- Codeine Withdrawal Symptoms
- Withdrawal Timeline
- Is Codeine Withdrawal Dangerous?
- Codeine Treatment Programs
- Therapeutic Modalities
- Lifestyle Adjustments
- Key Sources
- Medical Disclaimer
Codeine is an opioid-based medication that is used to treat pain and relieve diarrhea and coughs. While codeine is primarily prescribed for medicinal purposes, it is also widely abused and taken as a recreational drug.
While it may appear safe to take codeine due to its widespread availability, it is still a highly addictive substance. This is especially the case if an individual takes codeine in high doses and for long periods. The combination of the body’s tolerance and the unpleasant withdrawal symptoms that arise if codeine is discontinued make it a difficult drug to stop taking.
Fortunately, there are abundant treatment options for codeine addiction. In this article, we cover what symptoms can arise during codeine withdrawal and provide an approximate timeline for recovery. We also address the range of treatment options available and how to seek help.
Treating a codeine addiction often requires multiple stages of rehab that address a person’s physical, psychological, and emotional health. The first stage in this process is usually to detox from the drug before moving on to other stages of therapy. This requires a person to stop taking codeine, which is best done through medically supervised detox, especially as opioids can be difficult to withdraw from.
During the detox process, individuals will experience withdrawal symptoms which can vary between each person. This is also dependent on several factors, such as:
- Levels of tolerance
- Individual physiology
- How long the person used the drug
- Dosages and frequency of use
- Whether they engage in “poly-drug use” (using multiple drugs at once)
- If a person has co-occurring conditions or mental health issues
Codeine Withdrawal Symptoms
- Runny nose
- Watery eyes
- Stomach cramps
- Loss of appetite
- Weight loss
- Muscle pains
- Irritability and mood swings
- Problems sleeping
- Body aches
- Watery eyes
- Runny nose
Individuals who have abused codeine will usually have built up a tolerance to the drug, and this can worsen the withdrawal symptoms if they’re taking high doses. While there is no exact timeline for codeine withdrawal, it usually consists of the following pattern:
First Phase (Days 1-4)
The physical symptoms of codeine withdrawal usually peak within the first four days. During this period, individuals experience symptoms such as:
- Muscle pain
- Restless legs
Second Phase (Days 5-7)
While most physical symptoms begin to fade during this period, psychological symptoms such as depression and anxiety begin to emerge. Other effects that can occur during this phase are dehydration due to diarrhea and lack of fluid intake during the first few days of withdrawal.
Third Phase (Weeks 8-30)
By this point, nearly all codeine withdrawal symptoms should have ceased. However, other psychological symptoms, like depression and cravings, can persist for weeks or months.
Post-Acute Withdrawal Syndrome (PAWS)
Withdrawal symptoms that last for longer than a month are referred to as post-acute withdrawal syndrome (PAWS). The onset and duration of the PAWS period can vary depending on the type of drug; however, with codeine, the behavioral symptoms and cravings can last for months or even years (although this is rare).
The symptoms of post-acute withdrawal symptoms for codeine can last for weeks or months, and may include:
- Difficulty sleeping (falling asleep, staying asleep, waking up)
- Poor short-term memory
- Persistent fatigue
- Difficulty concentrating and making decisions
- Drug cravings
- Anhedonia (an inability to find joy in events, things, or people)
- Reduced interest in sex
Is Codeine Withdrawal Dangerous?
Opioid withdrawal is a difficult process that is best done under medical supervision. Complications can arise and become dangerous, depending on a person’s health and their level of addiction. Some of the risks that can occur during withdrawal include:
Electrolyte imbalance and dehydration can occur following vomiting and diarrhea during codeine withdrawal.
Withdrawal from codeine can cause high blood pressure and increased heart rate, which can aggravate an underlying heart condition.
Individuals withdrawing from codeine can experience fever, shivering, headaches, and delirium (if the fever is severe).
Anxiety can be a common side effect of drug withdrawal. If a person has an underlying anxiety condition, this can be worsened during detox.
As opioids like codeine are analgesic pain relievers, people going through withdrawal can develop an increased sensitivity to pain and a reduced pain threshold.
Risk of overdose
The withdrawal period is a dangerous time, as people can relapse due to the discomfort of detoxing. Withdrawal also lowers a person’s tolerance, so relapsing can result in fatal overdoses.
Alongside these complications, there are other health complications associated with long-term codeine abuse. However, these will depend on factors such as the duration and intensity of use.
Codeine Treatment Programs
While codeine can be a difficult drug to withdraw from, there are ample treatment programs available. Many centers provide individualized recovery programs so that your treatment is tailored to your individual needs. Below is a list of the most common types of substance abuse treatment programs and descriptions of what they entail.
