Dextromethorphan (DXM) Withdrawal: Symptoms, Timeline, and Treatment
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Dextromethorphan (DXM) is a dissociative anesthetic and a widely used synthetic compound in over-the-counter cough and cold medications. DXM has a long-standing record of effectiveness and safety in alleviating coughs when taken in therapeutic amounts and at a recommended dosage. When used correctly, DXM offers short-term relief from sinus congestion, coughing, a runny nose, nasal and throat itchiness, and watery eyes.
However, in large quantities, dextromethorphan may produce strong psychedelic effects and is often abused for recreational purposes. These effects are frequently likened to those produced by substances such as PCP or ketamine [1]. Misusing dextromethorphan along with other substances or alcohol can lead to severe side effects, health issues, or even death.
Dextromethorphan is available in tablets, gel caps, and liquid form. Traditionally, the inappropriate use of DXM was associated with its liquid form, but nowadays, individuals may misuse all three forms for recreational reasons. While not everyone who misuses DXM will develop an addiction, regular misuse can lead to addiction and may result in dependence and withdrawal symptoms.
The recommended dosage of DXM is 10 to 20 mg every four to six hours or 30 mg every six to eight hours. The quantity required for achieving the ‘high’ varies between 250 and 1500 mg. These large amounts of DXM produce psychoactive effects, causing euphoria and dysphoria, visual and auditory hallucinations, impaired motor skills, dissociative sedation, nausea, and vomiting [2].
During these robotripping experiences, individuals may also have the following symptoms:
Dependence or addiction to DXM eventually results in withdrawal. When an individual takes significant amounts of DXM over an extended period, their brain and body adapt to the substance, becoming dependent on it for everyday functioning.
Consequently, when these individuals cease its use or lower the dosage, they undergo a range of distressing physical and psychological symptoms referred to as Dextromethorphan withdrawal. These symptoms occur because the brain and body have difficulty readjusting to normal functioning without DXM.
The symptoms of dextromethorphan withdrawal can vary substantially in intensity and duration depending on gender, genetics, weight, body chemistry, severity of addiction, and presence of co-occurring mental health or substance use disorders.
Common physical symptoms of DXM withdrawal include:
Common psychological symptoms of DXM withdrawal include:
Like withdrawal symptoms, the duration of DXM withdrawal is also different for every individual. Certain crucial factors that govern the length of DXM withdrawal include overall physical and mental health, the dosage and frequency of use, and additional substance abuse.
Here is a general overview of the DXM withdrawal timeline:
Typically, signs and symptoms of DXM withdrawal initially manifest within 24 to 48 hours. However, these symptoms are fewer in quantity and not very intense.
In the initial week of DXM withdrawal, new symptoms might arise while existing symptoms typically intensify in severity. This phase marks the onset of what is referred to as ‘acute’ withdrawal.
In the second week of DXM withdrawal, symptoms usually decrease in intensity, and most will completely fade away by the end of the week. This is the final stage of acute withdrawal.
In some cases, certain symptoms of DXM withdrawal, particularly psychological ones, might last for as long as two years. These are referred to as ‘post-acute’ withdrawal symptoms.
Managing dextromethorphan withdrawal symptoms independently without professional medical help can be challenging, and the resulting discomfort can significantly hinder the ability to quit. Personalized medical detox programs can simplify the management of DXM detox and withdrawal, as well as enhance the chances of maintaining long-term sobriety [3].
Moreover, medical detox offers continuous oversight and pharmaceutical support to alleviate the intensity of withdrawal symptoms. Therapeutic interventions are also offered to assist in tackling the psychological effects of withdrawal and prepare for admission into rehab. A drug rehab program is an extremely effective method to tackle the factors leading to addictive behavior. It can also offer essential life skills, education, and behavioral therapy to control addictive tendencies and facilitate a sober lifestyle.
To maximize the chances of navigating through DXM withdrawal and preventing relapse, remember these tips:
Withdrawal symptoms from DXM are typically the most intense and toughest to endure when an individual abruptly quits “cold turkey,” meaning they cease taking DXM suddenly and without undergoing detoxification.
Stopping abruptly results in a much more distressing experience for the individual and greatly heightens their chances of returning to the habit. Hence, the most advisable approach is to gradually taper your usage, preferably with the assistance of healthcare professionals.
