Addiction Recovery: When Will I Feel Normal Again?

One of the major challenges in early drug or alcohol addiction recovery is how scary it is wondering if you’ll ever feel good or normal again. One of the best ways to cope with this is to learn about the withdrawal timeline for your primary drug of use, what post acute withdrawal syndrome is and how long it lasts, and what factors can impact your recovery and accelerate the healing process. Understanding the stages of withdrawal, and taking control of whatever aspects of the process you can, will greatly help your state of mind and give you hope for the future.

How Long Do Withdrawal Symptoms Last?

Alcohol Withdrawal Timeline

The worst phase of recovering from any substance is acute withdrawal, when you will experience the most intense symptoms. If you are detoxing from alcohol, symptoms will peak during the first three days, then fade away by seven to ten days.

Symptoms can start as early as just six hours after your last drink, and usually include:

• Tremors
• Headache
• Fatigue
• Nausea and vomiting
• Restlessness
• Depression
• Anxiety
• Brain fog
• Fever
• Confusion
• Irregular heart rate
• Teeth clenching and grinding

If you were a particularly heavy drinker or have been addicted to alcohol for a long time, you may be at risk of delirium tremens (the DTs), a severe acute withdrawal syndrome that begins approximately 72 hours into detox, and lasts for two to three days. Due to its potentially life-threatening nature, this form of withdrawal requires close medical supervision and treatment. DT symptoms include:

• Vivid hallucinations
• Severe mental confusion (delirium)
• Grand mal seizures
• Deep sleep that can last for 24 hours or longer
• Severe heart rate irregularities

Once you have made it past the acute phase of alcohol withdrawal, you may encounter some milder, but still troubling symptoms that can continue for weeks or months thereafter. This is called post acute withdrawal syndrome (PAWS), which will be discussed in depth later.

Opioids Withdrawal Timeline

Opioids include prescription painkillers like oxycodone, and illegal narcotics like heroin. The withdrawal experiences of all opioids have some similarities, but the treatment approach is sometimes different. Individuals recovering from opioid addiction have a very high chance of encountering post acute withdrawal syndrome.

Prescription painkiller withdrawal

Anxiety and depression are common among all withdrawal syndromes.

The most common approach to detoxing from prescription opioids like oxycodone is to reduce the dosage gradually under a doctor’s close supervision. This makes for a much longer withdrawal process, but this is usually worthwhile, because the symptoms will be much milder.

Withdrawal symptoms usually start between eight to 12 hours since the last dose, peak on day three, and fade after a week to ten days. These include:

• Runny nose and eyes
• Sweating and chills
• Sleep difficulties
• Depression
• Anxiety
• Nausea and vomiting
• Abdominal cramping and diarrhea
• Aches and pain

Heroin withdrawal

Although some people choose to detox from heroin cold turkey, this is not advisable, as it almost always leads to relapse, and could result in some serious health consequences as well. A medical detox or medication assisted treatment is the smarter approach for any form of opioid withdrawal.

A medical detox for heroin usually lasts a week to ten days. Patients withdraw from heroin at their body’s natural pace while closely supervised by a medical staff that will provide medications and treatments to treat individual withdrawal symptoms. The typical withdrawal symptoms of heroin are the same as those for prescription opiates, although they usually begin a few hours earlier (approximately six hours after last dose) and are much more severe due to the drug’s higher potency. For this reason, many individuals in heroin addiction recovery are advised to detox using medication assisted treatment (this approach is also used for the more serious cases of prescription opioid addiction).

Medication assisted treatment (MAT) combines therapies like counseling and cognitive behavioral therapy with medications like methadone and buprenorphine, which have been FDA approved for the treatment of opioid dependence. At the appropriate dosage, these medications eliminate withdrawal symptoms and drug cravings so that you can work on the root causes of your substance use, and make lifestyle changes that will support abstinence. You can stay on MAT for months or years—however long it takes to create a life strong enough to withstand the gradual weaning process.

Stimulant Withdrawal Timeline

Stimulant drugs affect the central nervous system, and unless you frequently took stimulants in combination with other drugs like benzodiazepines or alcohol, the withdrawal process rarely includes physical health risks. However, detoxing from stimulants is extremely difficult psychologically, and is therefore best experienced with the aid of professionals in a medical treatment facility. Such treatment can also make you better prepared for the possibility of post acute withdrawal symptoms that may begin after detox.

Adderall withdrawal symptoms usually begin soon after the last dose wears off. The most common symptoms are fatigue, brain fog, and depression, although some risky symptoms such as seizures and increased heart rate are possible. Symptoms peak between 48-72 hours in, then begin to improve. Cocaine withdrawal symptoms hit early—as soon as an hour or two after your last use—and include acute dysphoria (the inability to experience pleasure), hostility, aggression, increased appetite, exhaustion, and difficulty concentrating. Most of these symptoms will peak in a few days and pass in around a week, although the dysphoria may last longer and improve more gradually.

One of the most severe stimulant withdrawal syndromes occurs with crystal meth detox. The worst phase of symptoms will relent after two weeks at most, but you can count on extended post acute withdrawal symptoms being more of a certainty than possibility.

During the first 24 hours, depression and fatigue begin, usually followed by anxiety, panic attacks, and possible suicidal thoughts. Hallucinations and paranoia are also common. Meth withdrawal symptoms are usually at their worst in the first 24 to 48 hours. Additional withdrawal symptoms such as vivid nightmares, irritability, mood swings, headaches, itching, aches and pain, and hopeless feelings will usually appear and peak during the first few days, most of them fading within one to two weeks.

