Withdrawal is sometimes called craving, clucking, or catting, because of the unpleasant physical and/or mental symptoms you can expect to experience. Put simply, it's your body's way of telling you that it's out of balance and needs a dose of your drug of choice to get back to normal.

Why do you get withdrawal?

Withdrawal will generally occur as a result of building up a physical dependence to a drug that you take regularly. This doesn't automatically mean that you're "addicted" to the drug. The lines are blurry, but it's a good sign that you should stop and have a think about your relationship with the drug in question.

What does withdrawal feel like?

You feel it in your body

Physical withdrawal can be quite unpleasant and make you feel unwell in a range of ways. The symptoms are often the opposite of the drug you are withdrawing from, e.g. with cannabis you might start to feel overstimulated and unable to be at ease. It can be anything from headaches to feeling like you've got the flu.

It affects your mind too

Psychological withdrawal can last for a while for some and can be triggered by people, places, times (and practically anything that has a link to your personal substance use). These feelings are generally relatively short but your experience will vary widely depending on many factors such as the drug, how often you take it, how much tolerance you've built up, your mental state, your physiology, etc.

Sleep might be difficult during withdrawal due to insomnia and there is always a temptation to redose to help you drop off to sleep. In most cases a user's sleep pattern will return to normal once your brain recovers its normal function.

What factors affect withdrawal?

The way you use your drugs can also play into your experience of withdrawal symptoms as different methods of using drugs increase the chance of building dependence. The quicker a drug gets into and leaves your bloodstream, the shorter or more extreme the high, the greater the likelihood of dependence. Such methods, like injecting or smoking, will increase the likelihood of experiencing withdrawal and make it more severe.

Taking recreational drugs is a highly ritualised experience. Routines like reaching for the rolling tray, visiting your dealer on a Friday evening to pick up a bag are also an integral part of the experience. We tend to have patterns of behaviour, so it's normal to miss those things and these gaps can contribute to the difficulty of withdrawal.

References: Eddy et al., 1965; NHS; Sleep and Substance Use Disorders; Differential Effects of Addictive Drugs on Sleep and Sleep Stages; Sleep Hygiene; Withdrawal syndrome; WHO - withdrawal

Different factors can influence the rate at which tolerance builds, such as drug and dose used, but frequency of use is also important. Occasional use of a drug will keep tolerance a lot lower than regular use, with tolerance building the quickest during binges.

Just as withdrawal is your brain adapting to a lack of drugs, your brain also adapts to the presence of the drug to protect you from overdosing. The same dose will start having less effects and you might notice that you need to take more to get high. This is called tolerance.

For example, this is why people who have been drinking alcohol at higher levels for some time can drink an amount that would be dangerous for someone without the same tolerance. It is this increase in tolerance which increases the likelihood of experiencing withdrawal symptoms.

References: The Dangers of Medication Tolerance; Drugs without the hot air

Top tips

• Stay hydrated → water, non-alcoholic drinks
• Avoid caffeine → it'll only stimulate you more
• If you're a frequent user, don't go cold-turkey

Alcohol has a depressant effect on the brain so with long-term regular use the brain compensates by over-producing substances that have stimulants effects, such as the neurotransmitter serotonin and the hormone adrenaline. When you abstain from alcohol, your brain and body are out of balance and become overstimulated.

A mild example of alcohol withdrawal is the hangover you get after a night of heavy drinking. Drinking more in the morning (known as "hair of the dog") might initially seem like a great idea as you lie reeling but it's really not advisable.

Careful: If you have a prolonged history of consistent alcohol use (a.k.a. chronic alcohol addiction), withdrawal can be life-threatening. Don't go "cold-turkey", talk to your doctor first.

Symptoms of alcohol withdrawal

Physical symptoms

• Hand Tremors (the shakes)
• Sweating
• Nausea
• Visual Hallucinations
• Seizures (in severe cases)

Psychological symptoms

• Depression
• Anxiety
• Irritability/aggressive behaviour
• Restlessness
• Insomnia

The physical symptoms of withdrawal usually improve 5 to 7 days after stopping drinking, with the first 48 hours of abstinence being the worst. Psychological withdrawal can last a lot longer and might require seeking the support of your doctor or a specialist drug service.

References: Drug Facts: Alcohol;Drink? The New Science of Alcohol + Your Health; Effects of Alcohol Dependence and Withdrawal on Stress Responsiveness and Alcohol Consumption.;Alcohol Withdrawal: Cold Turkey Dangers; Drinkaware; Alcohol Withdrawal Syndrome

Top tips

• Gradually reduce your dose → try smoking smaller joints or bongs, smoking fewer joints and bongs, or delaying use until later in the day
• Change route of administration → vaping is more economical and can give less withdrawal symptoms
• Know your drugs → watch out for Spice

When regular or heavy cannabis users suddenly stop using cannabis, rather than slowly reducing their intake, they can experience mild to moderate physical and mental symptoms. This is because when you stop using cannabis, the reduced stimulation of your cannabinoid receptors can result in physical cravings or a psychological desire to use cannabis again. The associated symptoms of cannabis withdrawal tend to be unpleasant but not dangerous.

