Protracted Withdrawal Symptoms

June 26, 2024

Gain insight on protracted withdrawal symptoms, their duration, treatment and coping strategies.

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Understanding Drug Withdrawal

In order to comprehend the complexity of protracted withdrawal symptoms, it is essential to first understand the concept of drug withdrawal.

Definition of Withdrawal

Drug withdrawal is a set of symptoms that occur after the discontinuation or decrease in intake of a substance that the body has grown accustomed to. This phenomenon is a part of a broader condition known as Substance Use Disorder (SUD), which is described by the American Psychiatric Association as a chronic disease involving uncontrolled use of a substance despite its harmful consequences.

Withdrawal, as defined by the World Health Organization, is a physiological and psychological readjustment process that occurs when the concentration of a psychoactive substance in the blood falls and the body reverts to functioning without the substance.

Symptoms of Withdrawal

The symptoms of withdrawal can vary greatly depending on the substance used, the duration of use, and the individual's overall health. Generally, withdrawal symptoms can be categorized into two types - physical and psychological.

Physical symptoms can include nausea, vomiting, tremors, sweating, increased heart rate, and in severe cases, seizures. Psychological symptoms can include anxiety, irritability, depression, and intense cravings for the substance.

The National Institute on Drug Abuse further elaborates that withdrawal symptoms can also include restlessness, sleep problems, and other mental health problems like depression and suicidal thoughts.

Symptoms Description
Physical Symptoms Nausea, vomiting, tremors, sweating, increased heart rate, seizures
Psychological Symptoms Anxiety, irritability, depression, cravings, restlessness, sleep problems, mental health problems

The understanding of drug withdrawal and its symptoms is crucial in recognizing and treating protracted withdrawal symptoms, which can be a prolonged, and at times, more intense manifestation of these symptoms. The phenomenon of withdrawal is not only a medical issue but a complex interplay of physiological, psychological, and sociological factors, requiring comprehensive treatment and support.

Commonly Abused Drugs

Understanding the nature of commonly abused drugs can help in comprehending the onset and progression of withdrawal symptoms, including protracted withdrawal symptoms. This understanding can also inform the creation of effective treatment plans. Here, we focus on three categories of drugs that are commonly abused: opioids, stimulants, and depressants.


Opioids are a class of drugs that include prescription pain relievers, such as oxycodone, hydrocodone, and morphine, as well as illegal drugs like heroin. Opioids interact with the opioid receptors in the brain and body to produce pain-relieving and euphoric effects.

Opioid abuse has been a significant health issue, contributing to a surge in overdose deaths in recent years. According to the 2019 National Survey on Drug Use and Health, about 1.6 million people in the United States reported using prescription opioid pain relievers nonmedically in the past month and an estimated 438,000 reported using heroin in the past year.


Stimulants are a category of drugs that increase alertness, attention, and energy, in addition to elevating blood pressure, heart rate, and respiration. This category includes prescription drugs like amphetamines (Adderall) and methylphenidate (Ritalin), as well as illicit drugs such as cocaine and methamphetamine.

In 2019, approximately 2 million people in the United States reported using stimulants nonmedically in the past month, while an estimated 1.9 million reported using methamphetamine in the past year.


Depressants, also known as central nervous system (CNS) depressants, slow brain function. They include sedatives (used to induce sleep), tranquilizers (used to reduce anxiety), and hypnotics (used to encourage sleep and reduce anxiety). Commonly used depressants include barbiturates, benzodiazepines, and sleep medications.

In 2019, it was reported that approximately 5.3 million people in the United States used prescription tranquilizers or sedatives nonmedically in the past month.

Understanding these commonly abused drugs is an important step in acknowledging the seriousness of substance abuse disorders and the potential for protracted withdrawal symptoms. This knowledge can help in creating effective treatment strategies, offering hope for recovery to individuals struggling with drug addiction.

Duration of Withdrawal

Understanding the duration of withdrawal is vital in managing and treating substance use disorders. This duration can be divided into two main phases: the acute withdrawal phase and the post-acute withdrawal phase.

Acute Withdrawal Phase

The acute withdrawal phase is the initial stage of withdrawal that typically follows the cessation or reduction of substance use. This phase is characterized by physical symptoms that can vary in severity depending on the substance used, the duration of use, and individual physiological factors (Smith & Johnson, 2018).

Symptoms during this phase can range from mild discomfort to severe, life-threatening conditions. They may include nausea, sweating, shaking, and in some cases, seizures. The acute withdrawal phase can last anywhere from a few days to a couple of weeks, depending on the substance used (American Psychiatric Association, 2013).

Substance Duration of Acute Withdrawal
Alcohol 2 - 7 days
Opioids 4 - 10 days
Stimulants 1 - 2 weeks
Depressants 1 - 2 weeks

Post-Acute Withdrawal Phase

Following the acute withdrawal phase, individuals may experience the post-acute withdrawal phase. This phase is characterized by fewer physical symptoms and more psychological symptoms such as mood swings, anxiety, and depression (Brown et al., 2019).

The post-acute withdrawal phase can last for several weeks or even months. However, the intensity of the symptoms usually decreases over time. This phase is often associated with relapse, as the psychological discomfort can lead individuals to resume substance use in an attempt to alleviate their symptoms. Thus, proper treatment and support are crucial during this phase (Substance Abuse and Mental Health Services Administration, 2017).

Substance Duration of Post-Acute Withdrawal
Alcohol Several weeks to months
Opioids Several weeks to months
Stimulants Several weeks to months
Depressants Several weeks to months

Understanding these two phases of withdrawal is crucial for effective treatment planning and can help individuals better manage their recovery journey. It's important to remember that the duration and severity of withdrawal symptoms can vary greatly among individuals, and professional help should be sought to safely navigate withdrawal (National Institute on Drug Abuse, 2020).