As highlighted above, medically supervised detox provides continuous individualized monitoring and assistance from healthcare professionals. Possible medical interventions for DXM withdrawal may include:
Therapy and counseling are also routinely used for DXM withdrawal management. The following are among the most effective and common therapies:
Here are certain useful self-help strategies to facilitate individuals through DXM withdrawal:
There are several effective methods to assist a loved one during DXM withdrawal. First and foremost, acknowledge the difficulties of DXM withdrawal and educate yourself about the withdrawal process and its physical and mental impacts. This will allow you to better support your loved one with compassion and understanding.
Another crucial aspect is ensuring effective communication and emotional backing to establish a secure, accepting environment that fosters open dialogue. Engage in active listening and provide emotional assistance whenever you can.
Next, avoid being an enabler. Even individuals with good intentions may unintentionally promote harmful behaviors in those struggling with substance use issues. Establish limits, avoid using items containing DXM, and think about individual or family therapy.
For more effective recovery, promote professional assistance. Any professional support, whether it’s detox, rehabilitation, or therapy, will significantly boost the chances of your loved one attaining and upholding sobriety.
Lastly, help them avoid relapse by learning to recognize triggers, create coping techniques, and implement healthy lifestyle adjustments. Most importantly, always acknowledge every achievement.
Sustained recovery from DXM is achievable only if individuals can effectively avoid relapse. Fortunately, numerous strategies and tools for preventing DXM relapse are available [4].
A relapse prevention plan functions as a guidebook to assist you in comprehending and predicting triggers more effectively and providing you with the necessary actions and resources to manage them. You can develop a relapse prevention plan with your addiction treatment team or personal therapist, and you can also make one by yourself. Moreover, you must regularly review and update the plan.
The prevention plan should include all your triggers, effective coping methods to soothe your feelings and divert attention from cravings, a contingency plan for managing high-risk scenarios, and a list of friends, family members, professionals, and support groups.
It is important to pursue continuous support and therapy to avoid relapse. Various forms of therapy are available for preventing DXM relapse, such as individual counseling and family therapy. Moreover, group therapy or support groups can be particularly beneficial, offering a continuous source of assistance, guidance, and community.
Experimenting with various activities while keeping an open mindset to evolve into the individual you genuinely aspire to be takes time and perseverance. However, it yields great rewards ultimately.
These include:
Users who have been using dextromethorphan (DXM) for an extended period (months to years) report experiencing strong cravings, flashbacks, and hallucinations within a three-day period after discontinuing use. Physical signs of withdrawal consist of diarrhea, fatigue, sweating, vomiting, and shaking chills.
The duration of DXM withdrawal will differ from individual to individual. Nevertheless, acute DXM withdrawal usually does not extend beyond 14 days. Post-acute withdrawal symptoms tend to be fewer in number and less severe yet can happen off and on for as long as two years.
No. Although it isn’t generally life-threatening to quit DXM cold turkey, it is not safe and not advisable without consulting a healthcare provider. Discontinuing DXM consumption abruptly can lead to withdrawal symptoms like muscle and bone pain, sleep issues, diarrhea and vomiting, cold flashes, and strong cravings.
DXM is a dissociative drug. Thus, addiction should be first addressed with medical detoxification. Other options include behavioral therapies, support groups, Medication-assisted treatment (MAT), mindfulness techniques, and continued support.
Supporting a loved one during detox includes seeking professional help, helping them be comfortable, being patient, providing practical guidance, and letting them know you’re there to listen.
If you or someone you care about is facing addiction to DXM, it’s crucial to contact experienced professionals who focus on addiction recovery. At Gratitude Lodge, we will assist you in rediscovering the sensation of seeing every day as a blessing. With sites in Long Beach, Newport Beach, and San Diego across Southern California, we provide numerous opportunities to engage with nature and cultivate gratitude on your path to sober living.
We offer a secure, pet-friendly rehabilitation experience for men and women seeking drug-related assistance. Our compassionate staff offers personalized care in a comfortable, elegant setting.
Call Gratitude Lodge at 844-576-0144 to learn more about our drug and alcohol detox programs and inpatient rehab.
[1] https://doi.org/10.1503/cmaj.131676
[2] https://pubmed.ncbi.nlm.nih.gov/25135924/
[3] https://doi.org/10.3238/arztebl.2010.0537
[4] https://americanaddictioncenters.org/dextromethorphan-dxm/abuse
Drug detox can vary according to the patient’s addiction factors, including the substance abused, how long the addiction has lasted, the patient’s medical condition, if any other disorders are present, and more. Our skilled and credentialed team at Gratitude Lodge work closely with every patient going through drug detox, facilitating the beginnings of a successful recovery at our rehab addiction centers in Orange County, CA.
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