimize and manage your cravings
• Learn how to stay motivated
• Learn how to deal with frustration, anger, boredom and celebration without needing to get high
• Get your loved ones involved in family therapy sessions that strengthen the whole family as a tool against relapse
• Get introduced to the 12 steps and a community support group

Image Copyright: Stephen Poff

Tapering from opioids or quitting cold-turkey? Here are some home-remedy tips to ease your discomfort.

When quitting opioids (and many other drugs) aches and pains during the first week of abstinence can make an already tough period much harder to bear. There’s not much you can do to eliminate achy pains (short of taking more opioids) but there many home-remedy style techniques that can actually help quite a lot.

None of the following are revolutionary, nor will any ease your discomfort completely, but that being said, none will do any harm, most will help to reduce your pain and all will get you doing something proactive – helping you pass the time and getting you feeling a little better.

15 Ways to Ease Opioid Withdrawal Pains

Try any or all of the following.

Remember, when tapering and especially when quitting abruptly, you won’t eliminate discomfort, no matter what you do. Fortunately, physical symptoms only last for a few days and with the right mindset, most people find them quite bearable.¹

1. Take OTC pain relievers, like Tylenol or ibuprofen.
2. Have a friend give you a massage or self massage.
3. Take a hot bath or a hot soak in a whirlpool spa. Try adding Epson salts to your hot bath.
4. Take a hot steam in a sauna. Be careful with this one if you’re losing fluids from diarrhea or vomiting.
5. Dehydration can cause headache and muscle pain, so drink something hydrating at regular intervals. If you’ve been struggling with diarrhoea, vomiting or excessive sweats, try sports drinks that replenish your electrolyte stocks (out of balance electrolytes can cause painful cramping.)
6. Aromatherapy. For headache, try a very small amount of lavender oil rubbed into your temples.
7. Try stretching exercises. These can help reduce muscle tension pain.
8. If aching muscles give you trouble, try a minute or so of vigorous exercise. It’s probably the last thing you want to do, but getting the blood flowing can reduce muscle-tension pain.
9. Try a cold compress to the head or neck.
10. Or, try a hot water bottle applied to any achy area.
11. Try a gentle self-massage into the muscle-area between your thumb and pointer finger. This can feel a bit painful at first, but by applying continuous gentle pressure for a minute or more you can often relieve pain in other areas of the body.
12. Have sex. If you can manage it, sexual activity can reduce muscle tension, ease restless legs, boost mood and keep your mind off your troubles for a while.
13. Distract yourself. The more you focus on your aches and pain, the worse they feel. Try zoning out with some cheesy comedy movies for a while, or play video games, or surf the internet, or talk to friends…
14. Get out of the house and take a walk. Again, it’s often the last thing you want to do, but if you can, a change of scenery can do wonders for your mental outlook. On top of this, light exercise can relieve muscle tension and get your blood flowing. While out in the world you’ll have to pay at least some attention to your surroundings, so this keeps you from hyper-focusing on your internal discomfort.
15. Sleep, if you can. It can work wonders.

If You Get Clean, Learn to Stay Clean

You can manage your opioid withdrawal symptoms, and with a little preparation, an appropriate environment and a positive attitude, you can successfully make it through the first difficult week.

But though people talk about the getting clean as if it’s the hardest part, remember, anyone can get clean, it’s staying clean that takes real work.

Some Tips for Successful Abstinence after Opioid Withdrawal:

• People who achieve opioid abstinence are at high risk of relapse.² Medications like Suboxone or methadone greatly reduce your odds of relapse, but many people, for a variety of reasons, choose to avoid these potent medications.
• If you go through the difficult process of withdrawal and the breaking of your physical dependency, fight against relapse so you won't have to go through it all over again.
• To safeguard your abstinence, you should consider some form of professional addiction treatment and also some form of community peer-group support (such as from NA or a similar group).
• Through addiction treatment programs you learn skills and strategies that help you avoid relapse, such as how to overcome cravings, how to deal with difficult emotions, stress or life-problems without resorting to drugs, how to reduce your exposure to temptation and much more.
  

You can detox safely on your own, but getting medication and professional support improves your odds of success. Learn about your different medication and treatment options.

“Though no one can go back and make a new start, anyone can start from now and make a brand new end.” Carl Bard¹

Heroin withdrawal - it’s terribly uncomfortable but rarely dangerous. You can do it safely on your own, but getting professional support and appropriate medication increases your odds of success.

Read on to learn more about:

• Withdrawal: what to expect and when to expect it.
• The benefits of a supportive detox program (though you can safely detox on your own.)
• How to decide between outpatient, residential and medical inpatient care.
• The different medications used to treat heroin withdrawal symptoms and why buprenorphine has become the treatment medication of choice.

Heroin Withdrawal Symptoms

Heroin withdrawal symptoms may begin as early as 6 to 12 hours after your last dose, they are most severe at between 2 and 4 days of abstinence and mostly gone by the seventh day. Typical withdrawal symptoms include:

• Anxiety, irritability and agitation.
• Muscle twitches and spasms.
• Muscle and joint pain.
• Headaches.
• Insomnia.
• Tearing.
• Runny nose.
• Increased sweating.
• Increased urination.
• Frequent yawning.
• Stomach cramping and diarrhea.
• Nausea and vomiting.
• Quickened heart rate and increased blood pressure.
• Dilated pupils.
• Goosebumps.
• Insomnia and heroin cravings.

Though severe physical symptoms subside within a week, lingering anxiety, depression, insomnia and drug cravings can persist for weeks or months. This is known as post acute withdrawal syndrome, or PAWS.

Heroin Withdrawal Risks and Dangers

Though heroin withdrawal feels pretty uncomfortable, it is almost never dangerous for people in reasonably good health.

Heroin withdrawal can be more dangerous for anyone with a co-occurring physical or mental health condition, for example:

• Withdrawal- related dehydration is more dangerous for a person with diabetes, or, a person with managed schizophrenia is at increased risk of an acute psychotic episode during the intense withdrawal period.

If you have a current psychiatric or medical condition, you should discuss your withdrawal plans with a health professional prior to detoxing.²

Rare but possible complications include:³

• Breathing vomit into the lungs (aspiration).
• Dehydration from excessive diarrhea and vomiting.

The Biggest Risk Is Relapse Overdose

Though heroin withdrawal symptoms probably won't hurt you, relapse overdose can kill you.

You are at significantly elevated risk of fatal overdose if you relapse after even short periods of abstinence. Most opioid deaths occur in people who have just detoxed.  If using after a break – be sure to use a much smaller dose than what you took prior to your break.

• A week or two of abstinence can reset your tolerance to zero and your old ‘normal’ dose could be potent enough to kill.

So Why Get Professional Help?

Most people can safely attempt a heroin detox without needing professional assistance. That being said, entering an outpatient or residential detox program offers some significant advantages.

Heroin withdrawal symptoms are rarely dangerous and people kick heroin without help all the time – so what’s the point of spending time, energy and money going to a detox program for the withdrawal period?

Well, some of the benefits of professional help include:

• Increased comfort – Getting appropriate medications at appropriate times can reduce discomfort. For most people, this is a significant benefit.
• Improved safety – Though heroin withdrawal alone is rarely dangerous, complication risks increase when heroin withdrawal co-occurs with a psychiatric or medical health condition.
  
• Getting into an ongoing treatment program – Just getting through the detox period does little to keep you clean over the long run.  Staff at a professional detox program will assess you and help you find an appropriate treatment program for continuing treatment at the end of the managed withdrawal period. Since many people with heroin addictions also have co-occurring mental illness, you may also get linked to appropriate mental health care.
  
• Getting linked to other service agencies – A detox program may also help you make contact with other social and governmental service agencies.

Though you can safely attempt a cold-turkey detox on your own, doing it alone leads to more discomfort and greater odds of early relapse. Getting professional assistance and appropriate medication increases your chances of a successful outcome.⁴

The Importance of Regular Monitoring

Why do you need to see a health worker each day?

Typically, on an outpatient basis you will see a health professional at least once daily for a check-in. In a residential detox, monitoring occurs more frequently. When observing your progress, health professionals will evaluate:

• Your overall progress (looking for any complications or excessive difficulties).
• The severity of your current withdrawal symptoms.
• Your response to any withdrawal medications.
• Your current motivation level.
• Your current other drug use.

Frequent monitoring helps to stop small complications from becoming serious problems, it facilitates a move from outpatient to residential care for anyone not doing well at home and it allows for medication adjustments to ease discomfort and reduce side effects.

Inpatient, Residential or Outpatient Detox?

