Withdrawal (“Lomka”): What Happens to the Body and Why You Need a Doctor

What Withdrawal Is and Why It Happens

In medicine, what people call “lomka” is known as abstinence syndrome, or withdrawal syndrome. It is one of the key signs of physical dependence in ICD-10 and DSM-5. With regular use of a psychoactive substance, the brain adapts to its constant presence: the number and sensitivity of receptors change, as does the production of the brain’s own neurotransmitters. The substance becomes part of a new balance, and the body functions “normally” only when it is present.

When the supply of the substance abruptly stops or drops, this new system is thrown off balance. Processes that the substance had been suppressing suddenly become active, while the body’s own regulatory mechanisms have not yet recovered. This produces symptoms that are essentially the opposite of the substance’s effects: if opioids relieve pain and calm, then withdrawal brings pain and agitation; if alcohol slows the brain down, withdrawal brings anxiety, shaking and a readiness for seizures.

What Withdrawal Looks Like With Different Substances

Withdrawal syndrome is not the same for all substances. Its severity, duration and danger depend on the type of substance, how long and how heavily it was used, the person’s age, other illnesses, and whether there have been severe withdrawal episodes before. Understanding the differences matters, because for some substances withdrawal is primarily agonizing, while for others it is potentially life-threatening.

Opioids

Opioid withdrawal begins a few hours after the last dose, depending on the substance. Symptoms include yawning, watery eyes, runny nose, sweating, “goosebumps,” dilated pupils, aching muscles and joints, abdominal pain, nausea, vomiting, diarrhea, insomnia, anxiety and overwhelming cravings. The acute phase usually lasts a few days, but weakness, sleep problems and cravings last longer.

Alcohol

Alcohol withdrawal shows up as shaking, sweating, a racing heart, high blood pressure, anxiety, insomnia and nausea. In severe cases, seizures and alcohol withdrawal delirium (delirium tremens) develop, with confusion, hallucinations and fever. Delirium is a life-threatening condition that requires treatment in a hospital.

Sleeping Pills and Sedatives

Abruptly stopping benzodiazepines and other sedatives causes anxiety, insomnia, shaking and heightened sensitivity to light and sound, and after long-term use of high amounts — seizures and psychosis. They should only be stopped gradually, following a schedule drawn up by a doctor.

Stimulants and Cannabis

Stimulant withdrawal is mainly psychological: low mood, apathy, sleepiness or insomnia, increased appetite, cravings and sometimes suicidal thoughts. Cannabis withdrawal involves irritability, anxiety, insomnia and vivid dreams. They are less dangerous physically but psychologically hard and often lead to relapse.

Why Withdrawal Without a Doctor Is Dangerous

Many people try to “tough out” withdrawal at home, seeing it as a matter of willpower. Sometimes this works, but the risks of this approach are high. During alcohol and sedative withdrawal, seizures and delirium can develop suddenly and are life-threatening without medical care. During opioid withdrawal, vomiting and diarrhea cause dehydration and electrolyte imbalance, which is dangerous for the heart, especially in people with chronic illnesses.

Another danger is relapse in the face of unbearable symptoms. After several days without the substance, tolerance drops, and if the person takes their usual dose, the risk of overdose, including fatal overdose, rises sharply. This period is considered one of the most dangerous for people with opioid addiction. In addition, low mood and hopelessness often worsen during withdrawal, and the risk of suicidal thoughts increases.

• Seizures and alcohol or sedative withdrawal delirium
• Dehydration and electrolyte imbalance due to vomiting and diarrhea
• Blood pressure spikes, arrhythmias, flare-ups of heart disease
• Overdose on relapse due to reduced tolerance
• Dangerous mixing of substances and medications in an attempt to feel better
• Severe low mood and suicidal thoughts

How Long Withdrawal Lasts

The acute phase of withdrawal usually lasts from a few days to one or two weeks, depending on the substance. With short-acting opioids, symptoms start sooner and are more intense; with long-acting substances, they start later but last longer. With alcohol, the peak comes in the first days, and delirium, if it develops, usually appears within a few days of stopping drinking. Sedative withdrawal can drag on for weeks.

