Cold Turkey vs. Tapering: Which Is Better for Ceasing Drug Use?

If there is one substance people have successfully quit on their own, time and again, it’s cigarettes. In fact, cigarette cessation guidelines conclude that the best way to quit smoking is by abruptly stopping. There is research that states outright that quitting “cold turkey” has a rate of success that is comparable to nicotine replacement therapy.

This, however, is not the case with prescription and illicit drugs. While nicotine remains highly addictive and produces intense cravings, it does not generate the harrowing withdrawal symptoms associated with certain substances, especially central nervous system (CNS) depressants.

With opioids, where the withdrawal symptoms are relatively mild, the way they profoundly impact the brain’s reward pathways makes quitting “cold turkey” virtually impossible.

This is not to discount the capacity of the human mind. Napoleon Hill, the influential self-help author, once said, “Whatever the mind of man (or woman) can conceive and believe, it can achieve.”

While the most disciplined and strong-willed among us can quit drugs and alcohol on their own, relapse rates indicate that for highly addictive substances, tapering — when administered through a professional addiction treatment program — offers people a greater chance at sobriety.

Therefore, it is the best method for ceasing drug use.

The Nature of Addiction

The National Institute on Drug Abuse (NIDA) views drug addiction as a brain disorder. In fact, NIDA defines addiction “as a chronic, relapsing disorder characterized by compulsive drug seeking and use despite adverse consequences.”

These are key features of drug addiction, as outlined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), by the American Psychiatric Association (APA). If someone displays two of these symptoms over 12 months, then they may have an addiction:

  • Taking more of the drug than intended and for a longer time than intended
  • A persistent desire to stop taking drugs or repeated unsuccessful attempts to quit taking drugs
  • A lot of time spent trying to get drugs, abuse them, and/or recover from their effects
  • Intense cravings or urges for specific drugs
  • Failing to go to work or school, or to meet obligations to friends and family because of drug abuse
  • Ongoing drug abuse despite physical, mental, emotional, or social problems associated with the abuse
  • Giving up hobbies or activities to abuse drugs
  • Ongoing abuse of drugs in inappropriate situations, such as using them in the morning before work, driving while intoxicated, or abusing drugs around children
  • Experiencing physical or psychological problems due to substance abuse but continuing to abuse drugs anyway
  • Physical tolerance, meaning the body needs more of the drug to experience the original level of intoxication
  • Experiencing symptoms of withdrawal when trying to quit the drug
Cold Turkey vs. Tapering

Drug Relapse Rates and How Addiction Happens

Relapse rates hover between 40 to 60 percent with drug addiction, which is comparable to asthma and hypertension estimates. In other words, drug addiction has such a profound and pervasive impact, that it effectively rewires the brain, changing how it processes reward, stress, and self-control.  

A person often arrives at addiction by developing a tolerance to a substance, meaning they take more of it to experience the effects a previous dose yielded. That tolerance can cause someone to consistently take drugs or alcohol to the point the person’s body becomes used to its presence. Without that substance, they experience withdrawal symptoms. This is the stage of dependence.

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That dependence can bloom into abuse and addiction when someone becomes incentivized to continue using drugs. In the case of opioids, in particular, which produces intense euphoria, the brain is so impacted that use is associated with reward. So they continuously use to the point of addiction.

Addiction can also occur when someone repeatedly uses a substance to avoid painful and, depending on the substance, life-threatening withdrawal symptoms.  

In such cases, a cold turkey approach is often ineffective and deadly.

The tapering approach is the best method for certain drugs. Read on to find out what those drugs are.

Tapering Works Best with These Drugs

Certain CNS depressants produce life-threatening withdrawal symptoms, so much so that quitting “cold turkey” is not recommended. Rather, a medically supervised tapering method, where someone is gradually weaned off a substance through gradual cessation or medication, works best. Tapering is the most effective approach in treating the following CNS depressant use disorders:

  • Alcohol
  • Benzodiazepines
  • Barbiturates

Alcohol

Few substances are as addictive as alcohol and produce withdrawal symptoms that are as dangerous.

Alcohol withdrawal symptoms include:

  • Sweating
  • Anxiety
  • Nausea
  • Vomiting
  • Shaking
  • Hallucinations
  • Seizures

Tapering Off Alcohol

Ironically, benzodiazepines work best in the taper treatment of alcohol withdrawal. The medications often employed to treat these symptoms include lorazepam, chlordiazepoxide, oxazepam, and diazepam. Of those medications, diazepam or Valium is preferred because of its ability to work quickly and last long. A 10 mg (milligram) dose of Valium can be administered every six to eight hours for alcohol withdrawal.

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Benzodiazepines

Benzodiazepines, which are commonly known as tranquilizers, are prescribed to treat conditions such as anxiety, insomnia, and muscle relaxation (along with alcohol withdrawal). Common “benzo” medications include Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam).

Doctors tend to prescribe these medications for short-term use only because of their addictive properties. When someone stops use, they often experience dangerous withdrawal symptoms such as:

  • Vomiting
  • Hallucinations
  • Nightmares
  • Sweating
  • Convulsions and tremors
  • Abdominal cramps
  • Severe anxiety
  • Restless leg syndrome

Benzos can produce symptoms of post-acute withdrawal syndrome (PAWS) that can last for years. Those include:

  • Anxiety
  • Problems concentrating
  • Energy changes
  • Irritability
  • Mood swings
  • Sleep disturbances

Tapering Off Benzodiazepines

The tapering process for benzodiazepines occurs through the gradual reduction of the drug in the user, who is then switched to another benzodiazepine to taper off of the one that caused the initial addiction. For benzodiazepine addictions, two tapering methods are typically employed:  

FAST TAPERING

Fast tapering occurs in a two to six-week stretch when withdrawal symptoms are monitored, and Valium is often administered as a replacement. Once the Valium has been established in the body, the dose will be cut by 25 percent within a day or two. Users at risk of incurring a seizure disorder may be administered anticonvulsant medications like gabapentin or carbamazepine.