Professionally supported and supervised heroin withdrawal can occur in three primary settings:

• In a medical inpatient facility, such as a hospital.
• In a non-medical residential setting – such as a community withdrawal center.
• On an outpatient basis (you sleep at home each night).

Most people can detox safely and effectively on an outpatient basis. 

You should talk with your doctor or with another addiction treatment professional to decide on the most appropriate detox-setting. Everyone has individualized needs, but you can use the following recommendations to get a general sense of which setting makes most sense for you.

Consider a medical inpatient facility if:

• You have an unstable medical or psychiatric condition that could worsen your withdrawal experience.
• You are dependent on more than one drug, for example heroin and benzodiazepines. Polydrug dependence greatly complicates withdrawal.
• You have a history of medical or psychiatric complications during past withdrawal periods.

Consider a general residential detox if:

• You don’t have any co-occurring medical or psychiatric conditions or polydrug dependence that could complicate withdrawal.
• Your living situation complicates your quit attempt - People with unstable living environments, those living with active drug users and those lacking a supportive person for detox assistance should consider a residential detox.
• Outpatient detox has not worked for you on repeated past occasions.
• You live in a very rural setting and can’t easily travel to see a health professional each day during an outpatient detox.

Consider an outpatient detox if:

• You have no medical or psychiatric complications
• You are not addicted to any other drug or alcohol.
• You have a stable living environment and people around you support your efforts.
• You have not tried detoxing on an outpatient basis yet (as a general rule of addiction treatment, the least intensive/intrusive treatment that gets results is the best options.)

Preparing for an Outpatient Withdrawal

When detoxing on an outpatient basis, advance preparation helps you avoid relapse through the first 7 days of withdrawal. To get ready, be sure to:

• Find a stable environment where you won’t have easy access to drugs and where you won’t be exposed to other people who are using heroin or other drugs.  Trying to detox among other people still using heroin is extremely difficult.
• Enlist a supportive person to care for you throughout the detox period. Make sure this person knows what to expect and what they can do to help you.
• Learn as much as you can about the withdrawal symptoms you can expect and about how long these symptoms will last.
• Research in advance how to cope with withdrawal symptoms. If you need medications to manage withdrawal symptoms, be sure to have these bought in advance of your detox attempt.
• Prepare for strong cravings and have a plan to deal with your cravings.

Remember, sweating, vomiting and diarrhea can lead to dehydration and dehydration increases your risks of serious complications. Make sure to stay hydrated, even when it’s difficult, and if you can’t, consider checking into a residential clinic.

Predicting Your Withdrawal Symptoms Severity

With withdrawal, you can at least partially predict the future by looking at your past. Two factors that can help to predict symptoms severity are:⁵

1. Past withdrawal episodes – Past episodes of severe withdrawal symptoms predict future tough withdrawals
2. Your recent use history – In general, the more you’ve been using, the tougher the withdrawals. You are considered to be on the low end of use if you use/inject once or twice a day and on the high end of use if you use/inject 4 or more times per day. 

Don’t Try to Fix All Your Problems at Once

Though you may consider your detox a new start on a better life, and though you might look forward to major life-improvements, don’t try to fix personal, legal or relationship problems while dealing with heroin withdrawal symptoms.

• During the detox period, you will struggle with irritability, anxiety, moodiness and lack of focus and concentration; this reduces your ability to think clearly and make good decisions.
• Trying to handle life problems while detoxing increases stress and this can increase drug cravings.

Heroin Withdrawal Treatment Medications

One of the most compelling benefits of any form of professionally supported heroin detox is complete access to a range of medications that can ease symptoms and drug cravings, such as:

1. General withdrawal symptoms medications
2. Clonidine
3. Buprenorphine or methadone
4. Naltrexone
   

General Withdrawal Symptoms Medications

A range of over the counter and prescription medicines can help to ease individual withdrawal symptoms. Examples of medications you might use include:⁶

• Acetaminophen or ibuprofen – for muscle and joint pain.
• Benzodiazepines – for anxiety
• Imodium – for diarrhea.
• Hydroxyzine (Vistaril) or diphenhydramine (Benadryl) – for restlessness, anxiety and insomnia.
• Promethazine (Phenergan) or metoclopramide (Reglan) – for nausea.
• Calcium carbonate (Tums) or milk of magnesia - for abdominal pain.

Since detox medications can interact with each other, and since benzodiazepines have a significant overdose risk, use under a doctor’s care and use with caution.

Clonidine

Clonidine is a high blood pressure medication that is also commonly used to treat opioid withdrawal symptoms.

Clonidine can reduce:

• Anxiety and agitation.
• Muscle aches.
• Sweating and runny nose.
• Cramping.
  

It is typically combined with other medications, such as medications to control nausea and diarrhea.

Note* Recently, buprenorphine has proven a more effective choice than clonidine + other symptoms medications.

Buprenorphine (Suboxone)

Buprenorphine is a partial opioid agonist that’s used to replace heroin in your body. When on an appropriate dose of buprenorphine, you feel reduced drug cravings and opioid withdrawal symptoms.

Studies indicate that people who get buprenorphine for heroin withdrawal have better outcomes than people who use clonidine combined with other withdrawal symptoms medications.

• Buprenorphine works better to reduce withdrawal symptoms and people on buprenorphine are less likely to drop out of detox than people on clonidine.⁷
  

Buprenorphine can be used as a long term maintenance medication, or as a short term detox medication. When used for detox, you would take the medication for between 5 and 21 days. On the first day or two you stabilize on a dose that offers nearly full withdrawal relief, and then you taper down from that dose over the following days. Here is an example of a proposed 7 day buprenorphine detox schedule

You must wait at least 6 hours after your last dose of heroin. Taking buprenorphine too soon after taking a short acting opioid like heroin can lead to precipitated withdrawal (full and sudden onset).

• Day 1 - Once experiencing withdrawal symptoms, you would take between 4 and 8 mg of buprenorphine, split into 4 mg morning and 2 to 4 mg evening doses. The evening dose is given if needed, to alleviate overnight withdrawal symptoms.
• Day 2 – 4 to 8 mg of buprenorphine  (4 mg morning and 2 to 4 mg in the evening).
• Day 3 – 4 to 6 mg of buprenorphine (4 mg morning and 2 mg evening).
• Day 4 – 4 mg of buprenorphine (2 mg in the morning and 2 mg in the evening)
• Day 5 – 2 mg of buprenorphine in the morning
• Days 6 and 7  - 0 mg of buprenorphine. You stay under observation and get other medications for withdrawal symptoms as needed.

Ideally, you take a flexible approach and use only as much buprenorphine as needed to stay reasonably comfortable. Residential programs generally offer more frequent monitoring and assessment and this may lead to a more individualized dosing schedule.

Since buprenorphine is a CNS depressant, combining it with benzodiazepines, alcohol or other depressants increases your risks of severe respiratory depression and death. If you can’t abstain from other drugs and alcohol during an outpatient detox, you should either check into a residential program or avoid buprenorphine.

(Note* When using Suboxone for long term maintenance, your daily dose should eliminate withdrawal symptoms and cravings. When used for a short duration for detox tapering you won’t get full withdrawal/cravings relief, but you will see a substantial reduction in symptoms intensity.)

Methadone

Methadone can be used in the same manner as buprenorphine. However, since methadone withdrawal is tougher and longer than buprenorphine withdrawal, buprenorphine is considered the better choice for detox.

Because methadone is such a long-lasting drug, a tapered detox will take longer (typically a few weeks to a month) than a buprenorphine detox.

Naltrexone

Naltrexone is an opioid antagonist that’s often prescribed to people who have completed an opioid detox. When you take naltrexone, heroin or other opioids cause little or no effects. Naltrexone may increase your odds of avoiding relapse, but it can cause a very temporary upswing in withdrawal symptoms when first administered post-detox.

What about (Ultra) Rapid Opioid Detoxification?

With rapid opioid detox you are placed under anesthesia and an opioid antagonist is used to flush out any active opioids from your opioid receptors – thus accelerating and intensifying the withdrawal procedure. Since you are under sedation during this initial period, you avoid the worst of the discomfort.

It’s a procedure with some obvious appeal, but unfortunately, consensus statements from groups like the American Society of Addiction Medicine and the California Society of Addiction Medicine show that experts generally don’t endorse the procedure as worth the risks (or the high costs).

Criticisms of (ultra) rapid opioid detoxification include:⁸

• It turns normally safe heroin detox into a procedure with significant risks.
• Though it purports to reduce withdrawal discomfort, withdrawal symptoms can still be severe.
• There is little standardization between providers.
• Though it increases the risks, relapse rates are not reduced (when compared to relapse rates after conventional detoxification).

