Substance Abuse Withdrawal Timelines

As all long-term drug users know, attempting to quit substance use leads to a horrible set of circumstances that makes cessation almost impossible: withdrawal. The body’s reaction to stopping use of a substance on which it has become reliant leads to withdrawal, a deep discomfort, a negative physical and mental response and, on occasion, serious side effects that can lead to injury or death.

Withdrawal is often directly responsible for a substance abuser’s inability to stop use without professional help. Within hours or even minutes after a dose wears off, symptoms begin to set in. Regardless of the specific physical signs, which can include everything from nausea and vomiting to seizures and delirium tremens, cravings during withdrawal are generally intense, leading to a nearly insurmountable urge to use. Withdrawal is among the hardest phases of recovery to work through and is where most users fail in their recovery efforts.

Defining Withdrawal

What is a withdrawal timeline?The term withdrawal is essentially a colloquialism for the mental, emotional and physical response to an abrupt discontinuation of substance use. The multifaceted nature of withdrawal plays a large role in why effects can be so hard to resist; addiction often takes hold in multiple ways, from changes in the chemistry of the brain to an emotional attachment to the effects of the high. For serious users, the symptoms can be nearly unbearable, leading to virtual incapacitation that makes it almost impossible to eat, work and even sleep.

While there are similarities from one substance to another, withdrawal side effects and timelines — including the presence of potentially fatal symptoms — vary quite dramatically. This is what to expect in withdrawal from the most commonly abused substances in the United States.


Alcohol, as a legal drug, is often thought of as one of the safer options for use. This can be true for those who regularly but moderately use when they decide to quit. However, this is not the case for all users. Alcohol is actually among the most dangerous substances to quit without professional support and oversight. Long-term drinkers may also be at risk for a severe reaction to alcohol withdrawal known as delirium tremens which includes hallucinations, seizures,  confusion, high blood pressure, and fever.

The physical effects of withdrawal from alcohol are relatively short; most symptoms cease after five to seven days. Stage one sets in within eight hours and can cause anxiety, insomnia and trembling extremities, lasting for around 16 hours. Stage two spans from 24 to 72 hours, with the most common effects including confusion and heart rate changes. The worst potential effects including delirium tremens span the next several days and can include fever, hallucinations, and seizures. Even after physical symptoms subside, cravings can continue for weeks, months or even years.

Alcohol Withdrawal Timelines


Because it’s a prescription medication, many individuals who start taking benzodiazepines often don’t realize their potential to be deeply addictive. As a central nervous system depressant, benzos create lasting physical effects on the brain and body that can be very challenging to overcome. In some cases, withdrawal can be dangerous, so quitting use should always involve professional intervention.

The timeline for benzodiazepine withdrawal can be highly dependant on the form in use. Symptoms of short-acting benzodiazepines like Ativan and Xanax generally begin right away, within six to eight hours, and peak on the second day. Within four to five days, side effects begin to taper off.

The story is different for long-acting benzos, however. Substances like Valium can take several days to a week for initial symptoms like anxiety, insomnia, nausea and agitation to set in. Side effects peak in the second week and can include seizures, tremors and a racing heartbeat. These will subside in time but may take four to five weeks to fully resolve.

Timelines for Withdrawal - Benzodiazepine


A strong stimulant that can be highly addictive, cocaine often causes withdrawal symptoms when users try to give it up. Cocaine withdrawal is typically not as intense as withdrawal from substances like alcohol and benzodiazepines but can still be uncomfortable and may influence relapse in users.

Withdrawal symptoms often begin within one to three hours after ceasing use and include irritability, anxiety and nausea. Withdrawal effects peak around four to seven days after the last use, with the most serious symptoms including depression, dysphoria and paranoia. These will likely subside after a week, although effects like cravings may persist for a month or more.

Withdrawal Timelines - Cocaine

Heroin and Opiates

Heroin and other opiates, including prescription medications like morphine and oxycodone, are highly addictive and are currently used at epidemic levels in the United States. Many individuals entering rehabilitation are struggling with opioid addiction and the challenges of detox.

Heroin withdrawal can be quite severe but is rarely life-threatening. Symptoms first set in around six hours after use and include muscle aches, nausea, insomnia and fever. Symptoms peak after 48 to 72 hours, with users experiencing stomach cramps, chills, vomiting, and irregular heart rate and blood pressure. These symptoms largely subside within a week after ceasing use.

While physical side effects of opiate cessation will wane in a relatively short timeframe, the mental aspect of opiate addiction is often stronger than the physical effects of withdrawal and can be virtually overwhelming. Many heroin users, even those who fully overcome the physical components of addiction, will relapse as a result. Unfortunately, this can lead to overdose death; many users don’t realize that tolerance decreases after stopping use and that previous doses cannot be resumed after moving through withdrawal.

Withdrawal Timelines for Heroin and Opiates

Post-Acute Withdrawal Syndrome

The physical symptoms of withdrawal vary from drug to drug but generally don’t exceed several weeks in duration. However, for some users, this isn’t the end. Post-acute withdrawal syndrome, also known as PAWS, isn’t universal but does occur in many long-term users. Sometimes considered the second phase of withdrawal, PAWS is generally long-lasting, making rehabilitation far more difficult.

With PAWS, symptoms are generally limited to mood swings and irritability, depression and fatigue, trouble concentrating and disturbed sleep. More psychological than physical, addressing side effects from PAWS is often less exact than during initial withdrawal. These symptoms can fluctuate from day to day or month to month but are generally universal for most individuals facing PAWS.

PAWS can last up to two years, keeping cravings and psychological challenges alive. Many forms of treatment in rehabilitation are intended to mitigate the effects of PAWS.

The Dangers of Self-Detox

The dangers of trying to do a self-detoxMany users believe that they can quit using without help. With nothing but advice on the internet, similar substances to use to alleviate symptoms or tips to pass the time, many substance users will attempt to quit solo at least once. However, this generally does not result in success. Most users who try to leave addiction behind without help end up using within days and, worse, take this kind of failed effort as a sign that quitting or changing bad habits is impossible.

In some cases, self-detox can be exceptionally dangerous. With substances like alcohol and benzodiazepines, the potential for symptoms like seizures and changes in heart rate or blood pressure can pose lasting risks to health. In some cases, the consequences of severe withdrawal can even lead to death. Without professional oversight, it can be very hard to see these kinds of signs and take proper action before it’s too late.

During a detox program at a rehabilitation center, withdrawal can be carefully monitored by addiction medicine doctors and nurses to ensure symptoms are kept in check. Both over-the-counter and prescription medications can be used to treat symptoms like insomnia, anxiety and nausea, and doctors can monitor patients for more serious effects. Further, a medical environment can provide access to medications commonly used to control cravings and aid in recovery, like disulfiram in treating alcohol addiction and methadone, buprenorphine and naloxone for opiate addiction. This kind of aid isn’t available without a doctor’s prescription, making detox in a treatment program an advantage for those working to overcome addiction.

Withdrawal Management at FHE Health

At FHE Health, our detox program is the first step in entering residential rehabilitation. During this time, members of our community are offered support and guidance during the worst stages of withdrawal, including medical oversight to ensure patients are in no danger. With a successful start to treatment, patients are able to transition into our rehabilitation program with a clear mindset and a healthier attitude towards recovery.

If you or someone you love is struggling with drug addiction, FHE Health can help. Our detox program is designed to support recovering substance users through withdrawal in a safe and healthy manner. Please contact us today to learn more about our treatment opportunities.

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