Withdrawal Symptoms by Substance: When Is It Dangerous to Stop at Home?

In short

• Alcohol and benzodiazepine withdrawal can be fatal without medical care.Untreated delirium tremens has a death rate of up to 20%, falling to about 1% once it is caught early, and for alcohol withdrawal NICE guidance recommends hospital admission whenever seizures or delirium tremens are a risk.
• GHB withdrawal deserves the same caution.Stopping it abruptly without treatment has been found to cause delirium in over 50% of cases, while a slow, supervised reduction kept it rare.
• Renewed Life Center runs detox with 24-hour nursing supervision.It starts with a risk assessment before withdrawal begins, and medication is used only when clinically indicated and prescribed by a medical professional. Our medical detox in Cape Town page has more detail.

Not sure how risky your situation is? Book a free, confidential call with our team. We reply the same day.

Somebody has decided to stop drinking, come off a prescription, or quit cocaine, and the question that follows is simple: what actually happens next. The substance matters. So does the amount, how long it has been used, and what else is happening in the body. This page goes through each one.

If you are worried about someone’s safety but nothing is happening right now, get help today. Call the Department of Social Development’s Substance Abuse Helpline on 0800 12 13 14, or send an SMS to 32312.

Why can’t someone just stop, and what is actually happening in the body?

Withdrawal happens because the nervous system has adjusted to a substance being there and now has to readjust without it. Research from the National Institute on Drug Abuse (NIDA) on cocaine shows how this works: repeated use makes the brain’s reward pathway less responsive to ordinary pleasures, while the circuits involved in stress grow more sensitive. Other substances act on different systems, but the pattern of the body adjusting, then having to readjust, is the same. That is a physical process, not a failure of willpower.

The substance itself is rarely the whole story. For many people it was doing a job long before it became a problem: quieting anxiety, dulling a difficult memory, or making an unbearable stretch of life survivable. Stopping removes the substance but not whatever it was managing, which is one reason withdrawal can feel harder than the using did. Our page on why dual diagnosis treatment matters goes into what usually sits underneath.

“Stopping removes the substance but not whatever it was managing.”

Why are alcohol and benzodiazepine withdrawal the most dangerous?

Alcohol and benzodiazepine withdrawal can cause seizures and delirium tremens, and both can be fatal without treatment. For alcohol, NICE guideline CG100 advises admission to hospital for medically assisted withdrawal for anyone already in, or assessed to be at high risk of, withdrawal seizures or delirium tremens. That guidance exists because, unlike most substances on this page, alcohol withdrawal can kill on its own.

Delirium tremens, the most severe stage of alcohol withdrawal, typically begins 48 to 72 hours after the last drink and lasts 1 to 8 days, according to a review of the condition. It is treated in hospital, not at home.

Untreated delirium tremensup to 20%

Caught early and treatedabout 1%

A South African study from Stikland Hospital, published in the South African Journal of Psychiatry, describes alcohol withdrawal as a potentially life-threatening condition, precisely because of that risk of seizures and delirium tremens. Benzodiazepines carry a related danger for a similar reason, and the two are sometimes used together, which raises the risk further. Our alcohol addiction treatment in Cape Town page covers how residential care handles this stage and what comes after it.

Benzodiazepine withdrawal follows its own timeline, and it depends on the drug. According to World Health Organization guidelines, withdrawal from short-acting benzodiazepines typically begins 1 to 2 days after the last dose and can continue for 2 to 4 weeks or longer, while withdrawal from long-acting benzodiazepines begins later, at 2 to 7 days, and can run for 2 to 8 weeks or longer. The same guidelines describe a gradual, decreasing dose, planned and supervised by a doctor, as the safest way to come off benzodiazepines, because it helps prevent the seizures a sudden stop can cause. Nobody should work out that reduction on their own.

Is GHB withdrawal dangerous too?

Yes. GHB withdrawal can turn severe fast: research into the condition found that stopping abruptly, without treatment, led to delirium in over 50% of cases. As with alcohol and benzodiazepines, this is not one to manage alone.

What happens when someone stops opioid painkillers or codeine?