Research indicates that people getting rapid opiate detox:⁹

• Do not have better outcomes than people who get a traditional detox.
• Are at greater risk of serious adverse health consequences.

What If You Can Never Stay Clean?

Relapse following opioid detox is very common. Getting addiction treatment after detox reduces the risks of relapse, but if you find that you can never maintain abstinence, even after multiple quit attempts, experts recommend that you try longer-term medication assisted treatment (MAT) with methadone or buprenorphine (Suboxone). People on MAT are far less likely to relapse back to illicit opioid use.¹⁰

Though some people prefer the idea of unmedicted abstinence, there are significant benefits associated with switching from heroin to long-term methadone or buprenorphine, such as:

• Better health and a reduced risk of early death.
• Reduced risks of HIV, Hep C and other infectious disease transmission.
• Reduced consumption of harmful adulterants that are added when cutting heroin for street sale.
• 24 hours of freedom from withdrawal symptoms and drug cravings – this stability can help you turn your focus to building a satisfying life (rather than focusing on getting and using drugs every day).
• Reduced need to commit criminal acts. 

If you can’t stay clean without medication, it’s far better to stay healthy and alive on methadone or Suboxone than unmedictated and at high risk of jail, disease and death while relapsing chronically back to heroin.

Image Copyright: BrandonCripps

Many people find that heavy marijuana use causes reversible thinking and memory problems. By focusing on the cognitive improvements of the first weeks of recovery, you can find the motivation to continue to work to avoid relapse.

Withdrawal symptoms are hard to take. Perseverance through discomfort comes easier if you know that it’s for a good reason, and you can see that you are making progress.

Many marijuana users find that longtime heavy use compromises thinking abilities. Fortunately, in most cases, thinking abilities return to a normal level within a month or two of quitting.

Here’s a way to spin improvements in cognitive abilities (a very good thing) into increased odds of staying quit (another very good thing):

1. A lot of people find quitting tough, especially when dealing with lingering withdrawal symptoms, like insomnia.
2. To counteract some of the negatives (like the lingering withdrawal symptoms…which you probably can’t avoid noticing) you should try to focus on how quitting improves your life – such as by noticing specific improvements in thinking abilities.
3. Unfortunately, we aren’t very good at noticing changes when they occur very slowly or gradually (as opposed to withdrawal symptoms, which come on very suddenly and noticeably).
4. If you pay more attention to how your cognitive abilities improve over the first couple of months after quitting, you can use these encouraging gains as motivation to continue your efforts.
5. To help you notice improvements, you should make a list before you quit (or in the early days) of the very specific ways that marijuana compromises your thinking abilities. Then revisit this list every week or so after quitting, to evaluate your progress, and to underscore that your improvements result from quitting marijuana.
6. To help you make this specific inventory, review the list you'll find below of common cognitive side-effects and circle whichever you identify with. 

Cognitive Side Effects of Heavy Marijuana Use

Researchers at Lund University Hospital interviewed 400 heavy marijuana users to develop a list of cognitive deficits/complaints that are associated with chronic serious use.¹

Has your marijuana habit diminished your intellectual capacity?

To find out and to create a framework for monitoring improvements after you quit, circle any of the following which apply to you. Then, over time, as you maintain marijuana abstinence, revisit this list to see how much improvement you’re making.

Note: This is a complete list of all cognitive symptoms reported by a large pool of heavy users. It is very unlikely that all will apply to your experience. Simply circle those that do (that you answer yes to) and disregard those that do not.

Verbal Skills

Compared to your pre-marijuana days:

• Are you less able to remember and use specific and precise words?
• Do find it more difficult to take an active part in discussions going on around you?
• Do other people have difficulty understanding what you’re trying to express?
• Do you have more difficulty understanding what other people are trying to express to you?
• Do you feel like you’re removed from others (as if you were in a glass bottle)?
• Do you find it more difficult to describe your feelings?

Memory

Compared to your pre-marijuana days:

• Are you more likely to forget meetings and appointments or commitments you’ve made?
• Do you have a harder time remembering your past?
• Do you have more difficulty estimating the passage of time?
• Do you find it harder to remember the plot of a book or movie as it unfolds?

Cognitive Flexibility

Compared to your pre-marijuana days:

• Do you have more difficulty maintaining comlex ideas in your head during a discussion?
• Is it harder to stay focused or to concentrate for long period of time?
• Once you get focused on one thing is it harder to suddenly shift your focus to something else?
• Do you have a harder time understanding other people’s viewpoints?
• Do you find that you talk TO other people rather than talk WITH other people?

Learning and Using Information

Compared to your pre-marijuana days:

• Are you more likely to keep making the same mistakes over and over again?
• Are you less able to assess your own behaviors and see where you’re going wrong in life?
• Are you less able to find appropriate solutions to problems you’re having?
• Do you care less about life-mistakes you make?
• Do you feel more like a failure than you used to?

Analytic-Synthetic Ability

Compared to your pre-marijuana days:

• Have you become more rigid in your opinions or in expectations of others?
• Do you have more difficulty sorting between important and extraneous information?
• Do you have more trouble classifying information correctly?
• Do you have more difficulty interpreting nuance and shades of grey within information?

Time-Space Abilities

Compared to your pre-marijuana days:

• Do you have more difficulty creating routines?
• Do find it more difficult to structure your day?
• Do you find you notice relations between others less than you used to?
• Do you find it harder to maintain a mental map?
• Do you find that you’re less aware of your surroundings?
• Do you feel more like you don’t belong within ‘normal’ society?

Focusing on Improvements

So, did you answer YES to any of the questions above?

If so, write down (or print off) a list of your specific marijuana-related cognitive problems.

• After quitting, revisit this list every week or so, and think about what progress/if any, you’ve made on specific items since quitting.

You should find, by about 6 weeks or so, that you’ve made dramatic improvements in problem areas. The trick is in managing to stay quit for long enough to reach this 6 week milestone!

When withdrawal symptoms get intense and when you start feeling stressed or bored, it’s easy to fall back to familiar patterns of getting high. By paying attention to the specific improvements you make during initial recovery, you can enhance your motivation to persevere and increase your odds of long term success!

Image Copyright: John O Nolan

How to get past the first 2 weeks of marijuana withdrawal symptoms. Learn what to expect from marijuana withdrawal, with tips and suggestions for coping with individual withdrawal symptoms.

People who claim that marijuana is not addictive have obviously never spent a sleepless night of headaches and nausea lusting for just that little something to take the edge off.

Marijuana detox is tough, and the withdrawal pains are very real and strong enough to keep a lot of people using more than they want for longer than they want to. Because marijuana detox doesn’t present with an obvious physical syndrome of symptoms, and because enduring social perceptions about the drug were formed in decades past, when the potency of marijuana was nowhere near what it is today, there exists a lingering misperception about the severity of marijuana detox and withdrawal pains.

Marijuana Detox Is Real

Marijuana withdrawal symptoms are real, they are medically recognized as such, and have been for years. Marijuana detox is not physically dangerous but they can be very uncomfortable, and since the cravings during a period of marijuana detox can be so strong; marijuana detox presents a significant obstacle to sobriety and the bettering of a marijuana addiction.

Marijuana is addictive, the health risks of frequent use are many, and the benefits inherent in quitting make an attempt at detox a very good idea.

• Research shows that a substantial percentage of heavy marijuana users will experience at least some withdrawal symptoms when quitting. In one major study of 500 heavy smokers, 59% experienced cravings and more than half experienced sleeping difficulties.¹
• The cumulative discomfort of withdrawal symptoms is severe enough to cause many people to abandon their quit attempts and go back to chronic use.

So though marijuana withdrawal symptoms won’t hurt you directly, if they keep you from quitting, they still exert a profound influence on your lifelong health and wellbeing.

If you choose to quit, don’t let marijuana withdrawal symptoms stop you. Read on to learn:

1. What withdrawal symptoms to expect (and how long they last).
2. About marijuana withdrawal medication options.
3. Ways to manage individual withdrawal symptoms, to make it past the first difficult week.

Marijuana Withdrawal Symptoms

Not all heavy chronic marijuana users will experience withdrawal symptoms upon quitting. For those that do, marijuana withdrawal symptoms can include:²

• Insomnia
• Vivid dreams
• Anxiety and feelings of nervousness
• Depression
• Moodiness
• Irritability
• Loss of appetite
• Abdominal pains
• Nausea
• Headaches
• Sweating
• Fever
• Chills
• Restlessness
• Marijuana cravings

Timeline

• Symptoms typically emerge on the first quit day and peak within 2 or 3 days. Symptoms generally dissipate by a week or two, though insomnia can linger beyond this point for 30 days or longer.
• Most people find that symptoms come and go over the first few days.
• While many people find that no one symptom is overwhelming, the additive effect of a combination of symptoms can become quite distressing.
  