Insomnia, depression, and mood swings usually continue through week three or longer, and in week four, many individuals in meth addiction recovery experience jitteriness or nervousness as their central nervous system attempts to recover normal functioning.

Depressant Withdrawal Timeline

The most common depressant addictions involve benzodiazepines such as Valium or Xanax.  Most often, this addiction begins with a prescription meant to treat an anxiety or panic disorder. During benzo withdrawal, the symptoms of this disorder will return, often rebounding worse than before.

The duration of benzodiazepine withdrawal will vary widely depending on how much you’ve been taking. As benzos will cause a life-threatening withdrawal syndrome very much like the DTs if the medication is stopped cold turkey, it must always be slowly tapered off according to a doctor’s instructions. Withdrawal symptoms will be minimized through this approach, though not entirely eliminated. Symptoms include:

• Mood swings
• Anxiety
• Panic attacks
• Seizures
• Irregular heart rate
• Aches and pain
• Blurred vision
• Nausea and vomiting
• Depression
• Sleep disturbances
• Cramps
• High blood pressure
• Breathing problems
• Fever and sweating
• Memory and concentration problems

Post Acute Withdrawal Syndrome (PAWS)

So, what exactly is post acute withdrawal syndrome, and how long does it last?

Drug addiction causes changes in brain chemistry, structure, and function, particularly when it comes to the reward centers of the brain. Drug and alcohol use reinforces itself, rewiring the brain to compulsively seek and use substances, despite the many negative consequences. Although the brain can and will begin healing itself after detoxification, it can take a long time.

Post acute withdrawal syndrome is not something that is frequently talked about, even within addiction treatment facilities. This is partly because it hasn’t yet been included in the Diagnostic and Statistical Manual of Mental Disorders, and partly because treatment providers don’t want to intimidate or discourage patients. The difficulty with keeping silent about PAWS is that patients who don’t know what is happening to them may become overwhelmed and vulnerable to relapse. The advantages of being informed, on the other hand, is that it gives you the opportunity to understand and accept your experience, while applying coping techniques to make the experience easier.

Between 75 and 90% of people in addiction recovery will experience post acute withdrawal symptoms, which include:

• Sleep difficulties (insomnia, vivid dreams, too much sleeping)
• Brain fog and other problems with thinking, learning, and memory
• Mood swings
• Impulsivity
• Inconsistent energy levels, from exhaustion to hyperactivity
• Aches and pains
• Anxiety
• Lack of motivation or enthusiasm
• Drug or alcohol cravings

These symptoms are not constant, and do not improve at a steady rate. Rather, they come and go unexpectedly, disappearing for a while, then reappearing. It is important to remember that just because post acute withdrawal symptoms can return at any time, they will not keep doing so forever. Eventually the brain will return to normal in a way that can be consistently maintained, providing a permanent relief from PAWS symptoms.

This permanent relief can take anywhere from two months up to a year or two to arrive, however. In the meantime, make sure to measure your improvement by comparing this month to last month or this year to last year, rather than unfairly judging your progress on a day to day basis.

Factors That Affect the Addiction Recovery Timeline

Completing detox treatment: a professional, medically supervised detoxification will allow your body to rid itself of addictive chemicals as safely and efficiently as possible. A professional detox can minimize your acute withdrawal symptoms, and teach you techniques for coping with any post acute withdrawal.

Attending addiction treatment: detox is not a cure for addiction, and an extended rehab program is needed for a successful recovery. You have to uncover and address the root causes of substance use, as well as heal the wounds and damaged relationships caused by chronic drug use.

Receiving aftercare: medications and counseling should not abruptly end after an addiction treatment program. You should continue to check in with treatment providers and pay close attention to your physical and mental state so that you can swiftly address any problems before they can reach a crisis point. Many people in addiction recovery find peer support groups and 12-step meetings to be an essential part of their aftercare and continued recovery.

Helpful Hints for Long-term Recovery

1. Learn how to manage stress well. Chronic drug and alcohol use creates changes in the autonomic nervous system, sometimes getting you “stuck” in the fight, flight, or freeze response. This can be repaired, but in the meantime you will experience a heightened response to stress. You have to learn healthy ways of reacting to, coping with, and dispelling stress from your body in order to maintain addiction recovery.
2. Accept what is. Fighting, resenting, or denying post acute withdrawal symptoms will only deplete your strength and stress you out. Accept symptoms as they occur, using the tools you acquired in treatment to cope with them as best you can.
3. Prioritize your recovery. Even after you’ve gotten strong enough to take on all the responsibilities, goals, and hobbies you want, you may have some days when PAWS forces you to do less. Give yourself permission to put recovery first whenever necessary.
4. Get plenty of sleep, exercise, water, and good nutrition. Your body and brain need the proper building blocks to repair themselves, and most of these repairs will happen while you are asleep. Unprocessed, nutritionally dense foods like fresh fruits and vegetables are not only necessary for healing, they can boost mood and energy.
5. Create and accept your new normal. Addiction recovery requires a personal and behavioral overhaul. You can’t do the same things, hang out with the same people, or even view life the same as you used to. Recovery is a new way of life that you have to build from the ground up—staying patient if PAWS interferes from time to time.