fun fact; drugs that act on your GABA nervous system (benzodiazepines such as xanax, also barbiturates and alcohol) are the only drugs that will kill you outright on withdrawal.
Stimulant withdrawal (amphetamines, cocaine, caffeine, nicotine) causes headache, confusion, fatigue, and occasionally suicidal ideation. Opiate withdrawal (oxycodone, heroin, fentanyl), causes anxiety and flu-like symptoms that can be fatal if severe enough (dehydration, GI complications) but, only in the same way that a flu can, and do not kill you outright. (THC / marijuana withdrawal is the chillest, usually only causing mild irritability and appetite loss, which the others do to a much greater extent).
Benzo (and other GABA active withdrawals) causes a rebound of your nervous system’s stress and fight or flight system that cascades from:
- extreme anxiety and most of the same flu-like symptoms as opiates then into
- vivid hallucinations (often of being covered in insects including tactile sensation) and paranoid delusions, then finally into
- back-to-back seizures that eventually result in nervous system failure, hypoxia, and death.
The old-school word for this is “the delirium tremens” or “DTs.”
If you are using these substances at a high enough and especially an unsustainable dose (which can cause respiratory depression / hypoxia and weakness of gait / traumatic head injury, similarly to an opiate overdose) you will need to be withdrawn in a either a specialized rehab with medical capabilities or if the addiction is severe enough a hospital or even specifically an intensive care unit. It’s possible that if you’re a binge drinker (drink large quantities but don’t drink at all some days) you may not need special withdrawal precautions. That said, addicts often minimize the extent of their addiction early in the recovery process so a lot of facilities that are unequipped to manage this type of withdrawal will refuse those patients outright until they’ve been medically evaluated. I’ve actually had a few patients were the ED was like “oh yeah he’s a lil jittery but not actively withdrawing” and a few hours into being on the unit they can barely bring a cup of water to their mouth without spilling it.
Obviously the history of legislative bans on alcohol is a great example of why criminalizing substance use is pretty much always a losing battle but it’s also WILD that alcohol is legal when specifically compared to marijuana being illegal.
This has been a PSA.
too long; abused xanax
How long till withdrawal will kill you generally?
no good answer due to normal variations in physiology and variations in the specific person’s quality and severity of addiction but in terms of timescale I would say a day-ish? Would be better to ask an ICU RN or MD. At my level and specialty of care (acute psychiatry) and assuming the pt has been screened appropriately by the ED to not already be in high acuity withdrawal (needs medical or ICU) we’re generally not talking minutes to a couple hours but we’re also not talking a week. The scale we use to measure is called the Clinical Institute Withdrawal Assessment.
Depending on the half-life of the medication used for the taper I’m reassessing that score either every 4 hours (ativan) or every 8 (phenobarb). My unit usually does phenobarb because it requires less frequent and precise assessment due to the elongated half-life. And I can always reassess ahead of schedule and give 1 extra dose as a standing PRN order without even needing to call the on-call MD if they’re having breakthrough symptoms.
Also keep in mind that it’s not just mortality we’re worried about. I can’t make withdrawal fun but I definitely don’t want it to suck any more than it has to. There’s also a lot of permanent but nonfatal damage that can happen in the meantime. And it’s actually also an issue of my safety and that of my coworkers. My subspecialty is actually specifically the management of violence and drug withdrawal is an item on MOST violence risk assessment scales. Actually the only one I don’t see it on irrc is the BROSET and that’s just because it’s a rapid 6-12h tool and the CIWA is already addressing that under the agitation and paranoia items at that time interval.
The paranoid delusions and audiovisual AND tactile hallucinations are no joke. One of the COMMON reasons I get called to medical units for backup is CIWA patients because we can’t take them until they’re on the tail end of a high dose taper but the medicine nurses aren’t always equipped to address the psychiatric symptoms and there’s more equipment available to throw / swing at them.
The real curious thing is that these expected neurological rebound effects aren’t universally experienced. Some people are affected more strongly and in weird ways by withdrawal.
Being ADHD probably has something to do with it, but I can take my adderall (a relatively high dose btw) every day for months and then quit cold turkey and feel no noticeable withdrawal symptoms besides being hungrier and laughing at things more easily on the first few days after quitting lol
Now I’m wondering if there are neurodivergences for which GABA modulators cause different effects than expected and for which withdrawal symptoms might be negligible. Then again, GABA is like the major inhibitory neurotransmitter so maybe it’s not possible for the brain to function/develop well at all with any anomalies dealing with those receptors.
(This is not my field; I’m just curious.)
tbh I’m not on the research end I’m on the butt end with the people experiencing it directly (which is where I wanna be the most I wanna do is maybe teach someday) so I have empirical backup but most of my knowledge is experiential. I guess the best way I can describe it is that certain stuff just starts giving you anxiety. Nurse knowledge is like 2-3 years of following strict rules you learned in school then when you hit your stride something crystallizes in your brain and you can just look at certain patients through that lens and your nervous system just says “absofuckinglutely not, no.” So I can’t cite stats I can just tell you where the needle is on how anxious it makes me. Which is it’s own type of knowledge.
This is crazy. My friend went a while taking GABA tablets as a supplement. (He said it made him perceive life more vividly) It could have literally killed him
so I looked into this because your comment sparked some curiosity and from what I can tell it’s less about the chemical itself and more about how your brain regulates and uses it. There’s also limited evidence as to whether GABA as a dietary supplement is even crossing the blood-brain barrier (where it would cause these effects). The other thing you need to keep in mind with most “natural” supplements is that the FDA regulates them under the F, not the D! Things like melatonin (which I even take personally) are regulated as FOOD, not DRUGS. Drugs have to
- be exactly the chemical they say they are
- in exactly the amounts they say they are per. pill.
- and as over the counter medications have to have approved safe dosages and frequencies on the packaging
- and all pills prescription or not have to have a unique alphanumeric imprint on each pill that can be used to identify it if it is separated from its packaging. Even different doses need unique imprints.
Food needs to:
- mostly probably be the thing it says it is. If it’s a plant it might be a different strain between different manufacturers.
- that plant also might have a variety of other chemical structures in it that aren’t advertised on the bottle.
- say almost whatever the manufacturer slaps on it in terms of dosage or frequency.
- have no imprint whatsoever to identify it if it’s not in the original packaging.
Like I said I use several supplements myself that even have good evidence behind them in terms of safety and efficacy. But you need to be aware of the ways in which they’re regulated differently than drugs and know that you’re gonna have to do a little more research for yourself to really find what’s going to be safe and effective for you. Finding a physician who’s educated in holistic and integrative therapies can be super helpful for something like this.