The APA’s DSM-5 Cannabis Withdrawal Diagnostic Guidelines

Do you meet the criteria for a medical diagnosis of cannabis withdrawal?

The American Psychiatric Association included cannabis withdrawal in its latest diagnostic manual, the DSM-5. To meet the APA’s diagnostic criteria you must:³ 

1. Have just quit marijuana after a period of heavy and prolonged use.

2. Experience 3 or more of the following symptoms within a week of quitting.

• Anger, irritability or aggression.
• Nervousness and anxiety.
• Insomnia or other sleep difficulties (vivid dreams.)
• Restlessness.
• Reduced appetite.
• Depressed mood.
• Physical symptoms causing significant discomfort, like shakiness, headaches, fever, sweating, chills or abdominal pains.

3. Your withdrawal symptoms must cause you significant distress or interfere with normal social or occupation functioning.

4. Your symptoms must not be better explained by another physical or mental health disorder or from intoxication or withdrawal from another substance.

Do You Need Inpatient Detox?

Marijuana withdrawal symptoms may be uncomfortable, but they aren’t normally severe enough to warrant a need for hospitalization. Inpatient or residential detox treatment is rarely needed, except possibly when:⁴

• There is a co-occurring severe uncontrolled mental or physical illness.
• You are also withdrawing from other substances.
• You have no safe or stable environment for the withdrawal process.
• You have tried on multiple past occasions to make it through marijuana withdrawal without success.
• You have a history of serious aggression or violence. Especially if past withdrawal attempts have prompted violent outbursts.

Factors That Affect Withdrawal Severity

The severity of marijuana withdrawal can vary greatly, even between people with seemingly similar use histories. Factors known to influence marijuana withdrawal include:

• Your degree of dependence – the more addicted you are, the more likely you are to experience withdrawal symptoms.
• Your past and recent use history – a longer history of regular use and heavier recent use are both associated with more difficult withdrawal symptoms.
• Expecting difficult withdrawals – your expectations also play a role. Like a self-fulfilling prophecy, if you expect the worse, you’re more likely to experience difficult withdrawals.
• Having a co-occurring mental illness.
• Getting forced into an involuntary withdrawal – such as when you can’t access any marijuana.

In general, adults tend to experience more severe symptoms than adolescents, most likely due to longer use histories.⁵

Medications for Marijuana Withdrawal Symptoms

Unfortunately, the one medication that effectively reduces withdrawal symptoms is one medication you’re not likely to get prescribed – oral THC (like Marinol.)⁶

Since you can’t access medications to reduce withdrawal intensity, you can only treat the individual symptoms. As always when considering new medications, talk to your doctor first.

Medications sometimes used to treat marijuana withdrawal symptoms include:

• For insomnia and anxiety – Sedating antihistamines such as Benadryl (diphenyhydramine), Z-drugs, like zolpidem (Ambien) and various benzodiazepines (clonazepam, diazepam etc.). Sedating antihistamines will only work for a short period as you grow quickly tolerant to the sedation. Both the Z drugs and the benzodiazepines are extremely habit forming.⁷
• For headaches and muscle pains and spasms – Paracetemol or ibuprofen.
• For nausea and vomiting - Metoclopramide or promethazine.

Though medications may help to take the edge off, behavioral techniques can help more to reduce discomfort. Read on for coping suggestions for various withdrawal symptoms.

Coping with Individual Withdrawal Symptoms

Once you make it past the first period of intense withdrawals (usually the first week or so) your odds of staying quit go up substantially. With preparation and education, you improve your odds of making it through, Read on to learn how to manage the worst of the withdrawal symptoms.

Marijuana Insomnia

Marijuana insomnia is one the most common and enduring withdrawal symptoms, and unfortunately, a lack of sleep tends to worsen the severity of other symptoms. You may never sleep well during the first period of withdrawal, but anything that improves your situation helps reduce your overall discomfort.

• Cut out or cut-back on caffeine (this can also help to reduce your anxiety.) If you are addicted to caffeine, complete abstinence could lead to headaches and other caffeine withdrawal symptoms, so you can just cut back a bit and limit caffeinated drinks after mid afternoon.
• Avoid stimulating vigorous exercise for a couple of hours before bed time.
• Avoid staring at screens (TV, tablet, phone, computer, etc.) for a couple of hours before bed time (the blue light emitted by these devises mimics daylight and tricks your body into wakefulness.)
• Make your bed and bedroom comfortable and inviting. Avoid spending time in bed for anything or than sleep or sex.
• Eliminate extraneous light and sound from your sleeping environment.
• If you really can’t sleep, don’t just lay in bed agonizing about it, get out of bed and do something relaxing for a half hour so – reading is great – and then try again.
• Consider herbal medications such as valerian root or melatonin.

Insomnia for a month or more = a possibly unrelated sleep disorder. Marijuana withdrawal insomnia may last longer than other typical symptoms, however, according to the APA, if insomnia persists for longer than about a month after your quit day, you may have an independent – non-marijuana related, sleep disorder.

Marijuana Withdrawal Irritability

• When you feel moody, take a deep breath and remind yourself your irritability is just a passing symptom of withdrawal and that you don’t have to act on any aggressive impulses.⁸
• Try deep breathing exercises, or just focus on taking slow controlled breaths.
• Count slowly to 10 in your head before responding to anyone with negativity.
• Remove yourself from an anger-provoking situation before you do something you’ll regret.
• Respond to feelings of anger with aerobic exercise. This helps you bleed-off nervous energy.
• Ask for patience and understanding from loved ones for your cranky behaviors during the first few days!
• Apologize quickly to anyone you treat poorly when irritable. This will make both you and your ‘victim’ feel better.

Marijuana Withdrawal Anxiety and Depression

• A hot bath can ease anxiety – and a number of other marijuana withdrawal symptoms.
• A half an hour of moderate exercise can ease anxiety and depression, tire you out physically to help with insomnia, stimulate appetite and help you manage periods of intense craving. You probably won’t feel like getting off the couch, but it will make you feel better.⁹

Marijuana Withdrawal Nausea and Loss of Appetite

• Avoid overly spicy or fatty foods.
• Since cooking smells can turn a queasy stomach, have someone else prepare your food for you.
• Try eating cold foods, as these tend to smell less strongly than hot foods.
• Do not eat and drink at the same time. Drink after you’re done your meal.
• Don’t lie down while eating or for a few minutes after finishing.
• A popsicle can sometimes help to reduce feelings of nausea.

Marijuana Withdrawal Headaches

• Take OTC pain relievers, like acetaminophen or ibupforen.
• Stay hydrated.
• Stave off tension headaches with relaxation techniques, such as slow breathing, progressive muscle relaxation or meditation.
• Eat at least small amounts of food on a regular basis.
• Get out of your stuffy room and get some fresh air.

Managing Marijuana Cravings

Marijuana cravings can be intense during the first week after quitting. It can feel as though they’ll never stop or ease-up, but they will. If you can hold out for a week, you’ll find that cravings dissipate substantially.

You can manage cravings with a technique called the 4 D’s.¹⁰

1. Distracting
2. Delaying
3. De-Catastrophizing
4. De-Stressing
   

1. Distracting

Though at the outset, a craving can feel like it will never end, in reality, virtually all cravings disappear within 30 minutes, and the more often you resist your cravings, the weaker they become.

When you feel a craving coming on, distract yourself by getting busy doing something else (washing the dishes,  walking the dog – whatever!) by the time you’re done, your craving will be gone.

2. Delaying

You don’t have to delay forever – just for 30 minutes.

If you feel like you can’t hold on any longer and you’re about to give-up, delay lighting up for 30 minutes. Promise yourself that if after 30 minutes you still need to smoke, you’ll do so (fortunately, by 30 minutes your craving will have passed.)

• To increase your odds of success, plan in advance what you’ll do while you wait – for example, walk around the block, call a friend, take a shower or tidy your room.
• It’s a lot easier to wait while engaged in something active than it is when staring at a ticking clock.

3. De-Catastrophizing  

In the midst of a strong craving it’s easy to get caught up in ‘end-of-the-world’ type thinking. For example, “I can’t take it any longer.” Or, “I’ll die if I don’t smoke right now.” Or, “these cravings are never going to go away.”

Fortunately, none of these exaggerated statements are true, so when you catch yourself moiled in catastrophic thinking, reexamine and reframe - change:

• “I can’t take it any longer” to “this is really uncomfortable, but I know it won’t last forever.”

