Withdrawal symptoms by substance: how long do they last?

Withdrawal symptoms peak for most substances within the first 24 to 72 hours and have largely faded after 7 to 10 days. For three substances the picture is different. With alcohol, GHB and benzodiazepines, stopping without medical supervision can be life-threatening (PMID 34288186, PMID 34073640).

That is the short answer. There is a second answer underneath it, and that is the one people get stuck on.

How you feel and what a laboratory measures run on two different clocks. We see that confusion come back through our customer service every week. Someone still feels rough after two weeks and concludes the substance must still be in there.

Usually it is not.

What exactly are withdrawal symptoms?

Withdrawal symptoms are the complaints that appear when your body has adapted to a substance and that substance falls away. Your nervous system has adjusted to the drug being present. Remove it, and that adjustment swings the other way. The word abstinence syndrome describes the same thing.

With substances that suppress your nervous system, such as alcohol, GHB and benzodiazepines, that system goes into overdrive when you stop. Tremor, sweating, palpitations, anxiety, and in the worst case a seizure or delirium (PMID 25427113).

With substances that drive your nervous system instead, such as cocaine and amphetamine, the opposite happens. There is no storm, there is an emptiness: exhaustion, low mood, heavy sleeping, and a strong pull toward the drug (PMID 10812287).

That distinction shapes almost everything below. One group is medically risky and the other is heavy but rarely dangerous.

How long do withdrawal symptoms last per substance?

The acute phase runs three to seven days for most substances, peaking in the first two days. Benzodiazepines are the exception, where it can run for weeks depending on the half-life of the drug. Below is how long complaints typically last per substance, and how long a urine test still sees the drug or its metabolite.

Read the table as two separate clocks running at once. The left half is about how you feel. The right half is about what a laboratory finds.

These figures are guide values, not a promise. Duration of use, quantity, liver function, age and the use of several substances at once all shift them. A hair test also looks back months instead of days, which changes the right-hand column completely.

Cannabis and MDMA are deliberately absent from this table. Zuivertest does not offer a test for either, and an overview implying otherwise would mislead you.

Why do you feel rough while your test comes back clean?

Because the substance leaves your blood long before your nervous system is back in balance. A urine test measures molecules. Withdrawal is an adaptation process in your brain, and that process pays no attention to a half-life. With cocaine the gap is widest.

Take two people who stop cocaine on the same day, after 6 months of weekend use. Both hand in urine at the same lab on day six. Both get a negative result, because benzoylecgonine has usually dropped below the cut-off after 2 to 4 days.

One of them feels reasonable on day six. The other sleeps a lot, feels low, and thinks about using all day.

That difference is not on the result. In a prospective study of outpatient cocaine users, mood and sleep complaints persisted for weeks after stopping, well past the point where urine showed anything at all (PMID 10812287). The result was identical for both.

With GHB the ratio actually inverts. GHB disappears from urine remarkably fast, often within 12 hours, while GHB withdrawal is the longest and most dangerous of the group (PMID 34073640). A clean GHB result therefore says almost nothing about your safety.

I think this is the most important point on this page. A negative test means the substance is gone. It does not mean you are through it.

Which withdrawal symptoms are dangerous?

With alcohol, GHB and benzodiazepines, withdrawal can be life-threatening. In all three the substance suppresses the nervous system, and sudden removal can trigger a seizure or delirium. With cocaine, amphetamine, ketamine and nicotine the picture is heavy but rarely acutely dangerous.

Delirium tremens is the most severe form with alcohol. It usually begins 48 to 96 hours after the last drink and brings confusion, hallucinations, fever and unstable blood pressure (PMID 25427113). Untreated, mortality is considerable; treated, it is low.

With GHB the timeline is shorter and steeper. In a Dutch observational study of patients in detoxification treatment, complications occurred despite supervision, and delirium and severe agitation were not rare (PMID 37864267). The substance is out of the body before withdrawal properly begins.

If you notice confusion, hallucinations, heavy tremor, fever or a seizure in yourself or someone else, that is a reason to seek medical help immediately. Call your GP, the out-of-hours service outside working hours, and 112 for a seizure.

What we do not do here is give a tapering schedule. That belongs with a doctor who knows your situation, not with a laboratory and not with a blog article.

Why can withdrawal be harder the next time round?

Because the nervous system remembers the previous attempts. With alcohol it has been described that repeated withdrawal episodes can raise the severity of symptoms next time, including a higher risk of seizures. That mechanism is called the kindling effect (PMID 27586815).

The idea behind it is that every withdrawal you go through leaves the nervous system slightly more excitable. Someone who has stopped and relapsed five times does not begin a sixth attempt at the same point as the first.

That is not a reason to avoid stopping. It is a reason to prepare the sixth attempt better than the first.

In practice it matters mostly for the question of who needs supervision. Someone with a long history of stopping and restarting is counted in the literature among the higher-risk group, even where earlier episodes were mild (PMID 34288186).

What this means for a laboratory is nothing at all. A test sees your current sample, not your history. If you do want that history recorded somewhere, a series of dated results does it better than one isolated test.