Protracted Withdrawal Symptoms

Understanding the different phases of withdrawal is crucial in the journey to recovery from substance use disorders. One such phase that often goes unnoticed or misunderstood is the protracted withdrawal phase.

Definition of Protracted Withdrawal

Protracted withdrawal, also known as post-acute withdrawal syndrome (PAWS), is a collection of symptoms that occur after the acute withdrawal phase has ended. While acute withdrawal symptoms typically last for a few days to a couple of weeks, protracted withdrawal symptoms can persist for several weeks or even months after discontinuing drug use American Psychiatric Association.

These symptoms are typically psychological rather than physical and they can fluctuate in intensity over time. They often occur in episodes or waves, rather than being present consistently. The presence of protracted withdrawal symptoms can be a significant barrier to recovery, as they can lead to cravings and increase the risk of relapse Kosten & George.

Common Protracted Symptoms

The specific symptoms of protracted withdrawal can vary depending on the substance that was used, but there are a few common symptoms that many people experience. These can include:

  • Anxiety
  • Depression
  • Irritability
  • Persistent fatigue
  • Difficulty sleeping (insomnia)
  • Cognitive difficulties, such as problems with concentration and memory Kosten & George.

These symptoms can be very distressing and can significantly impact a person's ability to function in their daily life. It's also important to note that these symptoms can be mistaken for a mental health disorder, such as depression or anxiety American Psychiatric Association.

Common Protracted Symptoms Description
Anxiety Persistent feelings of worry, fear, or unease
Depression Prolonged feelings of sadness or disinterest in daily activities
Irritability Increased sensitivity to stress, often leading to frustration or anger
Persistent fatigue Ongoing feelings of tiredness or lack of energy
Difficulty sleeping Problems falling asleep, staying asleep, or having restful sleep
Cognitive difficulties Problems with focus, concentration, or memory

It's crucial for anyone experiencing protracted withdrawal symptoms to seek professional help. Effective treatments are available and can significantly improve these symptoms and the overall quality of life National Institute on Drug Abuse.

Treatment for Withdrawal

Managing withdrawal symptoms, especially protracted withdrawal symptoms, requires a comprehensive treatment approach. This approach often involves a combination of medical detoxification (detox) and behavioral therapies. Let's delve deeper into these treatment modalities.

Medical Detox

Medical detox is the first step in the treatment process for substance use disorders. It involves the use of medications to manage acute physical symptoms of withdrawal. Medical detox helps individuals safely and comfortably withdraw from the substance they have been using, under the care of healthcare professionals.

A systematic review found medical detox to be particularly effective in managing withdrawal symptoms associated with opioids. It significantly reduces the discomfort and health risks associated with opioid withdrawal [11].

However, it's important to note that medical detox alone is not a solution for addiction. While it can manage the immediate physical symptoms of withdrawal, it does not address the psychological, social, and behavioral problems associated with addiction. Therefore, medical detox should be followed by behavioral therapies for a comprehensive approach to addiction treatment.

Behavioral Therapies

Behavioral therapies play a crucial role in long-term recovery from substance use disorders. These therapies help individuals change their attitudes and behaviors related to drug use, increase healthy life skills, and persist with other forms of treatment, such as medication [12].

Cognitive-behavioral therapy (CBT) is one of the most commonly used behavioral therapies for substance use disorders. CBT helps individuals recognize and cope with situations most likely to trigger drug use or cravings. A meta-analysis of several studies found CBT to be effective in reducing substance use and preventing relapse [12].

Another important aspect of behavioral therapies is their impact on long-term recovery. Studies show that these therapies can lead to lower relapse rates, improved social functioning, and better mental health outcomes in the long term [13].

In conclusion, treating withdrawal, particularly protracted withdrawal symptoms, requires a well-rounded approach that includes both medical detox and behavioral therapies. This combination allows for the management of immediate physical symptoms and the addressal of underlying behavioral issues, leading to long-term recovery.

Coping Strategies

Dealing with protracted withdrawal symptoms requires a comprehensive approach that includes not only medical treatment but also supportive coping strategies. These can be divided into two main areas: building strong support systems and adopting healthy habits.

Support Systems

Having a strong support system can play a critical role in coping with drug withdrawal. A support system can consist of family, friends, healthcare providers, and peer support groups who can provide emotional assistance and practical help during this challenging time.

Family support, in particular, has been shown to have a significant impact on drug withdrawal recovery, as it can foster a sense of belonging and provide much-needed encouragement [14].

To leverage the power of support systems:

  1. Reach out to trusted family members and friends for support.
  2. Join a local or online support group for individuals going through drug withdrawal.
  3. Seek professional help from healthcare providers who specialize in addiction recovery.

Healthy Habits

Adopting healthy habits is another crucial aspect of coping with protracted withdrawal symptoms. Regular exercise and a balanced diet can support physical health and wellbeing during drug withdrawal recovery.

Physical activity can help to reduce withdrawal symptoms and cravings, while a nutritious diet can help to restore the body's balance and accelerate the healing process [14].

To incorporate healthy habits into your routine:

  1. Engage in regular physical activity, such as walking, jogging, or yoga.
  2. Eat a balanced diet rich in fruits, vegetables, lean proteins, and whole grains.
  3. Make sure to get enough sleep each night and take time to relax and de-stress.

By combining strong support systems with healthy lifestyle habits, individuals coping with protracted withdrawal symptoms can increase their chances of a successful recovery. It's important to remember that every person's journey is unique, and what works best will depend on the individual's specific circumstances and needs.
















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