Synthetic cannabinoids like Spice are much more potent than cannabis. They fully activate cannabinoid receptors whereas THC, the main active substance in cannabis, is only a partial agonist. Not only is the high totally different, being potentially hallucinogenic and disorientating, but it's associated withdrawal is much worse and can also cause seizures, overdose and death.

Symptoms of cannabis withdrawal

Physical symptoms

• stomach pains
• shakes/tremors
• sweating
• fever
• chills
• headaches
• restlessness

Psychological symptoms

• irritability
• anger
• depression
• sometimes vivid and unpleasant dreams

These may all last longer than a week but you should notice them getting more manageable with time.

References: Cannabis Withdrawal & Detox Guide; How Long Does Withdrawal From Marijuana Last?; Cannabis withdrawal symptoms; What to expect from cannabis withdrawal; Leafly; Bahji et al. 2020; What is spice

Depressants are used for a variety of reasons and complications in life. They can help us feel better in certain situations, like taking opioids for pain or benzos for anxiety. Ultimately they are just a short-term fix and won't get to the cause of the problem. Usually your doctor will only give you a short-term supply, to avoid the possibility of addiction or withdrawal.

This information is particularly important if your supply has come from the black market, where dosage will vary and inconsistent supply is common. When supervised by a professional, withdrawal side effects are generally short term and manageable, even for long term users. It's not uncommon for users to feel incredibly anxious during withdrawal but they usually feel much better after a short period of time.

Symptoms of depressant withdrawal

Physical symptoms:

• Restlessness
• Insomnia
• Elevated hr
• Sweating
• Elevated bp
• Nausea and vomiting
• Tremors
• Abdominal cramps
• Diarrhoea

Psychological symptoms:

• Anxiety
• Confusion and paranoia
• Delirium
• Hallucinations
• Seizures

Benzos

Benzodiazepines like Xanax or Diazepam are generally misused with other drugs (poly drug use). Users enjoy the effects of combining them or believe that using benzos will reduce the effects of withdrawal from other substances, like heroin, or enable sleep following the use of stimulants, such as cocaine or crack.

Withdrawal from benzos can be very unpleasant and in extreme cases life threatening. Physical dependence is common with tolerance growing quickly. Withdrawal effects may include, but aren't limited to, increased anxiety, irritability, weight loss, raised heart rate / blood pressure, shaking or muscle cramps, insomnia and sensitivity to sound or light.

If a person has been using benzos for a prolonged period of time and has built up a tolerance to the drug, stopping use abruptly can be extremely dangerous. Going 'cold turkey' may cause seizures, which could result in further harm such as trips and falls.

Long term benzo use is linked to anxiety and depression and these manifestations of withdrawal may last for weeks or months depending on a variety of factors. Anyone attempting to withdraw from benzos should do so with support from medical professionals in order to taper (reduce in a planned way) effectively.

GHB / GBL

Taking GHB consistently then suddenly stopping can induce withdrawal. For some people, this can come on after just 7 days of persistent use. If you use GHB heavily for long periods of time, you MUST NOT quit cold-turkey. Your withdrawal symptoms will be more intense and can be life-threatening, see our section about GHB addiction if you're planning to quit GHB.

Symptoms of withdrawal can come on a few hours to several days after the last dose of GHB and they usually last for 12 days, but sometimes longer. Some people can continue to experience some withdrawal symptoms, like anxiety, depression and insomnia, for months or even years after their last dose of GHB.

References: Healthline; Bateson A. 2002; Pétursson H. 1994; Hu X. 2011; Benzodiazepines: How They Work & How to Withdraw; NHS.UK

Ketamine withdrawal can produce strong cravings, anxiety and misery, and even shaking and sweating. These withdrawal symptoms aren't dangerous and they will eventually pass.

Nitrous Oxide isn't commonly known for its addictive properties however regular re-dosing is common so patterns of behaviour can develop quickly. Nitrous Oxide is usually delivered by internet orders or by dealers, which may affect accessibility to those who are craving, particularly in a time of ‘Lockdown’.

DXM (dextromethorphan) is a synthetically-produced substance used in over 140 cough syrups and other cold medications. In the withdrawal period, a DXM user may experience symptoms like insomnia, muscle aches, abdominal pains, nausea, vomiting, severe headaches and dysphoria. Psychological withdrawal among DXM users is manifested by intense cravings. Symptoms generally last a few days and in the main are considered mild.

As the use of opioids causes comfort and relaxation, withdrawal from opioids is very unpleasant although usually not life threatening. The symptoms usually begin around 6-30 hours after last use, and symptoms are worse in the later stages i.e. 72 hours onwards and last for around a week. Psychological symptoms tend to last longer than the physical symptoms. For some users it might be helpful to have support through this as it can be difficult to maintain resilience throughout withdrawal, however this isn't always an issue for everyone.