SLOW TAPERING

Slow tapering lasts between three to six months and is the safest route for people who are at risk for relapse or seizures. Valium is also introduced as a replacement drug due to its properties. Daily doses are usually cut by 5 percent to 10 percent every week.  

Barbiturates

Barbiturate medications include amobarbital (Amytal), methohexital (Brevital), pentobarbital (Nembutal), secobarbital (Seconal), and phenobarbital (Luminal). Barbiturates are generally prescribed for sleep and anxiety disorders, although phenobarbital is primarily prescribed to treat seizures, convulsions, skull pressure, and trauma. This highly potent, old-guard class of medicines derived from barbituric acid can produce distressing withdrawal symptoms.

The following symptoms that occur include the following:

  • Hallucinations
  • Seizures
  • High body temperature
  • Suicidal behavior

Tapering Off Barbiturates

Medications are administered in the tapering process for barbiturates. Also, barbiturates are gradually decreased from the body until the person is drug-free. Barbiturate addictions, however, are rare because they are not prescribed as much.

Opioids

Though opioids such as oxycodone, hydrocodone, methadone, heroin, and morphine do not produce life-threatening withdrawal symptoms, their ability to hijack the brain make it difficult to quit. They also produce painful and uncomfortable withdrawal symptoms that can compel someone to continue use. That’s why medically assisted detox via tapering works best with opioid addictions.

Withdrawal symptoms produced by opioids include:

  • Intense depression, to the point of suicidal ideation
  • Insomnia
  • Nausea, diarrhea, and vomiting
  • Deep pain in the muscles and bones
  • Fever and flu-like symptoms, such as sweating, chills, and high temperature
  • High blood pressure
  • Anxiety and panic attacks
  • A desperate craving for more opioids under the conviction that going back on the drugs will alleviate the pain

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ARE YOU STRUGGLING WITH ADDICTION AND SEEKING HELP? GET IN TOUCH WITH ONE OF OUR TREATMENT SPECIALISTS NOW.

Tapering Off Opioids

One of the most controversial methods of opioid detox is using another opioid to gradually taper someone off the original substance. This is called opioid replacement therapy. Typically, this involves methadone replacement therapy. Methadone is not nearly as powerful as heroin or prescription opioids such as oxycodone or hydrocodone. The medication provides patients with a sense of contentment, without the intense sensations associated with opioid use. Methadone is often prescribed as a long-term treatment.

Another taper medication that is used is Suboxone, the brand name for the combination of buprenorphine and naloxone — two opioid treatment medications. This medication allows patients to safely detox without exposing them to the intense experience of opioid withdrawal.

These Drugs Are Safe to Quit Cold Turkey

The drugs that appear to be the easiest to quit cold turkey include:

  • Marijuana
  • LSD (d-lysergic acid)
  • PCP (phencyclidine)
  • Magic mushrooms (psilocybin)

LSD, PCP, and “shrooms” are not physically addictive and have no associated withdrawal symptoms that are physical in nature. Thus, cold turkey is a prudent option. However, long-term effects from these hallucinogenic drugs are not well known. These substances can also induce effects and distorted senses weeks, months, or even years after use.

Marijuana, which is part hallucinogenic and part CNS depressant, can induce physical and emotional side effects that are relatively mild, such as irritability, anxiety, cravings, and disrupted sleep. Also, people can incur withdrawal symptoms such as headaches, restlessness, depression, tremors, decreased appetite, stomachaches, tension, and concentration issues.

These symptoms begin within a day or two after marijuana use ceases. They peak in just under a week, but people experience improvement after that.

Why Tapering Is Best

The most serious and acute substance addictions of our times require a tapering process, the kind administered through a professional treatment program.

This is especially true for people who abuse more than one substance or have co-occurring disorders such as a mental health issue and a substance addiction.

Polysubstance abuse and co-occurring disorders are indications of severe addiction and require the medically supervised, evidence-based approaches offered through a professional recovery program.

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What You Get In Professional Treatment

If you or a loved one is in the throes of an opioid, alcohol, benzodiazepine, or barbiturate addiction, then a professional treatment program that offers tapering or medication-assisted treatment (MAT) is the most effective solution.

Tapering and medication-assisted programs are offered in the acute treatment phase, where the substance(s) is safely removed via tapering and withdrawal symptoms are alleviated with medications.

After acute treatment, you will receive comprehensive therapy and counseling through clinical stabilization services and partial care. Both programs can help you get to the root of your addiction and equip you with education and strategies to avoid relapse and maintain sobriety.

Once your treatment is completed, you or a loved one can be connected to a recovery community like a 12-step program, which can provide additional support as you return to your daily life.

Get Help Today

Your addiction does not have to be your downfall. We can help you locate a professional program with proven treatment strategies to safely and effectively get you drug or alcohol-free.

Call (844) 326-4514 anytime, day or evening, for a free consultation with one of our knowledgeable addiction recovery specialists. They can help you find the right treatment option. You can also contact us online for more information.