What is post-acute withdrawal?

After the acute phase, many people go through a longer period of milder complaints: shifting mood, poor sleep, low energy, irritability and craving. That phase is called post-acute withdrawal. It can run for weeks to months and moves in waves rather than a straight line.

That wave pattern causes most of the disappointment. You feel fine for three good days in a row, and day four is suddenly heavy. That does not mean something is going wrong.

In the cocaine study above, mood and sleep kept fluctuating for weeks in people who had stopped completely (PMID 10812287). A systematic review of treatment outcomes in cocaine use disorder found this same phase associated with relapse (PMID 38720357).

There is no test in this phase that tells you how far along you are. What a test can do is confirm that nothing new was added during those weeks.

What can a laboratory see and not see about withdrawal?

A laboratory sees exposure. Nothing more. It measures whether a substance or its metabolite is in your sample, at what concentration, and whether that concentration sits above the agreed cut-off. It does not measure addiction, withdrawal, quantity or moment of use.

With alcohol the picture is slightly richer, because markers exist that reflect a pattern over a longer period. CDT in blood and EtG in hair were developed to assess abstinence over weeks to months, and are used that way in forensic and clinical settings (PMID 29807559, PMID 20373230).

For drugs, that long-term equivalent does not exist in urine. It does exist in hair: a hair analysis looks back months instead of days, depending on hair length.

So if someone asks you to prove you have used nothing for three months, a urine test is the wrong instrument. It only looks back a few days.

If you want to record on paper which substances are and are not in your sample, you can build your own panel at Zuivertest and choose per substance. You need no doctor's referral, and only you see the result.

When should you involve a doctor?

With alcohol, GHB and benzodiazepines: before you stop, not afterwards. With daily use of any of those three, a GP is the first step, because they can assess the withdrawal risk and supervise it where needed. With the other substances, a doctor matters mainly if complaints persist or become severe.

Thuisarts.nl and the Farmacotherapeutisch Kompas describe per substance when supervision is needed. RIVM additionally publishes monitoring and risk assessments of substances circulating in the Netherlands, including new psychoactive substances.

One thing you can do today if you are stopping: write down the date of your last use. Without that date, every result and every timeline afterwards is guesswork.

My own conclusion, after laying these eight substances side by side, is that the table above mostly teaches what a test is not for. I would read it as a map of your first two weeks, not as a results form.

We go deeper per substance on what happens and what stays measurable. Read on about GHB addiction and why stopping alone is dangerous, about alcohol withdrawal, about ketamine addiction, about cocaine addiction, and about abstinence and how to prove it objectively.

How long each substance stays detectable is set out in our overview of how long drugs stay detectable. How your body breaks those substances down is covered in how your body breaks down drugs and alcohol.

Every blood test result at Zuivertest includes a professional assessment by a BIG-registered doctor. Discuss your results with your GP before making treatment decisions.

Sources

• Wood E, Albarqouni L, Tkachuk S et al., "Clinical management of the alcohol withdrawal syndrome", Addiction, 2022 (PMID 34288186)
• Schuckit MA, "Recognition and management of withdrawal delirium (delirium tremens)", New England Journal of Medicine, 2014 (PMID 25427113)
• Jesse S, Bråthen G, Ferrara M et al., "Alcohol withdrawal syndrome: mechanisms, manifestations, and management", Acta Neurologica Scandinavica, 2017 (PMID 27586815)
• Kamal RM, Dijkstra BAG, van Noorden MS et al., "Characterization of the GHB Withdrawal Syndrome", Journal of Clinical Medicine, 2021 (PMID 34073640)
• Dijkstra BAG, Beurmanjer H, Goudriaan AE et al., "GHB: a life-threatening drug, complications and outcome of GHB detoxification treatment, an observational clinical study", Addiction Science and Clinical Practice, 2023 (PMID 37864267)
• Coffey SF, Dansky BS, Carrigan MH, Brady KT, "Acute and protracted cocaine abstinence in an outpatient population: a prospective study of mood, sleep and withdrawal symptoms", Drug and Alcohol Dependence, 2000 (PMID 10812287)
• Rodrigues LSS, Fernandes JM, de Melo E et al., "Predictors of cocaine use disorder treatment outcomes: a systematic review", Systematic Reviews, 2024 (PMID 38720357)
• Andresen-Streichert H, Müller A, Glahn A et al., "Alcohol Biomarkers in Clinical and Forensic Contexts", Deutsches Ärzteblatt International, 2018 (PMID 29807559)
• Appenzeller BMR, Schuman M, Wennig R, "Abstinence monitoring of suspected drinking drivers: ethyl glucuronide in hair versus CDT", Traffic Injury Prevention, 2010 (PMID 20373230)
• Thuisarts.nl, information on stopping alcohol and drugs (thuisarts.nl)
• Farmacotherapeutisch Kompas, benzodiazepine and opioid monographs (farmacotherapeutischkompas.nl)
• RIVM, drug monitoring and risk assessment of psychoactive substances (rivm.nl)