Opioid withdrawal, including from codeine, is intensely unpleasant but rarely life-threatening on its own in an otherwise healthy adult, which sets it apart from alcohol, benzodiazepines and GHB. The timing depends on the drug: World Health Organization guidelines put the onset of withdrawal from shorter-acting opioids such as heroin at 8 to 24 hours after the last dose, lasting 4 to 10 days, while withdrawal from methadone and other longer-acting opioids begins later, at 12 to 48 hours, and can run for 10 to 20 days.

Codeine is an opioid, and the same general pattern applies to it. The real danger with opioid withdrawal is usually not the withdrawal itself but what follows it: tolerance drops during the time off the drug, and going back to a dose the body can no longer handle is what makes relapse risky. A supervised, gradual taper is the safer route wherever it is available, rather than stopping outright.

What happens when someone stops cocaine or other stimulants?

Stopping cocaine or another stimulant brings on a crash: exhaustion, a flat or irritable mood, and a pull back toward the drug that can feel stronger than the withdrawal itself. According to NIDA, repeated cocaine use blunts the brain’s response to ordinary rewards while making its stress circuits more reactive, which is why the low mood after stopping can be severe rather than merely uncomfortable.

That low mood deserves to be taken seriously. If someone talks about ending their life, treat it as an emergency, not something to wait out. The numbers to call in South Africa are further down this page.

“Treat it as an emergency, not something to wait out.”

Is cannabis withdrawal dangerous?

Cannabis withdrawal is not medically dangerous in the way alcohol, benzodiazepine or GHB withdrawal can be, but it is real and common. A meta-analysis in JAMA Network Open, pooling data from over twenty thousand people who used cannabis regularly, found that 47% experienced a withdrawal syndrome. It will not send anyone to hospital on its own, but irritability, sleep trouble and a drop in mood are common enough that most people are better off expecting them.

What are the warning signs that mean you need medical detox, not a home detox?

Certain signs mean home withdrawal is not safe, whatever the substance: seizures or a history of them, confusion or hallucinations, a high fever, vomiting that will not stop, mixing more than one sedating substance, and any talk of suicide. Any one of these on its own is a reason to get medical help straight away.

Who do you call in South Africa in a withdrawal emergency?

For a seizure, chest pain, breathing trouble or loss of consciousness during withdrawal, call an ambulance on 10177, or 112 from any mobile network.

For crisis support, including suicidal thoughts, call the Department of Social Development’s Substance Abuse Helpline on 0800 12 13 14, or send an SMS to 32312.

Save both numbers before withdrawal starts, not while it is happening. A family member or friend who already has them loses less time when it counts.

What does medically supervised detox involve, and how does Renewed Life Center run it?

Medically supervised detox starts with a risk assessment before withdrawal begins, then ongoing monitoring and timely clinical support while symptoms are managed and sleep and routine are stabilised. At Renewed Life Center, that runs with 24-hour nursing supervision, and medication is used only when clinically indicated and prescribed by a medical professional.

Getting to that point starts with one phone call. The first conversation is 20 to 40 minutes by WhatsApp, video or phone, free and confidential, with no obligation to proceed, and we reply the same day. From there, admission can be immediate and typically happens within three days of first contact, with a clinical assessment within three days. Our medical detox in Cape Town page has more detail on how the stage is run.

Book a free, confidential call: 20 to 40 minutes by WhatsApp, video or phone, with no obligation. We reply the same day.

What else do people ask about withdrawal?

This article is general information, not medical advice.

Sources

1. SADAG: Department of Social Development Substance Abuse Helpline, 0800 12 13 14 / SMS 32312
2. National Institute on Drug Abuse (NIDA): cocaine research topic
3. NICE guideline CG100: alcohol-use disorders, diagnosis and clinical management of alcohol-related physical complications (NCBI Bookshelf)
4. Review of delirium tremens, PubMed Central
5. Stikland Hospital study on alcohol withdrawal, South African Journal of Psychiatry (SciELO SA)
6. World Health Organization: Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings (NCBI Bookshelf)
7. Study of GHB withdrawal characteristics, PubMed Central
8. Meta-analysis of cannabis withdrawal syndrome, JAMA Network Open, via PubMed Central
9. Western Cape Government: know who you can call in an emergency (ambulance 10177, cell 112)