Withdrawal effects can be managed with pharmacological interventions, such as opioid substitution treatment or medically assisted detoxification, but it's also beneficial to have psychosocial support alongside these. People who use opiates or opioids to manage trauma may find withdrawal even more difficult because of having to deal with these feelings without the comfort provided by the drug.

Symptoms of opioid withdrawal

Physical symptoms

• rapid pulse
• insomnia
• muscle cramps/tremor
• diarrhoea
• fever/chills

Psychological symptoms

• anxiety
• irritability
• anhedonia (decrease in pleasure from life)

References: Kosten T et al. 2002; Elsevier

Withdrawal from stimulants may be unpleasant for some users although it is not life threatening. The physical symptoms usually pass quite quickly but these psychological symptoms can last from weeks to months. Psychological symptoms can be longer lasting and have more of an impact on your life. You might benefit from seeking support from a mental health or specialist drug service to help you through this process.

Although the withdrawal can be unpleasant we know stopping stimulants has very positive outcomes in terms of wellbeing, including lowered resting heart rate and lower blood pressure, a reduced chance of developing kidney disease and a reduced risk of stroke, heart attack and aneurysm.

Symptoms of stimulant withdrawal

Physical symptoms

• chills
• tremors
• muscle
• aches and pains

Psychological symptoms

• strong cravings to use the substance
• anxiety
• irritability
• insomnia
• restlessness
• depression

References: UNODC

Here we've made a list of various ways to help you get through withdrawal. They're not exhaustive, so we've added some useful links for further reading where possible. Remember, you've already made a significant step by reading this guide and these strategies can help you get through withdrawal safely.

Use your local drug and alcohol services

This will allow you to access expert advice and information as well as structured support during withdrawal. Services are turning to digital means to support their communities with video appointments and webchats during this unprecedented time.

Useful links:

Getting help - NHS [UK only]

Eat well and stay hydrated

This can help to reduce many of withdrawal symptoms including mood swings that can be made worse through poor nutrition (Vit D E and zinc - see New Scientist) and dehydration.

Exercise

It doesn't need to be high intensity, walking or cycling are just as good as jogging or lifting weights. Exercise causes the release of lots of neurotransmitters and hormones, which is why you feel good after → use it to your advantage.

Useful links: Using exercise to improve your mood

Stay busy

Having something to do will help take your mind off the cravings. Exercise is also good for that, reading, watching TV, cleaning, anything really. This is a good time to pick up an old hobby or pursue a new one → are there any communal plots in the neighbourhood?

Useful links:

Gardening and it's positive effects on mental health

Gardens and health

Stress management

Techniques such as mindfulness, breathing exercises, meditation, yoga are useful to help you understand and manage your mental wellbeing but also your physical cues.

Useful links:

Mindfulness practices for recovery

Coping with mindfulness

Can mindfulness help stop substance abuse?

Mindfulness for opioid addiction

Mindfulness in opioid addiction recovery

Mindfulness meditation in the treatment of substance use disorders and preventing future relapse

Support network

Having friends and family to help you cope is hugely beneficial. If you know in advance that you will be experiencing withdrawal, inform them!

Sleep well

Try to sleep 7-9 hours and maintain a healthy sleep pattern. This may be made more difficult with withdrawal side effects that include insomnia but getting into a good pattern of sleep will give your body and mind the rest it needs to facilitate better control of mood swings and cravings.

With this extra time, you might find yourself using recreational drugs more than you usually would It’s a good idea to ration your supply and divide it out equally so you don’t end up increasing your use. It’s best to avoid binges at this time as these can increase tolerance really quickly which will make you more likely to experience withdrawal, and these symptoms can be more severe. This could also be an opportunity to take a tolerance break or at least lower your tolerance by using increasingly smaller amounts, less often, or delaying use until later in the day.

The way you use drugs is just as important in managing withdrawal as the dose and frequency of use. If you’re currently using in a way that gets the drug into your bloodstream quickly, such as injecting or smoking, consider exploring alternative methods. This will allow your body more time to adjust to the drug leaving your system making withdrawal a little easier, and as an added benefit may reduce harms overall.

Remember, the cause of withdrawal is a lack of the drug in your body, so the quickest way to make it stop is to redose. If you’re on holiday and decide to just continue drinking the morning after it’s not a major issue (although we still can’t recommend you do it), but if you’re in the middle of a recovery attempt, then redosing will send you back to the start.

As with most things in life, context is everything. In the midst of the COVID-19 pandemic, you might find yourself with an interrupted supply, or with limited funds. Even if you still have access to your drug of choice, it’s a good time to reflect on your relationship with it. Reducing your use could be beneficial to you and your wellbeing, and if done right, won’t negatively affect you in any way.

This guide is a starting point, you can find more information on our drug guides and we always encourage you to read further. Everyone is different and will react in their own way. Withdrawal will not necessarily be a terrible or extremely difficult experience for everyone and some will find it less problematic than others. So, look out for each other and be honest with yourself. Withdrawal can be unpleasant, but with the right help and self-care, you will get through it.

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