4. De-Stressing

Cravings cause stress and stress makes everything worse – including the intensity of your cravings!¹¹ Therefore, anything you can do to relax before and during a craving reduces the intensity of the experience. Ideas to try include exercise, getting into nature, a hot bath, yoga or massage and many others.

Besides stress, getting overly tired, hungry or thirsty can also increase the severity of your cravings, so try to eat regularly, stay hydrated and get as much sleep as you can (it can be challenging).

Long Term Withdrawal Symptoms

Though marijuana insomnia can persist for longer than a month, most withdrawal symptoms should disappear by about 2 weeks after your quit date.  If you still feel withdrawal symptoms after this point, you may want to see a counselor or doctor to get checked for underlying conditions.

• In some cases, people turn to marijuana to self-medicate mood disorders and other problems. With abstinence, mood disorder symptoms can return.

Finding Success

If you decide to quit marijuana, you increase your chances of success by learning about marijuana withdrawal, preparing to cope with symptoms and accepting your symptoms as transient signs of change - withdrawal symptoms aren’t fun, but they won’t last forever.

If you find that even with planning and coping efforts you cannot get past the discomfort and you continually relapse back to use, consider seeking professional help.

• There is nothing wrong with getting help to achieve a life-changing goal and everything wrong with ignoring help and continuing to use a drug that you no longer want to use.

Need to detox? Learn more about alcohol detox and find out what withdrawal symptoms you can expect, how long it will take to end and whether or not you need professional help to make it through to the other side.

When you decide to stop drinking, you have to think about getting through the alcohol detox stage.

Read on to find out more about alcohol withdrawal symptoms and to learn what you can expect from an alcohol detox - such as:

• Common alcohol withdrawal symptoms; when they start and how long they last for
• What are the DTs (delirium tremens)?
• Can you do it on your own, or do you need professional help?
• Why do we get alcohol withdrawal symptoms anyway?

Alcohol Withdrawal Symptoms

If you drink heavily every day for a while you will likely experience alcohol withdrawal symptoms if you stop drinking suddenly.

Alcohol withdrawal symptoms will usually begin within 5 to 10 hours of your last drink and will get worse for about 48 to 72 hours. Withdrawals generally last for a few days, but they can endure for weeks.

Common withdrawal symptoms include:

• Fatigue
• Depression
• Anxiety
• Difficulty in concentrating and thinking clearly
• Irritability and moodiness
• Feeling shaky
• Having nightmares

Withdrawal symptoms sometimes experienced include:

• Nausea, vomiting and a loss of appetite
• Quickened heart rate
• Pale and clammy skin
• Headaches
• Dilated pupils
• Insomnia
• Sweating
• Tremor

Dangerous withdrawal symptoms sometimes experienced include:

• The DTs, see below for a complete description of these life threatening alcohol withdrawal symptoms¹

The Delirium Tremens

About 5% of people going through alcohol withdrawals will experience the life-threatening delirium tremens (DTs).²

You are more likely to get the DTs if:

• You have ever had the DTs before
• You have ever before had an alcohol withdrawal seizure
• You have another illness concurrently as you go through alcohol withdrawals
• This is not your first alcohol detox ³
  
• You drink more than 7 or 8 pints (473 ml) of beer per day or more than 1 pint of liquor per day
• You have been drinking heavily for more than 10 years

In addition to regular symptoms of alcohol withdrawal, people who get the DTs may also experience:

• Whole body shakes
• Significant confusion and an inability to maintain attention
• Significant agitation and irritability – rapid cycling between moods
• Excitement, fear or delirium
• Falling into a very deep sleep which persists for longer than 24 hours
• Having hallucinations
• Feeling very restless or becoming very active
• Significant fatigue and sleepiness
• Becoming overly sensitive to sensory stimuli such as touch, light and sounds
• Having seizures (seizures are most commonly experienced by people who have had difficult alcohol withdrawals in the past and occur most often within 12 to 48 hours after a last drink⁴

The DTs will most commonly occur within 48 hours of a last drink, but in some cases delirium tremens have emerged as long as ten days after a last drink.

The DTs are a medical emergency. Even with intensive medical care (which can include intubation etc.) and emergency medications and sedation between 5% and 15% of those with delirium tremens will die. Without emergency medical intervention, the fatality rate is much higher.

Do You Need Professional Help to Detox?

It depends on your situation:

• Some people can safely detox at home on their own (after consulting with a doctor)
• Some people can detox safely at home while participating in an outpatient detox program
• Some people cannot detox safely at home and need to enter an inpatient medical detox program
• Some people, such as those going through the DTs, will need to be transferred to an intensive care facility

Because a doctor can prescribe medications that can greatly ease the pains of alcohol withdrawal, and because for some people, going through a detox without medical supervision can be very dangerous, there is no reason why anyone should do an alcohol detox without first consulting with a doctor. You don’t necessarily have to go into a medical detox, but don’t be foolhardy and don’t go through unnecessary discomfort – SEE A DOCTOR FIRST!

You are likely going to need an inpatient detox under medical supervision if:

• You this is not your first alcohol detox and you have a history of severe alcohol withdrawal symptoms
• If you have gone through alcohol detoxification on multiple previous occasions
• If you have ever before had withdrawal seizures or delirium tremens
• If you have a co-occurring psychiatric or medical illness
• If you are pregnant
• If you have a recent history of very high alcohol consumption
• If you lack a sober and responsible social support network⁵

If your doctor gives you the green light to detox at home, you will still want to be aware of signs that could indicate a worsening situation and the need to get emergency medical assistance.

If you detox at home, you will need to have someone with you at all times who can monitor your symptoms and get you to the hospital/get emergency help if needed. You will also probably need to go see your doctor on a daily basis for a few days so she can evaluate your condition as it changes over time.

Why Do People Get Alcohol Withdrawal Symptoms?

If you use alcohol for long enough, and in sufficient quantities, your brain adapts to this use by making some changes to the way it works, and this is one reason why people who drink regularly will develop a tolerance to alcohol and need much more to feel the same effects as an occasional drinker.

When you drink alcohol it increases the release of a neurotransmitter called GABA in the brain. GABA is a neurotransmitter that controls the release of other neurotransmitters, like dopamine, norepinephrine and glutamate. GABA slows down and controls brain activity.

When you drink very heavily, your brain responds to this constant influx of alcohol by reducing the number of GABA receptors and by changing their function. Without sufficient GABA in the brain you would normally experience too much neural activity and symptoms like tremors and sickness and anxiety and many others - but since you are using a lot of alcohol each day, the alcohol slow things down in the brain just like a normal amount of GABA would.

If you then suddenly stop drinking alcohol, your brain isn’t getting enough GABA and it isn’t getting the alcohol to slow things down – and so it races and too many excitatory neurotransmitters get released and you experience alcohol withdrawal symptoms.

Fortunately, your neurochemistry largely recovers in a few days or weeks, and as GABA function normalizes, symptoms of alcohol withdrawal disappear.⁶

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A newer and in some ways preferable alternative to methadone maintenance therapy for the treatment of opiate addiction is Suboxone therapy. Suboxone therapy can be used to help addicts overcome the initial pains of withdrawal safely and humanely, and can also be used as a long term form of opioid replacement therapy.

What Is Suboxone?

Suboxone is composed of two active ingredients, buprenorphine and naloxone. Buprenorphine is a partial opioid agonist and it binds to the same receptors in the brain that drugs like heroin or narcotic pain pills do. Since the buprenorphine binds to these same receptors, the brain doesn’t notice that you have stopped taking the drug of abuse, and you feel no withdrawal pains.

Buprenorphine

Buprenorphine is only a partial agonist though, and although it does bind to these same receptors, it offers little euphoria and little of the high that becomes so problematic with the abuse of pain pills or heroin. Users, once switched to buprenorphine, can once again participate normally in society, free from the pains of withdrawal and also free from intoxication.

Naloxone

The other active ingredient, naloxone, is incorporated to increase the safety of the drug by lowering the likelihood of abuse. Although buprenorphine does not readily induce a high, if injected in quantity and especially if combined with a tranquilizer type drug, it can be abused. Naloxone is an opioid antagonist, and if you take naloxone you cannot feel any opioid pleasure, and you go into immediate and very intense withdrawal.

Suboxone is taken sublingually (under the tongue) and when taken as directed your body does not absorb much of the naloxone, and you do not feel these withdrawal inducing effects; but were you to try to abuse it though injection administration, not only would you not get high, you would enter into severe detox pains almost immediately.

