The most self-explanatory treatment for a substance use disorder or dependency is to just stop using the drug. One would think that terminating use of a harmful drug would solve all problems related to drug misuse, but the action itself can actually have dangerous consequences. Many drugs are associated with withdrawal symptoms that can range anywhere from a mild headache to death. Some of these drugs that cause withdrawal symptoms include caffeine, alcohol, and opioids. Severity and symptomatology can vary for each different type of drug, but it’s worth exploring how dangerous each can really be in order to emphasize the importance of seeking proper treatment for substance use disorders.
Many people take some form of caffeine, a stimulant, for energy during the day. Caffeine makes people feel more awake, alert, productive, and social. According to a review by Juliano and Griffiths (2004), 80–90% of adults regularly use caffeine, often in the form of coffee, tea, and soft drinks. However, regular use can become associated with physical dependence, which is when people rely on caffeine for daily functioning, and tolerance, when the body desensitizes to the drug and more is needed to produce the same effects. If a regular caffeine user goes a day without taking the stimulant–and sometimes after only 18 hours (Greden et al., 1980)–they may experience withdrawal symptoms. The most common caffeine withdrawal symptom is a headache, with around half of participants in clinical studies experiencing this symptom (reviewed by Juliano & Griffiths, 2004). According to the same review, other symptoms include decreased energy and alertness, depressed mood, difficulty concentrating, irritability, and fogginess. Higher doses of regular caffeine intake lead to more severe withdrawal symptoms when use is reduced, so these symptoms and others could be heightened in those who decide to suddenly stop using caffeine or lose access to it. Although these withdrawal symptoms are mostly physically harmless, they can impact basic functioning and may increase people’s risk for danger in other areas of daily life. For example, when people are tired or unfocused, they are more likely to get into car accidents (Summala & Mikkola, 1994).
On the other hand, some withdrawal symptoms can be life-threatening like those associated with alcohol. Alcohol withdrawal occurs when regular consumers suddenly decrease consumption or stop drinking entirely. Symptoms can start from 2 hours to 4 days after last intake and may include sweating, tremors, sleep problems, increased heart rate, nausea and vomiting, headache, irritability, anxiety, and loss of appetite (Saitz, 1998). Studies have shown a wide range (13%-71%) in how many people will develop alcohol withdrawal symptoms after cessation of heavy use, which is believed to be a result of individual differences such as pattern of alcohol use, coexisting illnesses, and genetic variations (Saitz, 1998). Similar to caffeine withdrawal, the sleep disturbances caused by the sudden cessation of alcohol use can contribute to risks for harm in everyday life, such as during driving. Additionally, in around 10% of people, alcohol withdrawal from heavy use can be associated with more severe symptoms known as delirium tremens that include shaking, confusion, hallucinations, fevers, and in some cases, seizures (Trevisan et al., 1998). These symptoms are very dangerous and around 5% of patients who experience delirium tremens die from cardiovascular complications, severe seizures, trauma, or infections (Trevisan et al., 1998). Additionally, alcohol withdrawal can cause symptoms of anxiety and depression, increasing the risk for suicide and further contributing to mortality rates. These life-threatening symptoms demonstrate why people with alcohol use disorders should seek professional help and treatment options instead of attempting to just quit drinking cold turkey.
Because of their effectiveness in pain management, opioids are another common drug that people can end up using for long periods of time. Terminating the use of opioids (prescribed or not) without gradually tapering the dosage and frequency also causes negative withdrawal effects. Symptoms of opioid withdrawal–which include gastrointestinal problems, muscle pains, changes in body temperature, insomnia, and anxiety–can appear from 8 to 48 hours after the last dose and can last up to a month (Burma et al., 2017). Although these symptoms are clearly uncomfortable and could impact daily functioning, it is commonly believed that opioid withdrawal is not life-threatening. However, new evidence suggests that some of the symptoms, specifically those concerning the gastrointestinal system, could have more severe, deadly consequences. In an article from 2016, Darke and colleagues argue that vomiting and diarrhea from opioid withdrawal can cause dehydration and hypernatremia (too much sodium in the blood) that can and have led to fatal heart failure in some people. They directly cite the case of a woman who was incarcerated in 1998 and experienced heroin withdrawal symptoms, but likely did not receive proper care which ultimately led to her death. Although rare–only 10 cases have been reported–it appears as though opioid withdrawal can be life-threatening if people are not in a position to get proper care or do not have sufficient resources (like clean water, sufficient shelter, care facilities, etc.).
It is possible to safely stop the misuse of drugs like caffeine, alcohol, and opioids, but in some cases, additional help and treatment is needed. One of the main reasons people continue using substances or relapse after attempting to quit is because of these negative withdrawal symptoms. Because of this, professional systems of support are important and should be made more accessible for people experiencing substance use disorders.
Burma, N. E., Kwok, C. H., & Trang, T. (2017). Therapies and mechanisms of opioid withdrawal. Pain management, 7(6), 455-459. https://doi.org/10.2217/pmt-2017-0028.
Darke, S., Larney, S., & Farrell, M. (2017). Yes, people can die from opiate withdrawal. Addiction, 112(2), 199-200. https://doi.org/10.1111/add.13512.
Greden, J. F., Victor, B. S., Fontaine, P., & Lubetsky, M. (1980). Caffeine-withdrawal headache: a clinical profile. Psychosomatics, 21(5), 411-418. https://doi.org/10.1016/S0033-3182(80)73670-8.
Juliano, L. M., & Griffiths, R. R. (2004). A critical review of caffeine withdrawal: empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology, 176, 1-29. https://doi.org/10.1007/s00213-004-2000-x
Saitz, R. (1998). Introduction to alcohol withdrawal. Alcohol health and research world, 22(1), 5-12.
Summala, H., & Mikkola, T. (1994). Fatal accidents among car and truck drivers: effects of fatigue, age, and alcohol consumption. Human factors, 36(2), 315-326. https://doi.org/10.1177/001872089403600211.
Trevisan, L. A., Boutros, N., Petrakis, I. L., & Krystal, J. H. (1998). Complications of alcohol withdrawal: pathophysiological insights. Alcohol health and research world, 22(1), 61-66.
2 thoughts on “How dangerous is drug withdrawal?”
Great blog post, Jenna! I like how you talked about withdrawal symptoms associated with three different types of drugs.
Jenna, I love your post! You really shed light on why quitting substances can be so tough without the proper medical support. How you describe how different withdrawals can feel depending on whether it’s caffeine, alcohol, or opioids is eye-opening. And your point that any withdrawal should be handled with care is so so important! Even for the same drug, everyone’s experience can be different depending on the person.
I resonate with your thoughts on opioid withdrawal, especially having read Dr. Hart’s book. The stereotype of withdrawal as some uniform ordeal is just so misguided. I’m glad you drove home the point that it’s a complex, individual process – it really requires compassion and tailored care.