While it can be tempting to stop codeine use on your own, going cold turkey is not recommended. Because of the uncomfortable and severe symptoms that can accompany opioid withdrawal, it is recommended that you do this under medical supervision where you can be kept safe and comfortable. Stopping on your own can result in complications and dangerous side effects that need monitoring.
Detox programs are designed to medically supervise a person’s withdrawal from substances. As withdrawal from drugs like opioids can be dangerous, a detox center allows a person to gradually wean off substances in comfortable surroundings. Available at certain clinics, rehab centers, and medical facilities, detox programs are usually led by medical staff who have experience with addiction and drug withdrawal. The benefit of a detox center is that assistance is always on hand, and they can often provide medications or other care to ease symptoms and make withdrawal as easy as possible.
Short-Term Inpatient (Residential)
Inpatient treatment can either be short or long term, depending on your needs. Short-term inpatient centers typically consist of medical detox, followed by an addiction treatment program involving therapy or counseling. Lasting for around 30 to 90 days, short-term inpatient programs often provide 24-hour medical support and include a team of doctors, counselors, clinicians, and therapists. Ranging from basic amenities to luxury options, short-inpatient rehab is suited to individuals who require detox and therapy but don’t require long-term treatment.
Long-term inpatient treatment is like short-term rehab, but the length typically ranges between 3 to 18 months. This type of program is best suited to clients with severe addictions or co-occurring mental health issues who need extended support. Long-term inpatient programs can also be more effective as they provide an opportunity for a person to not only detox from substances, but to also spend time getting to the root causes of their addiction. Like short-term programs, long-term inpatient rehab can vary in terms of basic or luxury amenities. Treatment typically consists of individual psychotherapy, group therapy, wellness programs (e.g., health and fitness), family programming, nutrition, and more.
Partial Hospitalization Programs (PHP)
Partial hospitalization programs (PHP) are often a step down from inpatient treatment, as they provide similar intensive therapies while allowing a client to live at home. PHP programs are also referred to as “day treatment” and typically involve 4 to 8 hours of treatment per day for 5 to 7 days a week. Like inpatient treatment, medical staff are usually on hand to assist with detox, medication management, and withdrawal symptoms. PHP programs also include in-depth therapy programs, such as individual and group counseling, and sessions that focus on key issues such as anger management, relapse prevention, coping skills, employment assistance, and more.
Intensive Outpatient Programs (IOP)
Intensive outpatient programs (IOP) are ideal for individuals who must fit therapy around other activities, such as work and family. IOP is also ideal for patients who have just completed inpatient treatment and require ongoing therapy. While PHP is usually intended to be shorter term, IOP can often go on for a longer period, requiring 2 to 4 hours of treatment per day for 2 to 5 days a week. IOP programs can vary, but they are usually a mixture of individual and group counseling, 12-Step programs, psychotherapies like cognitive-behavioral therapy, holistic therapies, and educational sessions about addiction, preventing relapses, and building new skills.
Standard Outpatient Programs
The most basic rehab programs are standard outpatient. These programs involve less time commitment and are often viewed as a stepping stone towards independent, sober living. Standard outpatient programs typically involve treatment 1 or 2 days per week and are ideal for clients who are juggling other responsibilities like family, school, or work. Standard outpatient programs typically include counseling, support groups like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), and the 12-Step system, as well as practical sessions that deal with autonomy, goal setting, and skill-building.
During rehab, centers and clinics provide a range of treatments such as medications, counseling, and behavioral therapies. Below are some of the more effective therapy options for codeine addiction.
Rehab facilities that offer dual diagnosis are often staffed with psychiatrists or clinical therapists that can diagnose and/or treat co-occurring mental health conditions. This kind of treatment is especially useful for people who have underlying issues such as depression, anxiety, and post-traumatic stress disorder (PTSD). This allows clinicians to address these conditions alongside withdrawal from the codeine itself.
Cognitive-Behavioral Therapy (CBT)
Cognitive-behavioral therapy (CBT) is one of the most effective therapies for substance abuse and concurrent mental health conditions. CBT helps individuals change negative cycles of thought and behavior into more positive ones. Proven to be effective for addiction and mental health conditions, CBT also helps clients learn how to recognize “automatic thoughts” and dysfunctional thinking patterns, as well as how to understand the behavior of others, and how to develop a greater sense of self-understanding and confidence. CBT also helps clients find solutions to triggers that might encourage drug use.