1. Because the drug has a much lower abuse potential than methadone, you are not required to come to a clinic to take their dose under supervision, you can be prescribed a month's supply of the pills, purchasable at approved pharmacies.
2. A second advantage to Suboxone over methadone relates to the eventual need to detox off of the replacement opiate. Although methadone works well as an addiction treatment medication, the withdrawal pains of a methadone taper can be severe. Suboxone is an opiate, and all opiates do require a period of eventual withdrawal, but the pains of withdrawal off of Suboxone are nowhere near as intense as heroin withdrawal symptoms, and far easier than with methadone.
   

Suboxone Side Effects

Suboxone is very well tolerated by the vast majority of patients. Some people may experience some minor side effects, including:

• Nausea
• Headache
• Sleepiness
• Dry mouth
• Sexual dysfunction
• Urinary retention
• Dizziness and others

The risks of overdose are low, but it can cause respiratory depression, especially if taken with alcohol, sedatives, tranquilizers, or any other form of CNS depressant medication.

In very rare occasions, patients have reported a hypersensitivity to the naloxone in the medication. The naloxone, which normally if the medication is taken as directed has no effect, in these patients with a hypersensitivity does cause a reaction, and does induce a severe period of withdrawal. This is very rare.

It is quite easy to transition from short acting opiates such as heroin, hydrocodone or OxyContin onto Suboxone, but it can be quite difficult to transition from longer acting opiates such as methadone. Patients addicted to methadone and wanting to switch to Suboxone will generally transition between the two medications via a period on a drug such as OxyContin.

Suboxone Problems

Because of the easier withdrawal period and because it can be taken home in month-long doses, most people prefer the idea of Suboxone therapy over methadone therapy. Unfortunately, Suboxone won’t work for everyone.

Suboxone has a dosage ceiling, or a limit of maximum effects, and for some people, such as heavy daily heroin users, Suboxone just isn’t strong enough to take away all withdrawal symptoms and drug cravings. In such cases, methadone is clearly the better choice.

In America, the two greatest problems regarding the use of Suboxone are availability and cost.

Doctor's must receive special certification before achieving licensing to prescribe the drug, and there are simply not enough doctors who may give it. Additionally, current legislation caps the numbers of patients each doctor may prescribe Suboxone to, further compounding the problem.

Secondly, the drug remains quite expensive, and for those without adequate private health insurance or without the means to self finance the drug, it can be prohibitively expensive.

Suboxone, for Detox and for Long Term Therapy

The Two Ways Suboxone Is Used

You can use Suboxone in two ways:

1. Similar to methadone, as a long term replacement solution
2. As a way to ease the pains of cold turkey detox, Taking the Suboxone for a week or more.

Long Term Replacement

Easing the Pains of Withdrawal

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Are a few hours of pleasure worth a lifetime of depression?

Regular use of ecstasy increases your tolerance to the drug, and you need to take ever increasing amounts to feel a same or even diminishing high. With tolerance, there is a real risk of dependence, and once ecstasy users achieve a level of dependence they must also endure a period of withdrawal after use is curtailed.

Although ecstasy withdrawal and detox does not induce dangerous physical symptoms, the psychological symptoms of withdrawal can be severe and long lasting, and ecstasy addicts may require inpatient treatment to learn the strategies needed for future drug avoidance.

Symptoms of Ecstasy Detox

The primary symptoms of ecstasy withdrawal and detox are all psychiatric in nature, and ecstasy addicts in detox report severe and long lasting feelings of depression, problems with sleeping, difficulties concentrating, and memory problems. These sensations of detox can linger for months or even years after use is curtailed.

Additionally, because ecstasy is almost never sold in its pure form, ecstasy addicts may present with a secondary and undiagnosed addiction to psycho stimulants that dilute ecstasy sold at the street level. These secondary addictions can induce any number of distinct symptoms of withdrawal.

Ecstasy Treatment

The only effective treatments for the symptoms of ecstasy detox are psychiatric prescription medications…and time. Anti depressant medications can help to ease some of the feelings of depression, and in some cases anxiolitics help with experienced anxiety.

Because of ecstasy's role in the seratonergic systems of the brain, ecstasy detox induces severe and lasting sleeping difficulties. The brain takes time to regulate its depleted serotonin and until it does, sleep can present a challenge. Addictions professionals in general do not advise the use of sleeping medications because of their potential for abuse, and recommend instead sound sleeping policies as the best way to a restful nights sleep.

Ecstasy detox reduces the ability to concentrate, and also the ability to form and retain memories, both processes also related to the seratonergic systems of the brain. Like sleep, these mental processes will get better in time.

Quit Ecstasy

From the first time you take ecstasy and every time thereafter, you destroy brain cells and compromise your future ability to feel happiness, to sleep, and to consolidate memories. If you are abusing or dependent on ecstasy you need to stop now, before the damage becomes irreversible. If you cannot stop on your own, you need to consider professional treatment assistance.

The mind can only take so much, and its supplies of pleasure producing chemicals are finite. Artificial manipulation of the mind always contains an element of risk, and for those people who play too frequently with their neurochemistry, the ultimate consequences can be high indeed.

If you cannot stop, you need to learn what it is that makes you crave intoxication, learn how you can overcome cravings to use, and learn how to enjoy yourself without a need to get high. A period of in or outpatient treatment may provide you with the therapy and re-education you need for a better life free from ecstasy and other drug abuse.

No matter how you got addicted, once dependent, you need to endure the pains of opiate detox. Few people have the strength to go it alone, and when the pains get bad and pills can be bought at the nearest pharmacy, it's hard to maintain resolve. For the best chance at sobriety you need professional help; help that can ease the pains of detox and also keep you away from access to pills and a too easy failure. It’s not going to be easy and you can expect some discomfort; but you can do it. Don’t let a fear of detox deter you from what needs to be done. Get off pills today, start enjoying life again tomorrow.

Does prescription opiate detox have to be painful?

Break Free; Prescription Opiate Detox

For so many of us, the drugs we were originally prescribed for pain relief result in far greater pain than they ever resolved. Seductive, potent, and when prescribed by a doctor, seemingly legitimate; these drugs catch far too many of us in a web of dependency, and once caught, it's very hard to get free.

It Doesn't Matter How You Got Addicted

Because we buy these pills at the pharmacy we forget that these prescription opiates can addict as readily as heroin, and that some have called the eventual detox off of prescription medications even more painful than street corner and illicit opiates of abuse. Ultimately, it doesn’t matter at all how you got addicted, and whether you took a little extra for fun, or whether you just took them for pain…but for too long, the problems you face are one and the same.

Symptoms of Prescription Opiate Detox

Individually experienced symptoms vary greatly depending on the severity of abuse, the duration of the addiction, and even the health and physiology of the individual; but in general, some commonly experienced symptoms of opiate withdrawal are:

• Nausea
• Insomnia
• Pain
• Anxiety
• Depression
• Vomiting
• Seizures
• Irritability
• Leg restlessness
• Diarrhea

Symptoms will generally present within hours of the last dosage, and gain steadily in severity until peaking within a day or so of cessation of use. Symptoms will endure with intensity for a period of three or four days before gradually subsiding, although lingering symptoms of detox may persist for months.

Prescription Opiate Detox Treatment Options

Once you decide to break free from prescription opiate addiction, you have five basic  options to choose from

1. Go cold turkey on your own
2. Slowly taper down
3. Enter a medical detox program
4. Get an ultra rapid opiate detox
5. Enter an opiate substitution program, using methadone or Suboxone

Cold Turkey Detox

The length and intensity of the withdrawal pains will vary depending on the length and intensity of your use. In general, longer acting medications, like methadone, result in a more prolonged but slightly less intense withdrawal period than shorter acting medications like OxyContin. The withdrawal period is very uncomfortable and many people who attempt a cold turkey detox fail to complete their attempt due to the intensity of the withdrawal symptoms.

Also, because people who detox without assistance rarely get any addiction treatment either, the relapse rates back to opiate abuse are very high. Too often, the pains of a cold turkey detox are endured for little long term gain...

Cold turkey prescription opiate detox is an option, but because the success rates are low and the discomfort high, it may not be your best choice.

Historically, opiate addiction was often treated within the criminal justice system, a kind of forced cold turkey detox to abstinence. Relapse rates for this form of treatment near 100%¹

Tapering

Many people who become dependent on prescription opiates are able to minimize withdrawal pains while working towards complete abstinence from opiate by tapering down their daily dosage over a period of weeks or months.

Dose tapering is a very sensible way to break free from opiate dependence, but it is rarely a successful approach for those that are addicted and dependent on opiate drugs.

