Individuals in treatment for substance abuse usually do not feel better immediately. Many believe that just getting through the initial phases of heroin or painkiller withdrawal treatment is the most important component of recovery. Even though enduring the primary stages of heroin withdrawal or opioid withdrawal is the first step in the process of recovery, the reality is not all cases will follow the exact same timeline. Each case is unique and will follow its own timeline.
In some situations, symptoms associated with substance abuse detox can linger on for weeks, months, and sometimes years after the initial detox process. Patients can experience less-severe symptoms of acute withdrawal in addition to issues such as impaired cognitive functioning, prolonged mood and sleep disturbances, as well as persistent drug cravings. The following information on the timeline of opioid withdrawal gives a comprehensive summary regarding the reality of protracted withdrawal.
Acute Opioid/Heroin Withdrawal Timeline
For short-lasting opiates, symptoms of withdrawal begin to set in around 6-12 hours after the last dose. For long-acting opiates, symptoms usually emerge within 30 hours after the last dose. Symptoms of early withdrawal include agitation, anxiety, sweats, muscle pain, trouble sleeping, hypertension, fever, and increased heart rate.
At 72 hours after the last dose of opiates, symptoms will reach their peak level and usually persist for at least a week. Symptoms include depression, opioid cravings, diarrhea, nausea or and/or vomiting, and stomach cramps.
In some circumstances, psychological symptoms including drug cravings can go on for longer than a week and surpass the traditional timeline for acute withdrawal. Aftercare therapy and support from mental health professionals are important components of a complete treatment program and can reduce symptoms of post-acute withdrawal.
Chronic substance abuse causes major changes to an individual’s brain chemistry, which can have a lasting effect on one’s behavior and emotions even after detox. Known as protracted withdrawal, this state occurs when signs and symptoms appearing in acute withdrawal continue to persist well after being mitigated through a medically supervised detox process. Protracted and post-acute withdrawal can affect individuals in varying degrees for the first one to two years after recovery
Opioid Post-Acute/Protracted Withdrawal Symptoms
While research on specific protracted withdrawal symptoms associated with certain drugs are limited, the National Institute of Health discovered that heroin withdrawal symptoms including sleep problems, anxiety, and depression can last for several weeks in the aftermath of opioid detox. Other associated symptoms found were fatigue, dysphoria, and agitation.
Research done on the cognitive impact of post-acute/protracted withdrawal showed individuals who had not used opioids for an extended period demonstrated a reduced ability to concentrate on a task compared with individuals who never used opioids.
Individuals in recovery from heroin abuse also demonstrated problems in executive functioning lingering for months after the stages of acute withdrawal. Other symptoms of protracted withdrawal include constant fatigue, reduced libido, an inability to experience pleasure, and issues with short-term memory, executive brain functioning, decision-making, problem-solving, and impulse control.
Protracted and post-acute withdrawal can affect individuals in varying degrees for up to the first one to two years after recovery. Each case is different, and while some patients do not experience symptoms after the initial acute withdrawal stage, others have extended symptoms. Other individuals notice a drop in their withdrawal symptoms throughout the first and second month of sobriety but then notice symptoms developing again as time goes on. The severity of the symptoms can also vary, depending on the person.
Treatment Of Protracted And Post-Acute Withdrawal
Protracted and post-acute withdrawal symptoms can lead patients to regress back to using substances as a way to alleviate physical and mental discomfort, which increases the chances of relapse. Oftentimes, relapses occurring due to the impact of post-acute withdrawal symptoms can be attributed to the individual not understanding their symptoms or believing that these impairments will persist forever.
While these symptoms are extremely disconcerting, they will eventually decrease completely. Health care providers can assist individuals after the detox process has made them physically and medically stable and improve the patient’s ability to remain drug-free. Treatment programs like Bright Future Recovery, a heroin detox facility in California, strive to help their clients stay on the path of recovery by incorporating the following methods into their approach to addiction treatment and recovery:
It is important that patients understand it is normal not to feel completely recovered during the first weeks and months of sobriety. Educating clients about the symptoms of protracted withdrawal can help individuals generate practical views of the healing process. When they are reminded that recovery is a process, they will be better equipped to handle the hurdles they face along the way. Informing individuals about the symptoms of protracted withdrawal can help them be prepared to recognize potential signs. Education can also provide patients with the knowledge they need to understand that the symptoms will not go on forever and can be managed with appropriate support.
Individuals experiencing memory and concentration difficulties may feel especially discouraged with the onset of persistent withdrawal symptoms. The support of mental health professionals provides coping techniques to lessen feelings of discouragement if withdrawal symptoms should return. Consistent encouragement from professionals and peers is especially helpful at decreasing disheartening feelings prone to arise due to the impact of cognitive issues in recovery.
Monitoring For TBI
Research has indicated that the symptoms of protracted withdrawal are comparable to those of traumatic brain injury (TBI) and co-occurring disorders. Providers will carefully evaluate and re-evaluate individuals as the recovery process continues and take note of any signs of depression or related symptoms in order to determine if the patient is experiencing protracted withdrawal symptoms and requires additional support.
Evaluation Of Sleep Conditions
Treatment providers can help identify when an individual’s sleep issues are due to protracted withdrawal or are a result of other causes, such as poor sleep routines, stress or other conditions. Treatment also provides clients with education about the importance of maintaining good sleeping habits, such as establishing a routine of going to bed and waking up at the same time, participating in physical activity, and reducing caffeine.
Treatment facilities can assist individuals going through protractive withdrawal by prescribing medications as necessary in order to control prolonged symptoms. Medications can help lessen anxiety and assist with sleep problems. Providers can also educate their patients on the side-effects of all medications.