After the acute phase, many people go through a period of so-called protracted or post-acute withdrawal: mood swings, anxiety, sleep problems, low energy and concentration, and waves of cravings. It can last for weeks or months and often leads to relapse. That’s why it’s important not to stop at detox, but to continue with addiction treatment, psychotherapy and support.

How Withdrawal Is Managed Under a Doctor’s Supervision

Medical detox begins with an examination: the doctor finds out which substances were used, for how long and in what amounts, when the last dose was taken, whether there are chronic illnesses, and whether there have been seizures or delirium in the past. Blood pressure, pulse, temperature, degree of dehydration and level of consciousness are assessed. Based on this, a decision is made on whether detox can be done at home or is safer in an inpatient unit.

Then treatment is given to ease symptoms and prevent complications: replacing fluids and electrolytes, correcting blood pressure and heart rhythm, relieving pain, nausea and insomnia, and protecting the nervous system. The doctor selects medication classes and dosing for each individual patient — taking anything on your own “on someone’s advice” is dangerous. Alongside this, work on motivation for further treatment begins from the very first days.

When Inpatient Care Is Needed

Inpatient care is recommended for withdrawal after long-term heavy use of alcohol or sedatives, if there have been seizures or delirium in the past, with a combination of several substances, with serious heart, liver or lung disease, during pregnancy, with suicidal thoughts, and also if there is no one at home who can stay with the person.

What Happens After Detox

Once the acute symptoms have been relieved, the doctor discusses the next steps with the patient: addiction treatment, medication to reduce cravings if indicated, psychotherapy, rehab and work with the family. It is these stages that determine whether sobriety can be maintained.

What Loved Ones Should Do If Someone Is in Withdrawal

It’s important for loved ones to understand that withdrawal syndrome is a medical condition, not “an act” or a punishment for using. Don’t give the person alcohol, sleeping pills or other substances to “ease” their condition: this can be dangerous. Provide a calm environment and access to water, don’t leave them alone for long, and keep an eye on their consciousness, breathing and temperature. Call a doctor if their condition gets worse or you’re not sure you can cope.

Remember that during withdrawal a person may be irritable and demanding, and may promise anything for relief. Stay calm, don’t get into arguments and don’t give them money. The best help is to persuade them to see a doctor and to support them in continuing treatment after detox. Take care of yourself too: a consultation for relatives with a psychologist or addiction doctor helps you get through this period.

How Narcology 24 Can Help

At Narcology 24, an addiction doctor can come to your home around the clock, assess the person’s condition and risks, and carry out detox for withdrawal from alcohol, opioids, sedatives and other substances. If treatment at home isn’t safe — when there is a threat of seizures or delirium, or serious illnesses — inpatient care is offered with round-the-clock monitoring of blood pressure, heart rhythm and fluid balance.

After stabilization, we help with the transition to the next stage: addiction treatment, psychotherapy, rehab and family support, plus care from a psychiatrist if there are co-occurring mood or sleep disorders or psychotic symptoms. Relatives can get advice on how to support the person during the first months. Seeking care is anonymous and voluntary, and the information is protected by medical confidentiality under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System.”

When to see a doctor

• You use a substance regularly and want to stop, but you’re afraid of withdrawal
• Without the substance, you get shaking, sweating, a racing heart, pain or insomnia
• You’ve had seizures, visions or confusion during withdrawal before
• You’ve been taking sleeping pills or sedatives for more than a few weeks
• You have chronic heart, liver or lung disease, diabetes, or are pregnant
• Previous attempts to go through withdrawal at home ended in relapse or a worsening condition
• During withdrawal, you’ve developed severe low mood or thoughts of death

Questions and answers

Medically reviewed by

Nurlan Isayev, MDAddiction psychiatrist · experience 10 years

Synthetic stimulant and cannabis addiction, addiction in teenagers, gambling addiction and online follow-up.