• People who are opiate dependent have become physically dependent on opiates to function. Anyone who takes opiates, whether legitimately or otherwise, for an extended period of time will become physically dependent.
• People who abuse opiates, whether prescribed legitimately or not, are at high risk for opiate addiction. People who are opiate addicted will crave the drugs and use their medications for reasons other than pain control, the opiates will become a central focus of their life, they will lose control over their use of opiates and continue to use/abuse these medications despite becoming aware of the harms that occur from that use.²

If you are opiate dependent only, and never take your medication in higher doses or with higher frequency than prescribed, then dose tapering is probably a good choice for you, and you should speak with your doctor to make a safe and sensible plan to proceed from.

If you are opiate dependent and opiate addicted, then you may find it difficult or impossible to stick to a tapering regimen. After all, since a hallmark of opiate addiction is a loss of control over how much and how often you use it is unlikely that you will have the control needed to steadily reduce your daily dosage.

Learn more about the difference between opiate addiction and opiate dependence.

Medical Opiate Detox

In a medical opiate detox, you receive medications and nursing care to reduce the severity of the withdrawal symptoms that you experience. In most cases, medical opiate detox occurs on an inpatient basis under supervision. This increases the safety of the process (although opiate detox is rarely dangerous – simply very uncomfortable) and increases your likelihood of making it through the intense initial phase of detox pains without relapsing.

In some cases, you will briefly transfer onto lower doses of longer acting opiate medications, like methadone or buprenorphine, to reduce the intensity of the withdrawal symptoms.

Other medications used in a medical opiate detox can include:

• Clonidine – a medication that can reduce the anxiety, agitation, muscle aches, cramping and sweats of the withdrawal period. This is a commonly used medication for opiate withdrawals
• Medications for diarrhea and vomiting
  

The medical detox period will end when the withdrawal pains subside substantially in intensity. The duration of a medical detox will vary depending on the type of opiate that was abused, your age and general level of health and the length/intensity of the opiate abuse. Longer acting medications like methadone result in a more protracted withdrawal period than shorter acting drugs like Vicodin or Oxycontin. A medical detox generally takes between one and two weeks to complete.

People who complete a medical detox program only and do not follow detox with any addiction treatment and/or medications are at extreme risk to relapse back to opiate use. Medical opiate detox is not considered addiction treatment, merely something that gets you ready and able to participate in addiction treatment.

*Warning – Most people who OD on opiates do so when relapsing after detoxification. Once through the withdrawal process your opiate tolerance (ability to handle large quantities of these drugs) diminishes greatly. Once fully detoxed, taking a dosage that would previously get you pleasantly high might now be enough to kill! ³

Ultra Rapid Opiate Detox

The premise behind an ultra rapid opiate detox is that you progress through an accelerated and intensified period of withdrawal pains while under anesthesia and numb to the agony you’d otherwise be experiencing.

While this obviously sounds very attractive, many experts express caution over the procedure, arguing the risks and costs may outweigh the benefits (if any).

Criticisms of ultra rapid opiate detox include:⁴

• There is a risk of vomiting while under anesthesia, and a corresponding risk of death. The American Society for Addiction Medicine (ASAM) warns people to undergo such a procedure only in hospital facilities equipped to perform emergency intubations.
  
• Research studies do not show that people who undergo ultra rapid opiate detox are less likely to relapse
• Research studies do show that people who have underwent an ultra rapid opiate detox procedure continue to feel moderate to severe withdrawal pains for some time following the procedure
• The cost of an ultra rapid procedure is far greater than for other treatment options

Ultra rapid detox may be a reasonable option for a person that is unwilling to use methadone or Suboxone and unwilling to proceed through a conventional medical detox program, so long as they receive the procedure in a facility equipped for life saving interventions and so long as they are well informed of the risks and benefits of the procedure and the risks and benefits of other options.

To sum it up – ultra rapid detox doesn’t always alleviate the pains of withdrawal greatly, it costs more than comparable treatments, it doesn’t offer a better long term prognosis and compared to alternative treatments, it is far more dangerous.

Suboxone or Methadone

Suboxone and methadone are medications that:

1. Take away drug cravings
2. Take away feelings of opiate withdrawal
3. Don’t get you high, so you can function normally one again

People use these medications for varying lengths of time (longer is generally better), get stabilized financially, in living arrangements and with personal relationships – and when they are feeling good and ready, start to taper down off the meds.

Although some people reject the idea of opiate substitution programs using methadone or Suboxone, thinking they are just trading one addiction for another, studies show that people using methadone and Suboxone are far less likely to relapse than people who detox using other methods, far less likely to commit crimes and far more likely to get health and avoid accidental overdose.

Put simply, people who want the very best chance at long term abstinence from the abuse of opiates should strongly consider either Suboxone or methadone, coupled with ongoing addiction treatment.

Read more:

Suboxone – the basic facts you need to know

Methadone – the basic facts you need to know

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GHB (Gamma-Hydroxybutyrate) is an endogenous substance present throughout the brain in minute quantities, it's also a popular and affordable club drug, and has been linked to date rape for its sedative properties – It's also very addictive, and the detox is tough and can be dangerous.

A single dosage of GHB will last for between 1.5 and 3 hours, and regular users may re-dose continually for a period of days. Heavy GHB use can quickly induce a physical addiction, and users stopping GHB after a period of heavy use will enter into withdrawal and detox pains within 1-6 hours of the last dosage having worn off. GHB Withdrawal pains last between 5 and 15 days, and cause a syndrome of both psychiatric and physical side effects.

Symptoms of GHB Withdrawal include:

• Severe anxiety
• Panic
• High blood pressure
• Hallucinations - both aural and visual
• Delirium
• Tremor
• Heavy sweating

There has been at least one fatality linked to GHB withdrawal, and the psychiatric symptoms of hallucination and anxiety can be severe enough to require sedation or physical restraints for safety, in a hospital setting. There are some similarities between a GHB detox, and a detox from alcohol or sedative hypnotics, and many of the same treatments (lorazepam etc.) may be used.

Medical detox is strongly advised for anyone needing to withdraw off of GHB after heavy use.

GHB Overdose

GHB originated as a medication for anesthesia, producing in patients a profound state of unconsciousness, and so it is hardly surprising that when used recreationally there is a risk of overdose leading to such states of unconsciousness, or even to death.

The dose response curve for GHB is quite steep, and accidentally ingesting too much can lead to a serious overdose. Since the dosages as sold at the street level are rarely uniform, this makes the recreational consumption of GHB quite risky.

If too much GHB is taken, after an initial and intense sensation of euphoria, the person will quickly fall into a deep sedation, a GHB induced coma. If enough is taken, this coma can lead to respiratory depression, and possible death.

It is vital that anyone witnessing a friend passing into unconsciousness after GHB ingestion monitor the vital signs continuously until the person wakes up. If pulse or breathing seems slow, an ambulance must be called. If there is any uncertainty, an ambulance should be called.

GHB inhibits the gag reflex, while also causing vomiting (a possibly fatal combination) and many have died choking on vomit. Watch carefully for vomit, and ensure the victim is placed in the recovery position, (on side, arms outstretched, face side to the floor) so that vomit will not impair breathing. Even as the victim seems to be regaining some consciousness, friends must watch carefully. The victim may regain enough consciousness to roll onto their back, but not enough to get up should they start vomiting.

First response personnel must be informed of any and all drugs the victim has taken.

GHB as a Date Rape Drug

Although GHB does have a soapy or salty taste, it is colorless, and when slipped into a drink is often diluted enough to go unnoticed. GHB has been used as a date rape drug.

GHB Street Names

• G
• Liquid E
• Liquid X (Liquid Ecstasy)
• Georgia Home Boy
• Grievous Bodily Harm
• Soap
• Salty Water
• Cherry Meth
• Jib
• Gamma OH
• Fantasy
• Everclear

The cravings can feel overwhelming, and you'll never feel lower in your life; but cocaine addiction can be beaten. Get into treatment, get away from access to drugs, and learn what you'll need to know to stay sober. Take a step forward to a better life; get help now and never use again.

Once addicted to cocaine, attempts to quit are paired with uncomfortable withdrawal symptoms and extreme cravings.

Breaking a cocaine addiction is difficult, but very possible. The risk of relapse is highest during the first period of abstinence, when withdrawal symptoms are strongest, but people who receive addiction treatment during this initial phase increase their odds of success.

Although cocaine withdrawal symptoms are not physically dangerous like the withdrawal symptoms of an alcohol detox, cocaine withdrawal can result in intense feelings of depression and an increased risk of suicide.

