For those who’ve never experienced it, detoxing and drug withdrawal are rumored to be harrowing experiences, definitely not for the faint-hearted. What’s the truth? It feels like “every horrible symptom you can think of, for any illness,” said Justin Caba, a reporter at Medical Daily. A former heroin user, Caba had followed in the footsteps of many who struggle with addiction, working his way from alcohol to prescription pills, until eventually he found himself using the less expensive heroin.

Many Americans appear to be on a similar track. While just 0.3 million Americans (age 12 or older) used heroin during the past month, according to estimates from the National Institute on Drug Abuse (NIDA), another 6.5 million Americans (about 2.5 percent) had used, nonmedically, prescription drugs. Commonly abused prescription drugs include OxyContin, which offers those who use it a blissful 12 hours of pain relief. Probably for this reason, Oxy (as it is commonly called) has become the gateway drug to its fellow opioid, heroin.

And that was the case for Caba, who, after a successful detox, has been clean now for a year and a half. When asked what the high of heroin felt like, Caba says that part is difficult to remember. “Being away from it has been all about not remembering what it felt like,” he said. Withdrawal, though, is another story, one he vividly remembers.

Symptoms of Detox

“The restlessness, you can’t just sleep through it, the worst is you just can’t get comfortable and sleep through it,” he said. And that’s what makes it so hard.

“Early on people will start out with yawning, watery eyes, runny nose, a bad body ache, kind of like having a really bad flu,” said Dr. Stuart Kloda, a New York-based medical doctor who provides private treatment for drug and alcohol addictions. “You can also have diarrhea, nausea, and vomiting. Commonly it’s believed that withdrawal is not life-threatening, but that’s not true in all cases.”

For people who have really severe diarrhea, Kloda says, withdrawal can become life-threatening. For people with pre-existing heart disease, the stress of withdrawal could lead to a heart attack. Others can begin to vomit forcefully and might end up tearing their esophagus and so endanger their lives. Generally, the more severe the physical dependence, the worst the withdrawal symptoms will be, Kloda notes.

In Caba’s words, the “first three days are hell and then it starts to alleviate.” He found the physical symptoms ended after about a week, while “the psychological symptoms took months… about two to three months,” he said. “They call it post-acute withdrawal symptoms.”

Psychological Fallout

For the first year, he says, a former user will suffer from drug dreams, where you wake up thinking you did the drug. (He gestures in such a way to suggest heart pounding fear.) In his first month, Caba had a drug dream every night, during the past two months, he had, maybe, one dream, he says.

“It comes back once in a while. I’ve heard people who have been off of it for 25 years once in a while will have a dream or the need,” Caba said. The psychological fallout also includes a distressing game of emotional catch-up. “In my case, it was like 10 years of suppressing feelings and emotions through drugs and alcohol,” Caba said. “It’s basically like all that comes back.”

Seemingly, many people will someday face the challenge of detoxing. Illegal drug use, which is highest among late teens and people in their 20s, continues to rise in the United States, according to NIDA. During 2013, the most recent survey year, 9.4 percent of the population (about 24.6 million Americans) used an illicit drug over the past month, estimates NIDA. This compares to 8.3 percent in 2002, with the increase reflecting higher rates of marijuana use.

Asked if withdrawal from marijuana has any symptoms, Frank Spera, a psychotherapist and licensed drug and alcohol counselor who practices at Summit Behavioral Health, says people don’t get the shakes or anything, but there’s an emotional withdrawal.

Because they’ve been escaping by using a drug, says Spera, they have to face reality and their emotions again once they stop smoking pot. With methamphetamines, Spera says, withdrawal usually takes three to five days and he’s seen, firstand, people have seizures. While NIDA describes the symptoms of meth withdrawal as including depression, anxiety, fatigue, and an intense craving for the drug, he focuses instead on the emotional side of withdrawal.

It's All About Pain

People drink or take drugs, Spera explains, to lessen pain. So when they stop it becomes “a question of working on the issues or problems in their life, in order for them to think in a way where they don’t need a drug or drink to mask that pain,” he said. “A lot of time what people think is not a big deal is part and parcel of what’s going on. It’s the theory of death by a thousand cuts… one cut is not a big deal, two cuts not a big deal, but they accumulate.”

While emotional therapy has earned its hard-won place in most detox regimens, there’s ongoing, heated debate within the addiction community about suboxone and other medical detox treatments. Caba is against methadone treatment but believes other treatments are not bad for someone wanting to detox. Kloda believes going cold turkey (the classic non-medical detox) is simply unnecessary in this day and age.

"You’re just so sick and there’s absolutely no reason for it," Kloda said.

Spera says "whatever works" since the percentages for first-timers staying off the drugs after a withdrawal are very low. However, he believes if people truly want to stop and are willing to work on their issues, the relapses will be shorter and fewer.

"What works for someone the first time may not work for someone else until the tenth time," Spera said. "We all trip at times. That doesn’t mean we cannot walk. It’s how many times you get up — that’s the important piece."