Dialectical-Behavior Therapy (DBT)
Dialectical-behavior therapy (DBT) is a type of cognitive-behavioral therapy that focuses on mindfulness, how to live in the moment, cope with stress, and improve relationships. DBT also helps clients identify negative influences in their lives and learn how to develop healthy coping skills. This kind of therapy is useful for people who have other mental health conditions, like anxiety or mood disorders. DBT is also effective for PTSD and for people who exhibit self-destructive behaviors.
The Matrix Model
The Matrix Model is another form of therapy that has shown to be effective in treating substance abuse. This 16-week approach is comprehensive and consists of a mixture of behavioral therapy, individual counseling, 12-Step support, family education, drug testing, and encouraging non-drug-related activities. Through guided therapy, patients learn about issues connected to addiction and relapse. These sessions are designed to promote self-esteem and self-worth while the patient and therapist work together to reinforce positive behavioral changes.
Contingency management is another effective treatment for addiction, and is based on a reward system. In most cases, the therapist provides incentives to the patient in exchange for ongoing abstinence and acceptance of treatment. One well-known contingency approach is Motivational Incentives for Enhancing Drug Abuse Recovery (MIEDAR), which is effective for teaching individuals that it is possible to achieve abstinence using self-control. Participants who continue to abstain receive rewards, such as prize draws for money or in-demand objects.
Medications & Supplements
Medication-assisted treatment (MAT) has become widely available for opioid addiction. These drugs often help a person manage withdrawal symptoms and minimize cravings. Below are some of the most common MAT therapy drugs for opioids like codeine:
Naltrexone stops opioids from acting on the brain and makes opioids less pleasurable, sometimes blocking their euphoric effects altogether. However, while naltrexone is an effective medication for preventing relapses or misuse, it may not stop drug cravings that are due to addiction.
Methadone is often used to help people wean off heroin and is a useful drug for preventing withdrawal symptoms and cravings. Methadone is a safer opioid alternative that allows your body to return to normal and ease the codeine withdrawal process.
Buprenorphine is widely used in medication-assisted treatments for opioid addiction. This medication produces weak opioid-like effects and is a safe way to wean off stronger opioids, like codeine. When combined with naltrexone, it is known as Suboxone, and it is an effective treatment for individuals addicted to other opioids like heroin, morphine, and codeine.
Sometimes doctors will prescribe other medications, such as anti-inflammatory drugs, to help with muscle or joint pain during codeine withdrawal. They may also provide anti-diarrheal medicines and anti-nauseants to help with stomach issues and vomiting.
Alternative or Holistic Therapies
Many rehab centers also provide holistic therapies. The purpose of these therapies is to treat the whole person and not just the symptoms. These can be incredibly beneficial for providing calmness, spiritual support, emotional expression, improving physical health, and teaching valuable skills. Some of the popular holistic therapies include:
- Nutritional therapy
- Animal-assisted therapy (e.g., emotional support dogs)
- Massage therapy
- Adventure therapy (e.g., hiking or rock climbing)
- Mindfulness and meditation
- Art therapy and music therapy
- Equine-assisted (horse) therapy
Recovering from codeine addiction can be challenging, but there are ways to make this process easier. Along with treatment, lifestyle adjustments and self-care can ease the symptoms while transitioning to a new life.
This can stimulate endorphins, which can help with anxiety, depression, and low mood. Examples include low- and high-intensity exercises such as walking, running, swimming, cycling, or yoga.
This can help calm anxious thoughts and reduce impulsive behavior, which is useful when recovering from addiction.
The right diet can help repair damage incurred following sustained drug use and lead to improved immunity, cognitive function, and energy.
Learning to avoid triggers like certain people, situations, or circumstances can help prevent a desire to take drugs.
While cravings can be difficult to manage, hobbies such as sports, art, music, or crafts can be useful distractions.
If you or a loved one are struggling with codeine abuse or addiction, you are not alone. Treatment and support are readily available. Contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment.
You can also find a list of treatment centers near you on our website to help get you on the path to recovery.
Case-Lo, C. (2018). Codeine Withdrawal: What It Is and How to Cope. Healthline. https://www.healthline.com/health/codeine-withdrawal.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2006). TIP 45: Detoxification and Substance Abuse Treatment. https://store.samhsa.gov/product/TIP-45-Detoxification-and-Substance-Abuse-Treatment/SMA15-4131.
Villines, Z. (2019). What to know about codeine withdrawal. Medical News Today. https://www.medicalnewstoday.com/articles/326849.
At RehabAid.com, we are dedicated to helping people recover from problematic substance use and associated mental health disorders. If you or a loved one are struggling with addiction to drugs or alcohol, you are not alone. Information on treatment and support options is readily available through the National Helpline of the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357. To further assist you along the path to recovery, the treatment center locator on our website allows you to easily find rehabilitation programs and services in your local area.
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