Additionally, research shows that over half of all cocaine addicts suffer from a co-occurring mental disorder, like depression or ADHD¹ and the left untreated, these conditions greatly increase the risks of relapse.

You may wish to attempt to break free from your cocaine addiction alone, without the assistance of professionals. However, because addiction treatment increases the odds of long-term abstinence greatly and because getting in contact with addiction specialists and mental health workers allows for accurate diagnosis and treatment of any co-occurring disorders, there is a lot to be said for getting a little help during what is always a very challenging period.

Cocaine Withdrawal Symptoms

• During the first weeks and months of abstinence following cocaine addiction, you can expect to experience some or all of the following withdrawal symptoms:
• Sleepiness and lethargy
• Extreme suspicion or paranoia
• Depression (and with it, an increased risk of suicide)
• An inability to find pleasure in much of anything
• Anxiety and irritability
• Agitation
• Vivid dreams or nightmares
• Increased hunger
• Intense drug cravings

Although cocaine produces no physical withdrawal symptoms like vomiting or shakes, it is considered a difficult drug to detox from due to the extreme nature of the cravings, agitation and irritability experienced during the withdrawal phase. The difficulty of the detox is compounded by the fact that for heavy users (daily users) withdrawal symptoms like depression can endure for months into abstinence.²

Detox Treatments

No medications are yet FDA approved for the treatment of cocaine addiction and for the management of cocaine withdrawal symptoms.  Many people going through cocaine withdrawal symptoms self medicate their uncomfortable symptoms with alcohol or other illicit drugs. This is a bad idea that tends to increase addiction problems rather than alleviating them.

Getting behavioral addiction treatment and support during the withdrawal period can help you to manage your symptoms and deal with your cravings. Some addiction treatment examples include:

• Working with a substance abuse counselor, therapist or psychologist
• Joining an outpatient addiction treatment program
• Going to drug rehab

As a general strategy, experts advise starting off with the least intensive/intrusive form of addiction treatment – trying it out – and moving up to more intensive forms of treatment only if necessary.

In addition to addiction treatment, it can be helpful to also participate in community support groups, or in self help groups, like Narcotics Anonymous (NA) or Cocaine Anonymous (CA).

Minimize Your Cravings

Cocaine withdrawal symptoms don’t end as abruptly as the physical withdrawal symptoms to drugs like heroin or alcohol, they linger for longer and become gradually more manageable, over the first weeks and months of abstinence.

During this initial phase, the risk of relapse is high but that risk can be moderated by participation in an outpatient or residential addiction treatment program (research shows that outpatient programs are as effective for cocaine addiction)³

In addition to getting treatment, you may also want to reduce your exposure or plan for things (triggers) that increase your cravings to use cocaine. Some examples of common triggers include:

• Special occasions, such as holidays or birthdays
• Going on vacation
• Times when you have to meet new people
• Feeling stressed by work or financial problems
• Feeling bored
• Hanging out with friends you used to use with or going to places where you used to use
• Having relationship problems
• Holding yourself up to unrealistic expectations
• Letting yourself get too tired or hungry⁴

Although it’s wise to minimize your exposure to those things that trigger your cravings, you’ll never be able to eliminate all risky stimuli from your life, and since things that trigger a cocaine memory can induce powerful cravings, even years into abstinence* it is very important, that you learn strategies to manage and overcome your cravings. This is one of the primary reasons why addiction treatment is so necessary for most people.

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Thinking about quitting but not sure if you’re ready? Want to quit but worried about the withdrawal symptoms and your pre-medication anxiety? To stop or not…how to make up your mind!?! Well, read on to find a list of common quitting pros and cons, and then make your own list – and then make a decision, once and for all.

To quit or not to quit…?

If you’ve been using benzos daily for more than a few weeks you’ve probably developed a physical dependency and will likely experience withdrawal symptoms when/if you try to quit.

On top of this, you started using benzos for a reason, likely for anxiety or insomnia, and though benzodiazepines lose their effectiveness over time, you may also feel worried about going back to life without your familiar meds…how will you deal with anxiety or insomnia without strong medication?

However…

On the other hand, there are lots of very compelling reasons to stop using medications that do you great harm, especially meds that become less and less effective over time.

So, you have to decide whether or not to quit, and if you decide to quit, you also have to work up the motivation to actually do it now – because as you surely know, it’s a whole lot easier to push off for the future what feels too difficult today.

Weighing the Pros and Cons

Well, there are two sides to this situation, and you may find that when motivation to quit goes hand in hand with apprehension about the process, it can be hard to come to a firm decision about what to do.

To make it easier for you, here’s a list of many of the common advantages and disadvantages associated with quitting benzos. After you read through the article, divide a piece of paper in half and make up your own list of pros and cons, using any from the article that make sense to you, as well as any personal reasons not included within.

At the end of this easy exercise, you may find it easier to come to a decision about your future on or off benzos.

Pros - Reasons to Quit¹

1. They probably don’t work very well any more - Because of how quickly you develop a significant benzodiazepine tolerance, after a while you wind up taking these pills just to get to a normal un-medicated state of functioning. According to the National Institute on Drug Abuse (NIDA) there is little evidence to prove that benzos work for insomnia after as little as 2 weeks of continuous use - and after 4 months of use, they likely don’t help with anxiety either.² And if that’s not bad enough, there’s evidence that the long term use of these medications actually worsens anxiety symptoms^.3
2. No more feeling drugged or emotionally distant all the time – Many people find that benzos separate them from their normal emotions and from true connections with loved ones. Do you want to look back at your life some years down the road and regret all the time you spent emotionally detached from those closest to you?
3. No more side effects – Do you ever experience benzo side effects? Would you miss them terribly!? Some common side effects include: memory problems, fatigue, stomach problems, headache, irritability, etc. And to make matters worse, though you become quite tolerant to anxiolytic effects of these medications, you do not develop the same degree of tolerance to some of the negative effects. So as you continue to increase your dose, you may find that side effects get progressively worse.
4. No more worries about drug interactions – Mixing benzodiazepines with alcohol or other sedatives can result in a serious amplification of intoxicating effects. As your benzo doses get higher over time, your risk of dangerous consequences for small mistakes goes up in kind. Some examples of dangerous consequences include: falls and broken bones, traffic accidents and even fatal overdose.
5. Your original problems (anxiety or insomnia, etc.) may no longer even trouble you – Do you still need to take benzos at all? Many people start taking to these medications to deal with an anxiety or insomnia problem and then, over time, the circumstances that created these problems disappear and the problems go away…but if you’re still on medications, you don’t even realize that you no longer need them! And what’s worse, since withdrawal symptoms typically include anxiety, insomnia and others, when you try to quit you feel this rebound anxiety, you think you still really need the medications, and you give up on your quitting attempt. So don’t get discouraged by feelings of anxiety at first. These are very likely just withdrawal-related and likely to dissipate within a couple of weeks.
6. You can always take these medications again, if you find you really need to - So there’s no reason to think that making a decision to quit today means you’ll never be able to use these effective medications ever again. In the future, however, you’ll probably want to limit your use to very short periods, so you don’t wind up dependent yet again.
7. A slow and structured tapering plan minimizes withdrawal symptoms - By slowly reducing your dose every couple of weeks over a number of months you greatly reduce the severity of withdrawal symptoms. So if a worry of withdrawal keeps you using, you may be using for little reason. Read the Guide to Benzo Withdrawal to learn more about planning a safe and comfortable detox.

Cons - Reasons to Just Stay On

1. Worries about withdrawal symptoms (cold turkey benzo withdrawal symptoms are notoriously difficult). Fortunately, you can minimize withdrawal symptoms by using a structured slow tapering plan.
2. Worries about a re-emergence of the anxiety, insomnia or other challenges that caused you to seek out medication in the first place. Fortunately, in many cases rebound anxiety is just a temporary symptom of withdrawal, which will fade away quickly.
3. Feeling worried that you won’t be able to cope with difficult or stressful events without access to pills, when needed. Fortunately, you can always take these pills again, if needed. Quitting today doesn’t mean you have to quit forever.

Deciding on Change

Made a decision yet?

Quitting benzodiazepines takes courage. It’s often easier and less scary to just continue to use these meds, but when you examine the situation carefully – you may see that continuing to use makes very little good sense.

So think about it and make your own decision (don’t get pushed into it).

• If you’re not ready to try today, think about revisiting the issue in a few weeks or months – to make sure you’re still on benzos for all the right reasons.
• If you are ready to quit, get educated, talk to your doctor to make a plan, and then get started! Remember, there’s no rush and by taking it slowly you can reduce the discomfort.

Image Copyright: Helga Weber